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. Author manuscript; available in PMC: 2018 Jan 8.
Published in final edited form as: J Fam Violence. 2014 Nov 29;30(1):113–122. doi: 10.1007/s10896-014-9653-y

Security in Father-child Relationship and Behavior Problems in Sexually Abused Children

Claudel Parent-Boursier 1, Martine Hébert 2
PMCID: PMC5758341  CAMSID: CAMS6267  PMID: 29321696

Abstract

While the influence of mother-child relationships on children’s recovery following sexual abuse has been documented, less is known about the possible contribution of father-child relationships on outcomes. The present study explored the contribution of children’s perception of security in their relationship to the father on internalizing and externalizing behavior problems, while controlling for sociodemographic variables and variables associated with the mother-child relationship. Participants were 142 children who disclosed sexual abuse involving a perpetrator other than the biological father. Regression analyses indicated that children’s perception of security to fathers contributed to the prediction of parental reports of children’s behavior problems, even after controlling for maternal psychological distress and perception of security to mothers.

Keywords: Child sexual abuse, perception of security to fathers, perception of security to mothers, psychological distress

Child sexual abuse (CSA) is a widespread social problem that affects children and adolescents, both boys and girls. Prevalence of CSA occurring in childhood (i.e. before the age of 18) is established at 18% for women and 8% for men (Stoltenborgh et al. 2011). Among all substantiated reports of child abuse in the US, 9% involve CSA, meaning that more than 63 000 children per year are reported to public services for sexual abuse (US Department of Health and Human Services, 2010). Numerous studies have shown that child victims of sexual abuse are more likely to demonstrate negative emotional, psychological, and social outcomes compared with non-abused children (Guelzow et al. 2002; Hébert et al. 2006a, b; Swanston et al. 2003; Walrath et al. 2003). However, outcomes following the disclosure of CSA have been described as quite diverse (Hébert et al. 2006a, b; Paolucci et al. 2001) and empirical reports have identified factors associated with variability of outcomes. Some studies revealed that abuse-related characteristics such as the duration (chronic) and severity of acts (penetration), the perpetrator’s identity (intra-familial perpetrator) as well as the use of coercion have been related to more detrimental outcomes (Hulme and Agrawal 2004; Merrill et al. 2001). However, other studies have failed to identify a link between abuse-related variables and children’s symptoms (Bal et al. 2004; Bennett et al. 2000; Romano and De Luca 2001), highlighting the need to consider other variables that may contribute to outcomes in child victims of CSA.

Authors argue that familial factors, such as quality of attachment to parents, parental capacity to support the child following disclosure, and family characteristics (e.g., cohesion and conflict), can influence a child’s capacity to cope with sexual abuse. On this matter, a study by Ray and Jackson (1997) found that adult survivors of CSA were better able to cope with the situation when the family environment was evaluated as being cohesive. Indeed, women who reported growing up in cohesive families were found to have higher self-esteem and better social and psychological adjustment, independently from the identity of the perpetrator involved (Ray and Jackson 1997). In a study involving children and adolescents aged 12 to 18 years old, Bal et al. (2004) found that victims displayed less internalized behaviors (e.g., depression) following disclosure if the family was described as cohesive.

In another study, using a sample of 50 victims of sexual abuse ages six to 12, and a measure of global general support, children’s perception of parental support was associated with less externalized behaviors and higher self-esteem (Tremblay et al. 1999). Yet, no association was found between parental support and internalized behavior problems. However, no distinction was made regarding maternal or paternal support in that study and children victims of all types of sexual abuse including situations involving the father were included. In the long term, Bhandari et al. (2011) found evidence that different aspects relating to the environment, such as family functioning, had a stronger impact on later psychological distress than characteristics of the abuse experienced.

The influence of the mother-child relationship on children’s recovery has been extensively explored among children that have disclosed sexual abuse (Cyr et al. 2003). Children who described their mothers as more supportive were found to display less psychological distress following the abuse (Rakow et al. 2011). Several studies have documented the positive impact of parental relationship on outcomes, without distinguishing between the maternal and paternal role (Elliott and Carnes 2001; Kouyoumdjian et al. 2005). In contrast, very few studies have specifically explored the possible influence of the father-child relationship in cases of CSA, when the father is not the perpetrator. In fact, in the general area of child development, studies on parental role and the influence of parent-child relationships have widely and almost exclusively explored the mother-child dyad or asked children to rate general parental support. Yet, recent studies underscore the different and complementary role of fathers in their child’s life (Lewis and Lamb, 2003; Paquette 2004a; Paquette et al. 2000). A number of studies have highlighted the influence of the father-child relationship on youth’s adaptation. For example, in a longitudinal study, children and adolescents who described their fathers as being more involved displayed less delinquent behaviors and less psychological distress (Harris et al. 1998). If the father-adolescent relationship deteriorated after a few years, adolescents displayed more delinquent behaviors and more depressive symptoms.

Specific positive influences derived from a strong and available paternal figure are salient to a child’s cognitive, affective and social development (Cabrera et al. 2007; Culp et al. 2000; Dubowitz et al. 2001). Perception of support as reported by the child (i.e. that the paternal figure is there for the child) is associated with better cognitive development (Dubowitz et al., 2001), internalized behaviors (e.g., good father-child relationships are associated with less depression) and externalized behaviors (e.g., less delinquent behaviors) (Coley, 2003; Culp et al., 2000; Deklyen et al. 1998; Dubowitz et al., 2001). Malmberg and Flouri (2011) even found that, in intact families, the quality of father-child relationship acted as a buffer to contextual risks, meaning that the father-child relationship may promote resilience in children. Findings suggest that the positive influence of the father-child relationship is independent from the mother-child relationship (Guelzow et al., 2002; Harris et al., 1998; Vazsonyi and Belliston, 2006). Kaczynski et al. (2006) explored, in 226 families with school-aged children (146 boys), the impact of parenting on problem behaviors. The authors found a tendency for father’s parenting to be more strongly related to internalized behaviors and mother’s parenting to externalized behaviors in boys. Other studies found that paternal involvement and attachment to fathers was significantly associated with externalized behaviors in adolescents (Williams and Kelly 2005).

Empirical reports that have explored the possible role of the father-child relationship in the aftermaths of CSA are scarce. In all, three studies were identified. The first study explored the psychological distress of more than 4 000 female navy-recruits (Mage = 19.7 years-old), comparing those who reported CSA (N =1 134) to non-victims. Results revealed that a retrospective recall of maternal and paternal support during childhood predicted psychological distress in adult women (Merrill et al. 2001). The second study involved 188 undergraduate women (including 44 victims of CSA; Mage = 21 years-old) and revealed that the presence of paternal support among women who reported CSA predicted better self-esteem. Women who experienced paternal support during childhood used less emotional coping strategies, such as avoidance, and instead relied on more active strategies linked to better psychosocial adjustment (Guelzow et al. 2002). In both studies, adult participants were asked to retrospectively recall their perception of support. Thus, it is possible that the information obtained may have been subject to memory bias.

To our knowledge, the third study is the only one to explore the possible role of children’s perception of security in the father-child relationship following CSA disclosure. Parent-Boursier and Hébert (2010) found, in a sample of 79 children aged six to12 years old, that perception of paternal security (i.e. being available and providing support) was a predictor of children’s internalizing behavior problems and self-esteem, even after controlling for the influence of perception of maternal security and characteristics related to the CSA (i.e. duration, severity and type of abuse). One important finding from this study is that children’s perception of security to fathers appeared to be distinct from perception of security to mothers. While this study added to the literature by identifying the specific contribution of father-child relationships to outcomes of CSA, it did have certain limitations. First, both measures of behavior problems and perceptions of security to parents were obtained by the child’s self-reports underscoring possible shared method variance effects. In addition, while self-reports enable an assessment of a child’s perspective on symptoms that may otherwise be inaccessible (e.g., death ideation), children may not always be the best informants to appraise externalizing behaviors (e.g., conduct disorders) (Cox 2009). Also the analyses did not take into account important socio-demographic variables, namely the child’s sex. Sex is an influential variable related to psychological and emotional outcomes (Wilson et al. 2005), as well as to perception of security in regards to each parental figure (Bacro 2011).

Documenting the influence of father-child relationships on outcomes following CSA disclosure is essential because fathers have the potential of acting as a significant support figure for the child. In a US sample, less than 10% of sexual abuse cases reported in a community sample of high school students were perpetrated by fathers; thus 90% of victims may potentially benefit from their father’s support following disclosure of CSA (Newcomb et al. 2009). Also, in cases in which mothers are unable to offer their support to the child, fathers or adults acting as the paternal figure can play an important complementary role for the child (Harris and Ryan 2001).

In this context, the present study aims to predict outcomes following CSA, namely internalized and externalized behaviors, while considering socio-demographic variables (i.e. age and sex), characteristics of the abuse (e.g., severity and duration), maternal variables, such as psychological distress and children’s perception of maternal security, and finally perception of paternal security. Analyses were conducted to examine the unique contribution of perception of security in the child-father relationship, over and above the influence of aforementioned variables: socio-demographic, characteristics of the abuse, and variables related to the mothers. Prior studies have demonstrated that maternal psychological distress is associated with children’s externalized and internalized behaviors (Frye and Garber 2005; Jaser et al. 2005); highlighting the need to control for this variable. In the present study, parental reports of internalizing and externalizing behaviors problems are used, while perceptions of security in the child-parent relationship are evaluated using child reports. Therefore, the methodological bias related to shared informant variance is avoided.

Methods

Participants

A sample of 142 families was recruited in three sites offering services to children following disclosure of CSA, situated in the province of Quebec, Canada. Ranging from six to 12 years of age, the mean age of children was 8 years and 10 months old (SD = 1.95). The sample consisted of 98 girls and 44 boys. For the present analyses, children reporting CSA perpetrated by their biological father were excluded. In addition, only children identifying two significant parental figures (biological or surrogate parents, living with the child full or part time) were included in the analyses.

Children reported experiencing either a single episode of CSA (27.2%), at least two incidents (41.2 %), or multiple episodes lasting 6 months or more (31.6 %). More than half of the cases (60.6%) involved oral, genital, or anal penetration or attempted penetration, a third (30.3%) involved unclothed touching, while a minority of cases (9.1%) reported clothed touching or contact with an exhibitionist. CSA was perpetrated by a close family member such as a sibling (14.1%), a stepparent’s child (13.4 %), or a step-parent (10.6 %). Other perpetrators identified included an uncle/aunt (9.2%), a cousin (7.7%), a grand-parent (7.7%) or another extended family member (1.4 %). A total of 35.9 % of CSA involved an extra-familial perpetrator.

Measures

Children completed a measure evaluating perception of security in the relationship to the mother and the father. Maternal psychological distress as well as the children’s level of behavioral problems were gathered from measures administered to mothers. Finally, abuse-related characteristics (i.e. severity and duration of the SA) were collected from case records.

Perception of Security

Perception of security to mothers and fathers was evaluated using an adaptation (Hébert 2001) of the Kerns Security Scale (Kerns et al. 1996). The concept defined by the authors included three important aspects: 1) the child believed that the attachment figure was available and met his/her needs, 2) the child relied on the parent in times of stress and 3) the child had an interest and could communicate well with the parental figure. The questionnaire included nine items that were completed following Harter’s response format (1982) (e.g., “Some kids find it easy to trust their dad (mom)”, “Other kids are not sure if they can trust their dad (mom)”). The child was asked to answer two separate scales for his/her maternal and paternal figures. On a four-point scale, the child indicated if the item described a child like him/her or not. The children were invited to complete the perception of security scale in relation to their biological fathers and mothers. However, when that was not possible (such as a situation in which the child did not maintain contact with his/her biological parent) and another significant paternal or maternal figure was present in the lives of children, the measure was completed with this parental figure in mind. Scores varied from nine to 36, where a higher score corresponded to a higher perception of security to the parent. Internal consistency was adequate (α = .84) and the test-retest reliability at 14 days was satisfying with the original version (r = 0.75) (Kerns et al. 1996). In the present study, internal consistencies of the scores were adequate (for security to father α =.83 and mother α =.68).

Maternal Psychological Distress

Maternal psychological distress was evaluated using a French version of the Ilfeld Psychiatric Distress Index (Ilfeld, 1976) proposed by Préville et al. (1992). The maternal figure rated 14 items on a four-point scale, ranging from never to very often, on symptoms of depression, anxiety, cognitive disturbance, and anger. The measure used refers to general psychological distress experienced in the past 7 days. A higher score represented more psychological distress for the parent. Internal consistency of the global distress measure was good (α =.85).

Behavior Problems

Internalized and externalized behavior problems were evaluated by the parent using the Child Behavior Checklist (CBCL) for 6 to 18 years-old (Achenbach and Rescorla 2001). For each of the 118 items, the parent indicated if they were “not true”, “somewhat or sometimes true” or “very true or often true” for their child. A higher score indicates greater behavior problems. T-scores of the two higher order dimensions of internalized and externalized behavior problems were considered as dependent variables as well as T-scores for eight subscales scores (for internalized: anxious/depressed, withdrawn and somatic complaints; for externalized: delinquent behaviors and aggressive behaviors, and three extra subscales: social problems, thought problems and attention problems). The CBCL is used widely in clinical research, including in trauma studies. Internal consistency of scores for the internalized (α=0.90) and externalized scores (α=0.94) are high. In addition, both internalized and externalized scores demonstrate high one-week stability scores (r =0.91 and 0.92, respectively) (Achenbach and Rescorla 2001). Validity of the CBCL has been established as a discriminant analysis correctly classified 87% of children (i.e. clinical or non-clinical). Also, CBCL scores have been found to correspond highly with other checklists such as the Conners Scale and the Behavior Assessment System for Children Scale (Achenbach and Rescorla 2001).

Characteristics of the SA

Severity and duration of the sexual abuse were evaluated using the Grille d’analyse de la victimisation de l’enfant (Parent and Hébert 2006) based on case records. Severity was coded following Russell’s classification (1983) on a three points scale: 1) no direct physical contact (i.e. exhibitionist acts, incentive to participate in sexual activities or clothed touching), 2) sexual abuse including physical contact and under clothed touching without penetration or coercion, and 3) very severe sexual abuse including penetration or attempted penetration (vaginal, oral or anal), acts involving physical coercion, or multiple perpetrators. The duration of abuse was also coded on three levels: single episode, at least two incidents, and multiple episodes lasting 6 months or more.

Procedure

Each interview with children and parents was preceded by an introduction on ethical considerations, such as voluntary participation, informed consent, confidentiality and anonymity. All children were alone with the interviewer during the completion of the questionnaire. Parents completed consent forms, a socio demographic questionnaire and the parent’s questionnaire, with the help of the research assistant if needed. The Human Research Review Committees of the University of Quebec in Montreal and the Ethics Committee of the CHU Sainte-Justine Mother and Child University Hospital Centerapproved this study.

Results

First, bivariate analyses between socio-demographic variables, abuse-related variables and perception of security to both parents and outcomes variables (internalized, externalized problem behaviors and subscales) are considered. Then, results from the hierarchical regression analyses are summarized.

Bivariate Analysis

Results indicated that children’s perception of security to mothers (M=29.03) was significantly higher than the perception of security to fathers (M=27.53) (t (143)=2.99, p <0.01). Table 1 summarizes significant correlations between studied variables: socio-demographic variables (sex and age of the child), maternal psychological distress, perception of security to mothers and fathers, and parent reports of children’s behavior problems. Results indicated that age was associated with internalized behavior problems as well as with social and attention problems; greater behavior problems being reported for older children. Sex was significantly associated to measures of externalized behavior indicating that boys are reported to display greater behavior problems.

Table 1.

Correlations among Study Variables

Problem behaviors Age Sex Maternal psychological distress Perception of security to mothers Perception of security to fathers
Internalized behaviors .26** .05 .32** −.11 −.28**
 Anxious/Depressed .30** .05 .26* −.12 −.24**
 Withdrawn .14 .14 .25** −.20* −.26**
 Somatic Complaints .17* −.07 .26** .02 −.18*
Externalized behaviors .14 .21* .24** −.17* −.27**
 Delinquent Behaviors .14 .17* .09 −.17* −.24**
 Aggressive Behaviors .16 .21* .25** −.12 −.23**
Social Problems .32** .06 .22** −.16 −.28**
Thought Problems .16 .10 .16 −.12 −.22**
Attention Problems .18* .11 .26** −.12 −.14
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Note. For sex, 1 = female, 2 = male.

*

p < .05.

**

p < .01.

Maternal psychological distress was significantly correlated to children’s behavior problems (save for delinquent behaviors and thought problems). Thus mothers with higher psychological distress tended to report greater behavior problems. Results revealed that perception of security to mothers was negatively correlated with withdrawal, the main score of externalizing behavior problems and the delinquent subscale. Perception of security to fathers was inversely related to all behavior problems scales but attention problems. Children that report lower security in their relationship were evaluated as displaying greater behavior problems. Finally, abuse-related variables (i.e. severity and duration of the abuse) were not significantly associated with children’s behavioral difficulties. As such, abuse-related variables were not included in subsequent analyses.

Regression Analyses

Hierarchical regression analyses aimed to test whether perception of security to fathers uniquely contributed to outcomes following CSA after accounting for socio-demographic variables (age and sex of the child), maternal psychological distress, and the child’s perception of security to the mother. Hierarchical regression analyses were performed on the two higher order dimensions of internalized and externalized behaviors as well as the eight subscales of the CBCL. Variables entered in the first step included the child’s characteristics (i.e. age and sex of the child). In the second step, maternal distress and perception of security to mothers were included. Finally, the child’s perception of security to fathers was included in the last step of the regression analysis.

Tables 2, 3 and 4 present significant predictors and the proportion of variance explained by step. The higher order scale of internalized behaviors was significantly predicted by the full model (F (5,141)=8.05, p <0.001). The overall model explained 23% of the variance in scores of internalized behavior problems with the first step accounting for 7%, the second step adding an additional 11% and perception of security to fathers uniquely contributing another 5% to the final model. Age (being older), higher maternal distress, and lower perception of security to father contribute to the prediction of greater internalized behavior problems.

Table 2.

Results from hierarchical regression analyses predicting parent-reported internalized behavior problems

Variables Internalized behaviors Anxious/depressed Withdrawn Somatic Complaints
β R2 ΔR2 F β R2 ΔR2 F β R2 ΔR2 F β R2 ΔR2 F
Step 1 .07 .07 5.52*** .10 .10 7.42** .05 .05 3.43* .03 .03 2.11
 Age .21*** .27** .11 .12
 Sex .15 .13 .22** −.01
Step 2 .18 .11 7.67*** .17 .08 7.09*** .15 .10 5.84*** .10 .07 3.59**
 Maternal psychological distress .31*** .25** .24** .25**
 Perception of security to mothers −.03 −.06 −.13 .08
Step 3 .23 .05 8.05*** .20 .02 6.60*** .19 .04 6.31*** .12 .02 3.59**
 Perception of security to fathers −.24*** −.17* −.23** −.16
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Note. Adjusted R2 = .20, .17, .16, .08, respectively.

*

p < .05.

**

p < .01.

***

p < .001.

Table 3.

Results from hierarchical regression analyses predicting parent-reported externalized behavior problems

Variables Externalized behaviors Delinquent Behaviors Aggressive Behaviors
β R2 ΔR2 F β R2 ΔR2 F β R2 ΔR2 F
Step 1 .08 .08 5.64*** .06 .06 4.15* .08 .08 5.98**
 Age .11 .11 .14
 Sex .30*** .24** .28***
Step 2 .16 .09 6.65*** .09 .04 3.54** .16 .08 6.40***
 Maternal psychological distress .23** .08 .25**
 Perception of security to mothers −.09 −.10 −.05
Step 3 .22 .06 7.84*** .14 .04 4.35** .20 .04 6.80***
 Perception of security to fathers −.27** −.23** −.23**
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Note. Adjusted R2 = .20, .11, .17, respectively.

*

p < .05.

**

p < .01.

***

p < .001.

Table 4.

Results from hierarchical regression analyses predicting other parent-reported behavior problems

Variables Social Problems Thought problems Attention problems
β R2 ΔR2 F β R2 ΔR2 F β R2 ΔR2 F
Step 1 .11 .11 8.85*** .04 .04 2.88 .05 .05 3.69*
 Age .28*** .11 .17*
 Sex .16* .18* .17*
Step 2 .18 .07 7.71*** .08 .04 3.08* .13 .08 5.09**
 Maternal psychological distress .21** .17* .25**
 Perception of security to mothers −.09 .21* −.08
Step 3 .22 .04 7.67*** .15 .06 4.71** .14 .01 4.36***
 Perception of security to fathers −.21* −.28** −.10
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Note. Adjusted R2 = .19, .12, .11, respectively.

*

p < .05.

**

p < .01.

***

p < .001.

The higher order scale of externalized behaviors was also significantly predicted by the full model (F (5,141)=7.84, p <0.01) with total variance accounted for of 22%. Socio-demographic variables entered at the first step of the regression explained 8% of the variance, while consideration of maternal variables in the second step added 9%. Adding perception of security to fathers contributed to 6% of explained variance of externalized problem behaviors of sexually abused children over and above socio-demographic and maternal variables. Indeed, being a boy, having higher maternal psychological distress, and reporting a poorer perception of security to fathers were variables that predicted more externalized behavior problems.

Perception of security to fathers uniquely contributed to the prediction of most subscales, even after taking into account the influence of the child’s sex, age, maternal distress, and perception of security to mothers. The full model was significant for six subscales: Anxious/Depressed (F (5,141)=6.60, p < 0.001), Withdrawn (F (5,141)=6.31, p < 0.001), Delinquent Behaviors (F (5,141)=4.35, p < 0.001), Aggressive Behaviors (F (5,141)=6.80, p <0.001), Social Problems (F (5,141)=7.67, p < 0.001), Thought Problems (F (5,141)=4.71, p < 0.01). For the six subscales, the full model explained between 14 and 22% of the variance, with perception of security to father adding from 2 to 6% of explained variance. Among other contributing variables, level of maternal distress was found to predict higher behavior problems for all subscales except delinquent behaviors. Perception of security to mothers was found to predict only scores on the thought problems subscale, with children reporting higher security being evaluated as displaying greater thought problems.

For two subscales, perception of security to fathers was not a significant predictor: Somatic Complaints (F (5,141) = 3.59, p < 0.01) and Attention Problems (F (5,141) = 4.36, p < 0.001). Somatic Complaints was only predicted by level of maternal distress accounting for 10% of explained variance. Attention problems were predicted by socio-demographic variables (ΔR2 = 0.05) and level of maternal distress (ΔR2 = 0.08) with the final model explaining 14% of the variance.

Discussion

This study aimed to add to the existing body of literature by exploring the contribution of father-child relationships to the prediction of children’s outcomes following CSA, after controlling for socio-demographic factors and variables related to the mother-child relationship. In order to do so, significant associations between studied variables were considered and their effects were accounted for. Since both maternal distress and child behavior problems were reported by the same informant, this procedure controlled for potential shared method variance effect. Most importantly, this elucidated the unique effect of the father-child relationship. Past studies had delineated the influence of the mother-child relationship (Cyr et al. 2003; Plummer and Eastin 2007; Rakow et al. 2011) or the global parental relationship (Bolen and Lamb 2007; Tremblay et al. 1999; Yancey and Hansen 2010) on children’s outcomes. Yet, until now few studies had more specifically explored the possible influence of the father-child relationship on children’s recovery following disclosure of sexual abuse.

In the present study, perception of security to mothers was significantly higher than the child’s perception of security to fathers. Our results are consistent with those reported in a recent validation study (Bacro 2011) as well as in the original study (Kerns et al. 1996), which stated that the actual cut-off point used to distinguish secure to insecure attachment was higher for the scale describing maternal relationship compared to paternal relationship. The explanation of this difference relied on the conceptual and theoretical basis of the Kerns’ attachment security scale rather than on an absolute difference. In fact, the framework on which the measure is based (i.e. attachment theory), may be more representative of the specific primary care giving role most frequently assumed by mothers (Kerns et al. 2000). Interestingly, one study found that when fathers were full-custodial single parents, attachment transmission as described by the attachment theory was more likely (Bernier and Miljkovitch 2009). Recent studies exploring father-child relationships proposed an “activation relationship” (rather than the attachment relationship), where fathers stimulate exploration in children rather than comfort (Paquette 2004a, b; Paquette et al. 2000). Therefore, the mean difference in perception of security to fathers and mothers may possibly be more related to the measure used and the way it was defined.

The main finding of this study was that perception of security to fathers predicted outcomes following a CSA – namely both internalized and externalized behavior problems and six subscales (anxious/depressed, withdrawn, delinquent, aggressive behaviors, social problems and thought problems)- even after controlling for socio-demographic characteristics, mothers’ psychological distress, and perception of security to mothers. Children’s perception of security to their fathers predicted all behavior problems displayed by the child following the abuse except somatic complaints and attention problems. Our results are thus consistent with prior studies conducted with non-clinical samples. Cabrera et al. (2007) recruited pre-kindergarten children from the general population whose parents requested childcare or parenting services in their community. They reported that paternal supportiveness (but not maternal) was positively associated with the children’s emotional regulation. Mothers’ intrusive behaviors (i.e. over-controlling or over-involvement) rather than support were found related to toddlers’ development. In addition, Michiels et al. (2010) found in a non-clinical sample of 552 fourth through six graders that perception of security to fathers added to the prediction of emotional difficulties and outweighed the same factor within mother-child relationships. Hence, our findings revealed that for a variety of symptoms, the relationship with the paternal figure may play a central role in the course of recovery following abuse.

Results were in line with prior studies that identified intensity and type of children’s behavior problems to be related to their age (Jaser et al. 2005), sex (Rescorla et al. 2007), maternal level of psychological distress (Frye and Garber 2005) and perception of security to both parents (Rakow et al. 2011). Various studies stated that boys tended to display more externalized behaviors (Rescorla et al., 2007) as found in the present study (main scale and both delinquent and aggressive behaviors), being more withdrawn, having more social and attention problems. Findings from a review by Romano and De Luca (2001) on the impact of CSA among boys and girls on later psychological functioning suggested that in comparison to girls, boys were likely to experience more episodes of abuse and more violent CSA. Moreover, boys may be at higher risk of experiencing physical abuse concurrently. As noted in previous studies, our results indicated that older children tended to be rated as displaying more behavioral problems (for internalized main scale, anxious, social, attention and thought problems) (Frye and Garber 2005; Jaser et al. 2005).

This study adds to the literature on CSA regarding factors associated with children’s outcomes following abuse. Results suggested that maternal psychological distress was a significant predictor of children’s behavioral problems, more so than perception of security to mothers. In fact, higher maternal distress was related with greater behavior problems for the child (with the exception of delinquent behaviors). This issue, supported by other studies, is of primary interest here: mothers’ psychological distress was found to be a good predictor of internalized and externalized problem behaviors (Frye and Garber 2005) and even superseded the mother-child relationship (Rakow et al. 2011). From a clinical perspective, these results underscore the importance of evaluating each family member following disclosure of CSA in order to select appropriate interventions that aid non-offending parents in the process of recovery. It is worth noting that while most interventions following CSA encourage the mothers’ participation, very few interventions have recommended the involvement of both parents (Simoneau et al. 2008). There is empirical data suggesting that, for anxious children, therapeutic gains were greater and positive effects on behavior problems and depression were maintained longer when both parents were involved in treatment (Bagner and Eyberg 2003). A better understanding of parental roles can lead to the identification of specific contributions of father-child and mother-child relationships on targeted symptoms following CSA. As such, emphasis must be placed on fathers’ involvement in treatment and intervention so that children exhibit less adverse impacts after the abuse.

The present study has some limitations. Studies in the field of CSA are inevitably based on convenience sampling, since all cases ought to be disclosed. Also, the parent-child relationship is quite a complex reality to evaluate. Even well-validated measures target only a portion of the parent-child relationship, perhaps even more in families confronted with traumatic events. Moreover, the bidirectional effect of the relationship should be taken into account in future studies. Surprisingly, in the present study, no significant relationship was found between abuse-related characteristics, such as severity and duration of the abuse, and children’s level of behavioral problems. Other important characteristics of the abuse, not evaluated in the present study, might have had a more influential effect, such as the use of threat or force. Furthermore, the young age of participants and a possible hesitation to disclose details surrounding abuse, may lead to partial information as to the exact circumstances and characteristics of the abuse. A further limitation is that, given the cross-sectional design of the study it is impossible to ascertain the temporality of intervening variables, nor is it possible to consider other events that may impact children’s recovery (for instance, involvement in legal procedure, etc.). Furthermore, other forms of maltreatment children might have experienced were not investigated. This variable will need to be explored in further studies as multiple forms of maltreatment may be associated with more pervasive negative outcomes (Pears et al. 2008). In addition, future investigations may attempt to evaluate and document aspects related to the relationship between each parent as levels of conflicts and coherence in parenting practices may be found to influence each parent’s relationship with their child.

Two main clinical implications should be underscored. First, since maternal psychological distress was a more important factor than perception of security of attachment in predicting outcomes, interventions should address mothers’ distress and support should be offered when needed. Furthermore, the father-child relationship, reported by the child as perception of security of attachment, was a predictor of outcomes and predicted its own portion of variance over and above child’s age, sex, and maternal psychological distress. Therefore, the importance of father-child relationships should be evaluated by clinicians for their specific effects on many internalized and externalized symptoms after a CSA. Interventions with non-offending parents should aim to promote parent-child communication and optimize parental support by providing skills to the parents in order to better deal with their own distress (Deblinger and Heflin 1996). Clearly, father-child relationships could also be a specific target for intervention. The inclusion of fathers can also provide children with a supportive male figure in their recovery following sexual abuse. In addition, clinicians and researchers may gain to refrain from using global parental support measures and instead evaluate maternal- and paternal-child relationships distinctively.

In summary, children’s outcomes following the disclosure of CSA - by a perpetrator other than the father- were predicted by the children’s age, sex, as well as maternal psychological distress rather than the mother-child relationship. Moreover, children’s perception of security to their fathers predicted the parents’ report of internalized problem behaviors (anxiousness and withdrawal), externalized problem behaviors (delinquent and aggressive behaviors, as well as social and thought problems in their children. Research efforts must continue to explore the possible impact of father-child relations on outcomes of CSA. Future studies should investigate outcomes in months or years after the disclosure to better document the contribution of father-child relationships in the recovery process of child victims of CSA.

Acknowledgments

This article is part of the first author’s thesis submitted in partial recognition of a doctoral degree. This research was funded by a grant from the Canadian Institutes of Health Research (CIHR # 77614) awarded to Martine Hébert. The authors wish to thank the children and the parents who participated in this study, members of the Socio-Legal Paediatric Clinic - CHU Ste-Justine, specially Anne-Claude Bernard-Bonnin, M.D. and Claire Allard-Dansereau, M.D., as well as practitioners from the Centre d’Intervention en Abus Sexuels pour la Famille (CIASF) and the Centre d’Expertise Marie-Vincent.

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