Maternal Response to the Disclosure of Child Sexual Abuse: Systematic Review and Critical Analysis of the Literature
 

^{Theresa Knott, PhD., Audrey Fabre*}

ABSTRACT: This critical analysis is intended to examine the breadth of contextual factors that influence maternal response among non-perpetrating mothers of sexually abused children.   The existing theoretical conceptualization of maternal response is inadequate, and has led to the dichotomization of maternal response into positive and negative domains.  Driven primarily by CPS policy and practice, the identification of discrete maternal response categories fails to recognize the fluid nature of the post-disclosure reactions of non-offending mothers.   Contextual factors including the presence of domestic violence, financial dependence, substance abuse and the mother's history of sexual victimization may contribute to an ambivalent reaction to her child's disclosure of sexual abuse.  Further understanding of the complexity of an oscillating maternal response dynamic is critical to advance practice with this vulnerable population.
 

1.  Introduction

1.1  Rates of Child Sexual Abuse

    In 2003, 78,188 (1.2 per 1,000 U.S. children) substantiated child sexual abuse (CSA) investigations were documented by Child Protective Services (U.S. Administration for Children and Families, 2005).  Results of a 1999 meta-analysis based on 22 American studies revealed that 30-40% of girls, and 13% of boys experience child sexual abuse (Bolen & Scannapieco, 1999).  More recently, Johnson (2004), reported that, globally, the prevalence of CSA among girls is 2-62% and boys is 3-16%.  Psychological sequelae associated with child sexual abuse may include depression, anxiety, somatic concerns, and compromised social and academic performance (Beitchman et al., 1992; Beitchman et al., 1991).

1.2  Maternal Response to Disclosure of Child Sexual Abuse

    As compared with other family & non-family members, non-offending mothers of sexually abused children are most likely to receive a CSA disclosure (Sirles & Franke, 1989).  The response of the non-offending mother is predictive of the child's short and long-term psychological adjustment (Elliot & Carnes, 2001; Esparza, 1993; Everson, Hunter, Runyon, Edelsohn, & Coulter, 1989; Spaccarelli & Kim, 1995).

    Driven primarily by CPS investigative procedures, the maternal response construct refers to the non-offending mother's a) belief of the child's disclosure of sexual victimization, b) provision of emotional support to the child victim, and c) protection of the child from future maltreatment.  While limited research has examined the impact of non-offending male guardians, the balance of evidence conceptualizes and measures the non-offending mother's response to CSA.

    A positive response ranges from 27%-87% among non-offending caregivers of children investigated for sexual abuse (Elliot & Carnes, 2001; Everson et al., 1989; Faller, 1998; Heriot, 1996; Knott, 2008; Sirles & Franke, 1989; Trocmé, et al., 2001).  The wide range of reported positive or supportive responses to a child's disclosure of sexual abuse can be due to methodological differences in collecting data and inconsistent operational definitions of 'positive response'.

Factors which may have implications for maternal response to disclosure of CSA, but have not been subject to rigorous examination include:

a)  mother's relationship to the perpetrator

b)  presence of domestic violence in the family

c)  mother's history of sexual abuse

d)  mother's substance abuse

e)  age of the victimized child

f)   culturally informed maternal response patternsxx

    While recent literature identifies an evolving conceptualization of the maternal response construct, few of the above contextual factors have been adequately explored.  Considering the influence of maternal response on the victimized child's developmental trajectory, it is critical to examine these mediating factors to ensure that intervention with this vulnerable population is informed by the weight of cumulative evidence.
 

1.3  Literature Review Methodology

    This study constitutes a review and critical analysis of the maternal response literature considering the fluid nature of maternal support, belief and protection.  Secondarily, this study will examine the theoretical limitations of the maternal response construct, particularly within the context of a CPS driven definition and operationalization.

    An extensive review of scholarly databases was conducted; excluding grey literature and non-academic sources.  Databases were searched from 1980 to 2011.  The databases that were searched included Psychinfo (EBSCO), Sociological and Social Services Abstracts (SOCA), Social Work Research and Abstracts (EBSCO), the Educational Research Information Clearinghouse (ERIC), Sage Journals Online (SAGE), and Social Sciences Full Text (WILSON).  This review isolated studies for which (a) Maternal response of a non-offending guardian was measured; (b) Maternal response was isolated to the disclosure of child sexual abuse.

2.  Background

2.1 Child Protective Services (CPS) and Maternal Response

    Empirical data has established a correlation between positive maternal response and fewer mental health and behavioral problems among child and adolescent survivors of CSA (Barker- Collo, & Read, 2003; Bolen, & Lamb, 2004; Elliott, & Carnes, 2001; Leifer, Kilbane, & Grossman, 2001).  Comparatively, inadequate maternal response to the disclosure of CSA has been associated with CPS involvement, in some cases, resulting in the removal of CSA victims from caregiver's custody (Cross, Martell, McDonald, & Ahl, 1999) and potential retraction of the sexual abuse disclosure (Berliner & Elliot, 1996; Lawson & Chaffin, 1992).  Despite these practice implications, the maternal response construct has not been subject to rigorous theoretical analysis.

    The absence of a fully developed conceptualization of maternal response has inhibited the initiation of evidence-based practice guidelines.  CPS intervention in cases of poor maternal response has relied on identifying a constellation of risk factors associated with poor maternal response, enforcing applicable child welfare policy, and modifying child conduct to elicit maternal belief, emotional support and protection.
 

2.2  Conceptualization of Maternal Response

    The existing maternal response literature is compromised as it lacks a precise, empirically based conceptualization of the post-disclosure reactions of non-offending caregivers (Alaggia, 2002; Bolen, 2002; Leifer, Kilbane & Grossman, 2001; Smith & Swayer, 2010). Elliott and Carnes (2001) suggest that studies focusing on maternal response to CSA disclosure often measure and evaluate the conceptual domains differently.  Bolen (2002) reviewed 27 maternal response studies and found that there is a lack of agreement on how "varying levels of support and belief are operationalized" (44). Maternal response concepts are not theoretically based, but instead loosely constructed around child welfare policy; ultimately creating measurement challenges.

    Despite these limitations, the CPS derived construct has three domains which are indicative of maternal response among non-offending caregivers of children exposed to CSA: maternal belief of the CSA disclosure, provision of emotional support and protection from further abuse.  Hence, maternal response has been categorized as supportive or positive, unsupportive, or negative, and
more recently, ambivalent (Bolen & Lamb, 2004; Bolen, 2002; Elliot & Carnes, 2001).  A supportive response tends to encompass meaningful emotional support that includes a partial or entirely believed CSA disclosure that leads to action against the perpetrator to protect the victimized child.

     Characteristic of an ambivalent response, the non-offending mother may oscillate between supporting the victimized child while simultaneously positioning herself with the perpetrator (Bolen & Lamb, 2004).  Given that ambivalence is a manifestation of internal conflict, Bolen & Lamb (2007a) also inferred that non-offending guardians may concurrently exhibit support and ambivalence.  Subsequent analyses have revealed that the support and ambivalence domains of the maternal response construct are statistically independent (Bolen & Lamb, 2007a).  In light of the CPS practice implications, further analysis is warranted to determine the level of ambiguity within the maternal response construct.
 

2.3  Post-Abuse Adjustment among Non-Offending Caregivers

    Disclosure of child sexual abuse may be a traumatic stressor for both the victim and the non-offending parent (Burgess, Hartman, Kelley, Grant, & Gray, 1990; Lewin & Bergin, 2001; Lipton, 1997; Tamraz 1996).  Apart from responding to the emotional needs of their victimized child, non-offending caregivers may experience guilt and/or an ambivalent response toward the child and/or the offender, while coping with the involvement of police and CPS (McCallum, 2001; Regehr, 1990).  Unsupportive caregivers are less likely to report child sexual assault to authorities and may be less amenable to interventions designed to ameliorate their post-disclosure responses (Malloy & Lyon, 2006).

    Maternal distress associated with the CSA disclosure has been found to exert a powerful influence on the psychiatric symptomatology of the sexually abused child (Lipton, 1997).  Lewin and Bergin (2001) found that non-offending mothers of sexually victimized children reported heightened symptoms of depression and anxiety, in addition to diminished parent child attachment when compared with mothers of non-abused children.  Mannarino, Cohen, Deblinger, and Steer (2007) indicated that 26% of the 164 non-offending mothers of sexually victimized children they examined met DSM IV criteria for clinical depression.  Deblinger, Steer, and Lippmann (1999) reported a correlation between the non-offending mother's level of depression and PTSD symptomatology among sexually victimized children.  Through the examination of the post-disclosure psychiatric symptomatology of non-offending mothers, a more systematic understanding of unsupportive and ambivalent responses is conceivable.
 

2.4  Children's Psychiatric Symptomatology as a Factor of Maternal Response

    Research evidence demonstrates that a supportive response from a non-offending caregiver is associated with improved mental health and social functioning (Lovett, 2004), better overall adjustment of the sexually abused child (Elliott & Carnes, 2001), and fewer externalizing and delinquent behaviors (Bolen & Lamb, 2007b).

    Lovett (1995) studied 60 CSA victims, ages 7-12, and reported that girls who perceived lower levels of rejection from their non-offending mothers had higher competency ratings and fewer behavioral problems as measured on the Child Behavior Checklist when compared with CSA victims who perceived otherwise.  Morrison and Clavenna-Valleroy (1998) examined 50 mother-daughter pairs using a repeated measures time series design to understand how maternal support was related to self-esteem and depression in adolescent victims of sexual abuse who were undergoing treatment.  Significant differences were found between the groups that perceived and did not perceive maternal support at the time of discharge from treatment.  When non-offending mothers were perceived as supportive, victimized girls reported increased self-concept and diminished depressive symptomatology.

    Maternal collusion in the sexual victimization of children is not an accurate explanation for an unsupportive maternal response to CSA disclosure.  The "myth of the collusive mother" (Faller, 1988), is refuted when examining the rate of positive maternal response to CSA disclosure.  Knott (2008) reports that among 373 suspected and substantiated CPS investigations of CSA, as many as 87% of non-offending mothers responded with support, belief and protection of the sexually victimized child.  Despite the historical prevalence of theories suggesting that mothers were collusive in the sexual victimization of their children, data suggests otherwise.  The utility of the of the maternal collusion myth as a comprehensive explanation for an unsupportive or ambivalent maternal response is limited.

    Kouyoumdjian, Perry, and Hansen (2005), and Holguin and Hansen (2003) suggest that assumptions made among adults about the abuse experience impact the non-perpetrating caregiver's negative expectations of the child's functioning abilities.  In fact, Kouyoumdjian, Perry and Hansen (2009) found that, among 67 sexually abused youth and 63 non-offending caregivers, caregiver expectations significantly influenced internalizing and externalizing behavior among survivors.
 

3.  Contextual Factors Influencing Maternal Response to CSA Disclosure

Alaggia (2002) reports that maternal response is "a process that is fluid, rather than static" (51).  An oscillating maternal response to disclosure of CSA is mediated by contextual factors, such as those articulated below.
 

3.1  Mother's Relationship to the Perpetrator

    In developing a robust conceptualization of maternal response it is critical to recognize the myriad factors influencing mothers' post-disclosure reactions.  Non-offending mothers were more likely to be supportive of their sexually victimized children when they did not reside with the perpetrator, or when the perpetrator was neither the father nor the step-father (Cyr, Wright, Toupin, Oxman-Martinez, McDuff, & Theriault, 2003).  Conversely, non-perpetrating caregivers were least likely to support the victimized child when the victimized child identified the perpetrator as a family member (Malloy & Lyon, 2006).  Non-offending mothers were more likely to take protective action in support of the victimized child if the non-perpetrating mother felt hostility towards the perpetrator (Heriot, 1996).  Maternal support was also positive when the perpetrator acknowledged the sexual abuse, suggesting that the perpetrator's admission may mitigate the doubt associated with the veracity of the CSA disclosure.  The admission creates enhanced allowance for maternal support (Cyr et al., 2003).  When the child's first disclosure of abuse was to the non-offending mother, she was also more likely to be supportive (Cyr et al., 2003).
 

3.2  Domestic Violence

    Empirical data reveals the increased likelihood of co-occurring domestic violence among families for whom an allegation of child sexual abuse has been suspected or substantiated (Bell, 2002; Bowen, 2000; Hiebert-Murphy, 2001; Kellogg & Menard, 2003).  Co-occurring CSA and domestic violence has implications for maternal response given that non-offending mothers may experience diminished capacity for adaptive coping as a result of DV victimization.  Additionally, the broad range of the non-offending mother's response may be inhibited by financial reliance on the CSA offender.  Compromised emotional availability as a factor of mothers' exposure to domestic violence has been repeatedly documented (Alaggia & Turton, 2005; Hiebert, 2001).  Kellogg and Menard (2003) reviewed 164 CSA cases and found that 58% of CSA perpetrators were also physically violent toward their partners.  Despite this, 60 percent of non-offending mothers who experienced domestic violence were reportedly emotionally supportive, 21% exhibited a neutral response, while 19% demonstrated poor maternal response.
 

3.3  Compromised Maternal Response Secondary to the Non-Offending Mother's Substance Abuse

    An evolving body of evidence suggests that non-offending mothers may be compromised in their response to CSA disclosure as a result of their drug and alcohol use (Knott, 2008; Leifer, Kilbane & Kalik, 2004; Rodriguez-Srednicki, 2001).  Non-offending mothers may experience diminished capacity to make accurate risk assessments secondary to impaired judgment resulting from substance abuse.  A host of contextual factors influence the non-perpetrating mothers' perception of heightened risk for CSA including, but not limited to mother's substance abuse, her own history of CSA, and her experience of domestic violence.  Leifer, Kilbane and Kalik (2004) reported that a lack of maternal protectiveness was conceptualized as a factor of mother's use of alcohol and/or drugs secondary to her own historical CSA trauma.
 

3.4  Age of the Victimized Child

    Elliot and Carnes, (2001) reported an increased tendency among non-offending mothers to believe the CSA disclosure of younger rather than older victims of sexual abuse.  Parent-child attachment and maternal investment in the protection of younger children has been offered as an explanation for this response pattern (Leifer, Kilbane & Grossman, 2001).  The disclosure of younger children may be more likely to be believed as adults perceive younger children to be otherwise ignorant of the details surrounding sexual intercourse (Elliot & Carnes, 2001; Sirles & Franke, 1989).  For these young children, any knowledge of sex or sexual behavior is assumed to be a manifestation of sexual victimization.
 

3.5  Implications of Cultural Identity on Maternal Response Patterns

    Shaw, Lewis, Loeb, Rosado and Rodriguez, (2001) examined psychiatric symptomatology as a factor of racial identity among CSA victims and their families.  Non-offending Hispanic mothers reported increased levels of depression, somatic complaints, anxiety, and aggressive behaviors among their victimized children when compared with the reports of non-offending African-American mothers.  The Hispanic girls in this study reportedly perceived their families as both unsupportive and unresponsive (Shaw, et al., 2001).  A similar maternal response pattern among Hispanic CSA victims and their non-offending mothers was documented by Sanders-Phillips, et al., 1996.  Religious commitments, patriarchal family structure, and emphasis on family unity have been offered as explanations for culturally specific maternal response patterns.  An emphasis on recognizing culturally informed models of maternal response is critical to effective service delivery with this vulnerable population.
 

3.6  False Allegations of Child Sexual Abuse

    While it is not our intention to address the legitimacy of the false allegations body of literature, within the scope of this maternal response paper, it is critical to acknowledge that false allegations of CSA can, and do occur.  The association between negative maternal response and children's recantation of legitimate CSA disclosures has been documented (Lovett, 2004), and may occur as a result of lack of support from the non-offending caregiver.  In some cases, however, intentionally false claims of CSA are made by children and youth; most frequently within the context of custody and access disputes.  When intentionally false CSA claims are made, and supported by the alleged non-offender a potentially deleterious impact on the victimized child may occur.  The child's potential to generate false memories is heightened, and the child's attribution of blame associated with an intentionally false allegation may propel psychiatric sequelae.
 

4.  Recommendations for Future Maternal Response Research

    Continued expansion of the maternal response body of research should focus on the inclusion of victimized families of color, for whom culturally informed patterns of maternal response to CSA disclosure are not well conceptualized and responded to by service providers.  McGuffy (2005) suggests that existing evidence fails to reflect the experiences of large segments of the population and supplementary research should focus on eliciting the unique characteristics of maternal response among low SES families and families of color.  Increased emphasis on response patterns when male victims report abuse is critical to the conceptualization of the maternal response construct, and provision of evidence-based practice with this population.  Shifting the body of literature towards capturing empirical data focused on inclusivity and diversity will benefit the social work discipline through increased knowledge related to the intersections of race, class, and gender (Plummer, 2006).

    Maternal protectiveness in cases of repeated and intergenerational sexual victimization has been relatively unexplored.  This suggests a need for further research in this area focusing on the prevention of recurrent abuse (McCallum, 2001; Pullins & Jones, 2006; Tjersland, 2006).  Non-offending mothers are at risk of post-disclosure trauma themselves, and may experience diminished risk assessment inadvertently resulting in children's continued exposure to CSA.   Through recognition of the non-offending mother's post-disclosure trauma, and focus on prevention efforts, mothers may be better equipped to prevent recurrence of CSA (Malloy & Lyon,
2006).

    Continued emphasis in the literature on dichotomizing maternal response into positive and negative categories fails to advance our understanding of the fluid nature of post-disclosure reactions (Bolen & Lamb, 2007a), and limits the breadth of child welfare responses.  Given the recognition that maternal response oscillates as a result of contextual influences, research efforts must continue to focus on the factors that characterize maternal ambivalence, ultimately resulting in the development of more relevant CPS policy and practice.

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