Macdonald, G.M., Higgins, J.P.T., & Ramchandani, P. (2006). Cognitivebehavioural interventions for children who have been sexually abused. Campbell Collaboration Systematic Review. Téléchargé du www.campbellcollaboration.org.
This systematic review assessed the efficacy of cognitive-behavioural therapeutic approaches in treating the sequelae of sexual abuse in youth under age 18. Studies were included in the analysis if a) the participants were children or adolescents up to 18 who had experienced sexual abuse; b) behavioural or cognitive-behavioural intervention techniques were used; c) outcomes were assessed using valid psychometric instruments related to child psychological functioning, child behaviour problems, future offending behaviours, and/or parental skills and knowledge; and d) the participants were randomly or quasi-randomly assigned to the experimental or control groups, with control group participants being given an existing treatment or no treatment. Interventions may or may not have included parents.
Two independent reviewers selected ten studies through this rigorous method of creening. Overall, a total of 847 children participated. There were no language restrictions. All but one of the studies were conducted in United States.
Meta-analyses showed that although cognitive-behavioural therapeutic approaches had a positive effect on diminishing some sequelae of child sexual abuse, such as depression, anxiety, and post-traumatic stress disorder, most of the results were not statistically significant at the 95% confidence level. For some domains, such as the child sexualized behavior problems, the conclusions drawn by studies were conflicting. The reviewers highlighted the need for more carefully conducted research. For instance, a few studies were conducted using only 10 to 20 participants assigned in each group, which limited their statistical power.
The reviewers also advocated for more rigour in the analysis and reporting processes of trials. For example, some researchers did not clarify the cut-off points they chose to assess clinical levels of symptoms experienced by participants.
In summary, this systematic review does not support cognitive-behavioural approaches as being the treatment of choice for reducing the sequelae of sexual abuse, even though some positive effects have been shown that merit further attention.
Cette recension systématique Campbell/Cochrane a été menée dans le cadre d’une méthode rigoureuse et transparente de recherche, de révision et de synthèse des études les plus pertinentes dans ce domaine de recherche. Cette étude a été approuvée à la fois par des experts de la pratique clinique dans ce domaine et par des experts des méthodes d’analyse synthétique de données. Les revues systématiques sont utilisées de façon croissante afin d’employer à bien les résultats des recherches existantes, tout contournant les biais et limites inhérents aux recensions narratives des écrits.
En effet, les revues systématiques des écrits diffèrent des recensions narratives des écrits en raison de leur stratégie plus rigoureuse pour identifier les études pertinentes, de leurs critères plus formels pour en évaluer la qualité, de leur effort pour identifier et contrôler leurs biais, et de leurs façons explicites de comparer les recherches entre elles. Ces différentes étapes ajoutent une valeur scientifique à la mise en commun des résultats des diverses recherches dans un domaine précis. Les revues systématiques mettent également en lumière la richesse et la complexité de l’information, démontrées à la fois dans les analyses principales et secondaires, ce qui se traduit dans l’application des résultats aux niveaux de la pratique et des politiques sociales.