121: Sleep Problems and Dissociation Symptoms in Sexually Abused Preschoolers

Abstract

Background: Children experiencing sexual abuse (SA) are found to display significant internalizing and externalizing behaviour problems compared to non-abused children, In addition, victims of sexual abuse also appear at greater risk of dissociative symptoms than non-maltreated children. Adult studies have shown a link between dissociation and sleep disturbances. Yet, few studies have been conducted with young children although retrospective studies on adult survivors have shown that the preschool period may be crucial in the development of dissociation. Objectives: The aim of this study was to document the contribution of sleep problems to the prediction of dissociation in sexually abused preschoolers. Design/Methods: The sample consisted of 224 children and the non-offending mother who were referred to the Child Protection Clinic of a tertiary care hospital following alleged SA. Abuse-related variables were abstracted from medical records. The child's level of dissociative symptoms was assessed with the Child Dissociative Checklist and the seven-item Sleep Problems subscale of the Child's Behavior Checklist (Achenbach & Rescorla, 2000) was used as an index of sleep disturbance. Maternal psychological distress was evaluated by the Psychiatric Symptom Index. Factors contributing to the prediction of dissociative symptoms were evaluated with a hierarchical multiple regression analysis. Results: The mean (± SD) age of the participants was 4.6±0.7 years, and there were 33 boys and 191 girls. Approximately 36% of SA children reported a single episode of abuse, 40% reported more than two episodes and 24% abuse lasting for more than six months. SA was described as complete or attempted penetration in 46% of cases. An immediate family member was identified as the perpetrator in 60% of cases. Entering age and sex of the child and maternal psychological distress in the multiple regression analysis to predict dissociative symptoms gets an R2=0.14, F (2, 138)=7.31; P<0.001. Adding other traumas experienced resulted in a significant increment in R2=0.20, F(1, 137)=10.97; P<0.01. With the addition of sleep disturbance, prediction of dissociation symptoms reached R2=0.37, F(1, 136)=36.07; P<0.001. After controlling for socio-demographic and maternal variables, and other traumatic experiences, sleep disturbance significantly added to the prediction of dissociative symptoms. Conclusions: Sleep disturbances appear to contribute to the frequency of dissociative symptoms. This regulation deficit should be addressed promptly, in order to help decrease long-term detrimental effects of sexual victimization, such as the development of dissociation.