A total of 42 studies were included: 3 quasi-RCTs, 8 controlled studies, 26 pre-test post-test studies, 2 post-only study and 3 case-studies. It was not clear overall how many participants were involved in the studies.
Individual therapy (3 quasi-RCTs; 1 controlled study; 3 pre-post test studies and 3 case studies): Individual therapies were more likely to be aimed at girls (40% girls only; 10% boys only; 50% both sexes). The sexual abuse was primarily intrafamilial (60%), although half of the therapies were also offered to victims of extrafamilial abuse. Duration of therapy lasted 2-18 months and the sample size varied from 1 to 56. Over 50% of the studies evaluated behaviourist-orientated interventions; some implemented by the mother or nursing staff. The outcome measures were based primarily on standardised measures (70%) and direct observations of behaviour (40%). Parents were the main source of data followed by the children themselves (percentages not stated). Overall, studies tended to demonstrate that participation in individual therapy (particularly behavioural therapies) attenuated a variety of symptoms and behavioural problems. Significant improvements were observed in behaviour, anxiety, depression, self-esteem and post-traumatic stress. Several studies also showed clinical improvements however, despite all of the improvements many children did not reach a normal level of functioning by the end of the study. Three studies showed improvements were maintained for a few months after therapy ceased. Only one study reported data on revictimisation rates. This single case study reported that the child had not been abused in the 12 months following the start of treatment.
Group therapy (3 controlled studies; 14 pre-post test studies; 1 post-test only study): Group therapies were more likely to be aimed at girls (71% girls only; 5% boys only; 24% both sexes). All studies focused on intrafamilial (100%) and 43% also offered therapy to victims of extrafamilial abuse. 90% of the studies lasted no longer than 6 months and 52% of the studies used groups of fewer than 10 participants. The outcome measures were based primarily on standardised measures (71%) and children were the main source of data (81%). Overall, many of the studies suggested that group therapy had significantly positive effects in attenuating numerous symptoms (in order of importance i.e. in terms of no. of studies demonstrating the effect): behavioural problems, self-esteem, depression, anxiety, post-traumatic stress, and sexuality. However, very few of the studies verified whether the effects were maintained. Only four of the studies reported data on revictimisation rates, two of which reported no further abuse in the 12 months following the end of treatment.
Treatment programme (4 controlled studies; 9 pre-post test studies; 1 post-test only study): Treatment programmes were evenly aimed at both sexes (29% girls only; 14% boys only; 57% both sexes). All studies focused on intrafamilial (100%) and >50% also offered therapy to victims of extrafamilial abuse. Duration of therapy lasted 2-24 months (most >12mths) and the sample size varied from 5 to 180. The outcome measures were based primarily on standardised measures (64%) and in-house instruments (57%). Parents (79%), children (64%) and therapists (58%) were all used as sources of data. Overall, the findings from these studies were more mixed than for individual and group therapies (both for measures reported by children and adults) and so no clear conclusions could be drawn. A number of studies did however find that treatment programmes had no significant effects on family functioning. Seven studies in total reported revictimisation rates (range 5-19%) over periods ranging from 15 months to 5 years. Two of the smaller studies reported no revictimisation occurring in a period of 15-36 months.