The Barriers and Facilitators to Abuse Disclosure and Psychosocial Support Needs in Children and Adolescents Around the Time of Disclosure

ABSTRACT

Background:

Children who experience sexual or physical abuse often delay their disclosure. This study aimed to clarify the barriers and facilitators to abuse disclosure in a sample of children and adolescents participating in a police interview regarding alleged abuse.

Method:

Semi-structured interviews were conducted with 13 children (nine girls) who participated in a police interview regarding alleged abuse. They were asked about their abuse disclosure, their own and others’ reactions to it, and the help and support they received from health service providers and other adults. Thematic analysis was used to identify themes, categories, and subthemes in the data.

Results:

The key theme that emerged was the domino effect of disclosures, which occurred in three ways: unintentionally, delayed, or to professionals. Delays in, and reluctance to, disclose is explained in various ways. Four sub-categories emerged: ambivalence in personal and others’ reactions, missed opportunities, reflection depending on age, and varied psychosocial support needs. Notably, disclosure delays did occur because children identified abusive acts as transgressions or did not considered the abuse significant.

Discussion:

The present study reveals the significance of others’ reactions to children’s disclosures. The pattern showed supportive responses when children reported transgressions committed by adults, whereas peer abuse was met with mixed responses. Importantly, health care providers such as doctors and psychologists were not preferred confidants. In line with previous research, disclosure to friends or non-abusive family members was more common. The present findings underscore the difficulty with which children disclose abusive experiences, even in instances where it led to a police investigation.

Conclusions:

Child care practitioners need to be better equipped to meet a basic standard facilitating children to confide in others about abusive experiences. To increase the likelihood of keeping children in therapy after abuse, more active involvement of the child during clinical intervention seems important.

KEYWORDS:

• Abuse disclosures
• adolescents
• children
• health care providers
• police investigation

Child maltreatment violates the right to protection against harm and exploitation (CRC, 1989). Recognizing this, many countries, including Nordic ones, have different measures to help children. In a Nordic context, with a highly involved welfare state and a low bar for what is considered violence against children, including corporal punishment, the late 1990s, and early 2000s were characterized by developing child-friendly forensic processes and units to care for children involved in abuse cases (Johansson et al., 2017). The Barnahus model, imported and adapted from Iceland, consists of a collaborative, multiagency public institution with health, child welfare, and forensic professionals under one roof, dedicated to children’s legal rights and well-being. The Barnahus facilitates disclosure in a child-friendly and caring environment. However, before arriving at the Barnahus, the child or someone else disclosed he/she is an alleged abuse victim. How children describe the disclosure process is still understudied. The aim of the present paper is to deepen our understanding of children’s disclosure process before arriving at the Barnahus.

The disclosure Process

Child maltreatment is associated with delayed disclosure timelines and barriers to help-seeking behaviors (Lemaigre et al., 2017). A Norwegian study found a 17.5-year delay from sexual abuse onset to disclosure (Steine et al., 2016). According to Jensen et al. (2005), the delay process is dialogical. In their study, children and families reported difficulties addressing child sexual abuse (CSA) due to language barriers and limited knowledge about CSA. Moreover, self-blame, shame, fear of consequences, not being taken seriously, or burdening parents (Goodman-Brown et al., 2003; Hershkowitz et al., 2007; Jensen et al., 2005; Lemaigre et al., 2017; McElvaney et al., 2014; Paine & Hansen, 2002; Schönbucher et al., 2012; Ullman, 2002) are reasons for non-disclosures or delayed disclosures. One study on CSA disclosures among adolescents shows they disclose to friends rather than parents (Schönbucher et al., 2012). Most of the literature on disclosures examine CSA victims, and only a few studies investigated barriers and facilitators for disclosure in the case of child physical abuse (CPA) (Bottoms et al., 2016; Foynes et al., 2009; Hershkowitz et al., 2005; Jernbro et al., 2017). One study found children were more likely to disclose CPA if the parents were not living together. Hershkowitz et al. (2005) reported, however, that when the parent was the perpetrator, disclosure was less likely. The severity of the abuse increased the likelihood for the child to disclose CPA even if lacking an adult confidant (Jernbro et al., 2017). Jernbro et al. (2017) further explored CPA disclosure barriers and found loyalty to the perpetrating parent, distrust in adults or authorities, fear of not being believed, self-blame, and normalizing the experience inhibited adolescent disclosure. Furthermore, inadequate adult responses such as an inability to take the child’s perspective or inaction due to a lack of evidence may lead to non-disclosures.

Except for Jernbro and Hershkowitz and collaborators’ studies, research on disclosures has mainly been on young adults retrospectively reporting on their disclosures. Moreover, studies have mostly focused on barriers to disclosure, but the process and facilitators leading to disclosure are understudied in a sample of children with different types of abuse experiences (Brennan & McElvaney, 2020). Understanding disclosure is important because it enables children to receive help for abuse experiences, and potentially ameliorate abuse sequelae. Moreover, disclosures may be facilitated through formal help-seeking behaviors, as child victims of abuse experience somatic and mental health problems that in some instances result in consultations with health practitioners (Rueness et al., 2020).

However, professional helpers such as general practitioners (GPs), school nurses, and school psychologists are less frequently confided in by children concerning child abuse and neglect (Hafstad et al., 2020; Jernbro et al., 2017). Seeking help from health professionals is often reliant upon parents’ or other adults’ initiative and help (Leavy et al., 2011). However, some parents are not in a position to be of help (Rothi & Leavey, 2006). For instance, when the family is perceived as part of the problem, adolescents may be reluctant to seek help from their family. In such instances, young people may rely on the GP or school-based professionals. Research has also suggested that with age, adolescents use, and are more willing to seek help from friends, mothers, fathers, and professional assistants including counselors (Del Mauro & Williams, 2013; Schonert-Reichl & Muller, 1996). There are some age differences among adolescents when it comes to preferred helpers. Older adolescents rely increasingly on peers compared to adults when in need of help and support (Dubow et al., 1990). Whether they choose to disclose child abuse to health professionals and how adolescents experience help after disclosure is not well understood.

Thus, to address these research gaps on disclosure and help-seeking behaviors related to child abuse, this study aims qualitatively to investigate: (1) adolescents’ reflections on the disclosure process, and (2) adolescents’ experiences with professional health-care providers before and after disclosure.

Method

Participants and Procedure

Thirteen adolescents (nine girls) between 12–16 years of age were approached at least half a year after participating in a larger study on adolescents’ mental and somatic health at the time abuse was disclosed and police interview(s) took place at a Norwegian Barnahus (see Rueness et al., 2020 for a description of the host study). Participants were approached by the research team by phone if they had initially agreed to be re-contacted. The majority of interviewees had been to the Barnahus concerning a CSA case (n = 8), whereas five adolescents came due to domestic violence, including CPA. The CSA was mainly perpetrated by peers known to the child, however, one child reported intra-familial CSA, and one reported an adult friend of the family. Participants’ average age when the abuse took place was 10 years (range 3–15 years), 14 years (range 12–16 years) when they disclosed the abuse and brought it to the attention of the police, and 15 years (range 12–16 years) when participating in the present interview. The time-lapse between police interviews and study participation ranged between 6–12 months.

All adolescents over age 12 who agreed to be re-contacted were approached either directly by phone or via their parents and asked to meet for a qualitative interview. The participants and parents were informed about the purpose of the interview in an age-appropriate way by phone. If they agreed to participate in the qualitative study, the interview time and place were arranged in agreement with the adolescent. Importantly, the adolescent was consulted to ensure that the place chosen felt safe and familiar. In some instances, the Barnahus where the police interview was conducted or the child’s home was chosen to meet at. One interview was, due to geographical distance, conducted over a video conference. All interviews took place after school hours and lasted approximately 33 min. Based on adolescents’ consent, all interviews were tape-recorded. None withdrew their consent.

Ethical Considerations

The present study was approved by the Norwegian regional board of ethics (REK sør-øst 2016/603). According to Norwegian legislation, children and adolescents between the ages of 12–16 can consent to participate in research on health issues without parental consent based on approval from the institutional review board. These were the circumstances for the present study. Due to the sensitive nature of the present study, the children’s vulnerability, involvement in a police investigation as alleged victims of maltreatment, and relatively young age, several ethical considerations were necessary. One such consideration was a six-month period between police interview and re-contact. This ensured the research interviews were perceived as voluntary, whereas the police interviews were compulsory. Moreover, interviews could not to interfere with the police investigation. All participants were informed that if information concerning their health or general situation were to concern the interviewer, steps had to be taken in agreement with the adolescent to ensure they received adequate help and guidance.

Interview Guide

A semi-structured interview guide was developed to deepen our understanding of abused adolescents’ decision to disclose. The interviews also addressed how health care was provided and whether professional assistants were concerned about any traumatic experiences when meeting before disclosure. Lastly, the interview guide prompted children to elaborate on their experiences meeting with health professionals and how they perceived any health-related assistance after disclosure. Although the interview guide was developed based on gaps in the literature on adolescents’ help-seeking behavior and processes of abuse disclosure, themes the adolescents introduced during the interviews were encouraged. For instance, follow-up questions were posed individually when adolescents described their disclosure experiences and help-seeking behaviors. Also, questions such as “do you have anything to add in addition to what we already talked about?” and “in your opinion, what is the most important thing we have talked about today?” were asked toward the end of each interview. Adolescents were also asked to briefly describe the police case and the abusive experience(s), to get the adolescents’ explanation as to why they participated in a police interview.

Thematic analysis was applied to identify patterns and themes in the data (Braun & Clarke, 2006). An inductive approach was taken when reading the interviews and categorizing themes. Both authors of the present paper, who also conducted all 13 interviews, read all interview transcripts to familiarize themselves and get a first impression. The first author re-read all the interviews to generate initial codes. Then, a search for themes was initiated, and identified themes were reviewed. This was done in several steps, first, by the first author, and then in collaboration with the co-author. Lastly, and in a collaboration between co-authors, we defined and named themes.

Results

By reading the transcribed interviews to identify themes, one resounding theme which came through was the domino effect of disclosures. Under this main theme, three categories and four sub-categories were identified (see Figure 1).

Figure 1. An illustration of the themes, categories, and sub-categories identified in the present study.

The Domino Effect of Disclosures

Importantly, all adolescents in the present study disclosed their abuse, an adult often filed the police report, and that led to adolescents’ participation in the present study. In the present study, the decision process was less pronounced in the adolescents’ accounts; however, a clear picture of a domino effect in disclosures was evident. By domino effect, we suggest a sequential pattern of disclosures often initiated with a disclosure to a friend or relative, and then gradually disclosures were made to parents, health professionals, the police, and sometimes child protection services. Especially among adolescents who experienced sexual abuse, they displayed a prolonged sequence of disclosures. The initial disclosure occurred with a friend before other grown-ups and parents were told, and ultimately, health care or other professionals were consulted about the experience. When disclosing to friends and parents, regardless of the disclosures being unintentional or delayed, ambivalence in personal and others’ reactions was reported. The attention to others’ reactions is interesting and may reflect the interviewees’ age as early, mid, and late adolescence, an age at which other’s reactions are particularly significant. However, although the disclosure process could be pictured as a domino effect, the method of disclosure differed slightly, resulting in what we label unintentional disclosure, delayed disclosure, and disclosure to professionals.

Unintentional Disclosure

Several adolescents indicated an unintentional disclosure, where they did not voluntarily disclose, at least not to adults. Many disclosed at least partly to friends, and friends either told adults or made them tell their parents or other adults who filed a police report. In some instances, adolescents experienced abuse together with a friend, and they described a discrepancy between the two friends in the motivation to disclose. However, when the other friend wanted to disclose to a parent or other adult, several participants respected their friend’s wish and that it would require self-disclosure.

Jennifer (16) explained that she and her friend had been at the same party where both were sexually abused. However, the two friends reacted differently to the abuse, leading to different needs in terms of disclosure:

Well yes, after about three weeks it [abusive experience] started bothering her [friend] a lot. I didn’t think much about it, because it was towards the end of summer and school had started again, and I didn’t have time to think about it, but it bothered her a lot. And she wanted to tell her mother, and she said she had to tell her mother that I was there too. Then she told everything, also about me, and then her mother called my mother and father, but they [friend’s family] had talked with me already. I said it was ok that they told my parents. (…) So then I told my father indirectly so that he understood, but I didn’t say it, and then they [friend’s parents] called that evening.

Jennifer considered the abusive experience less burdensome than her friend and did not see the need to disclose her experience to her parents. However, she was loyal to her friend when she expressed the psychological need to do so. This led to disclosure and a police report.

Two participants explained the disclosure was made on the adolescents’ behalf by a friend, who against the participants’ will, told the parents. Liv (14) had been sexually abused by a close friend who was a few years older. She expressed immense turmoil and confusion regarding this experience, including her concern for how her mother would react to it. Although she told several girlfriends, she was adamant she did not want an adult to know, especially not her parents. Liv stated,

She [friend] told my mother. I said, ‘you are not allowed to tell, you are really not allowed to tell.’ But then she did [tell] because she knew, she was smart enough to not listen to me, and did it [disclose].

While very reluctant to tell, she was happy she eventually did. Liv was one of several participants relieved about disclosure.

Yet, another way unintentional disclosures were made was due to friends strategically talking loudly about the adolescent’s abuse experience close to an adult helper. Anni (16) had been sexually abused by a family friend several years back when she still was in primary school. She had thought about the abusive experience several times, been asked directly, but only later told some of her closest friends. One day in school she and her friends were talking about Anni’s abusive experience right by the school advisor’s office. Anni reported, “And then the school social advisor came out [of her office] and said that if any of us needed to talk, she was there, and things like that.” Anni interpreted this as a direct invitation from the school advisor. She accepted and went on to explain how it helped her disclose to her sister and mother and receive help.

For all except one unintentional disclosure, the victim was a girl, and the abuse type was sexual. In instances of family violence one adolescent reported that the disclosure was unintentional and made possible because another offended family member filed a police case. This led to the child’s investigative interview, and abuse disclosure of both the child filing the abuse claim and the affected sibling.

The main reason offered for not disclosing was the fear of burdening parents,

I felt that nothing would get better if I disclosed it … And I thought that my mother and father would think a hundred times worse about it than I do, and then I thought they didn't need to know [about the abuse] (Jennifer);

feeling self-blame and wanting to protect the perpetrator, “I do not want the person who abused me to be hurt, I care about him [abuser], even if he did this and that.” (Liv); and minimizing the experience as not a big enough deal to involve parents or other adults, “I have grown up with this [harsh parenting], and I have gotten used to it … if you think about it, Norwegian culture and other cultures are very dissimilar,” (Robert).

Thus, there appeared to be a continuum between unintentional and delayed disclosures, in which both in reality are delayed, but where the latter was intended and a deliberate account about the abuse was communicated to a parent or other adult helper.

Delayed Disclosures

Several children delayed their disclosure. Some described the lack of knowledge as the main reason. Sandra (14) who had been sexually abused during her early elementary school years, explained that although the experience did not feel right, she did not recognize it as abuse and something worth disclosing until she got older and acquired new knowledge about abuse.

I was very much back and forth about how to say it, or I didn’t know exactly what had happened either, so I didn’t really know how to say it if I was supposed to disclose when I was younger [age for abuse]. … I guess I didn’t dare to say anything because I didn’t know how one should disclose, because I had barely learned about it [abuse]. We had been told that you should not get into strangers’ cars and things like that, I hadn’t learned it [about abuse] for real before fifth or sixth grade. (…) I was wondering a lot about whether it was right if it was allowed.

Stereotypes surrounding CSA misled or occluded sexual abuse experiences that were not in line with stereotypes. For Sandra, this uneasy feeling related to abusive experiences was ambiguous and confusing, which led her to withhold her experience for several years. The lack of words and a disclosure strategy precluded effective identification and abuse disclosure from the child, enabling continued abuse and deprivation of help and support. However, directly questioning children did not always lead to disclosures either.

Two adolescents were asked directly by parents or other family members but did not tell. Lilly (16) had been sexually abused by her step-father and described long-lasting abuse experiences becoming increasingly bothersome as she approached adolescence. Due to family conflicts, Lilly received help before disclosing, and child protective services was involved. When asked if anyone had understood or known about the abuse, Lilly admitted that her sister and brother-in-law had asked. She explained, “Eehm, I think my sister and her husband understood. Not really understood, but some things I did gave them hints. They asked me, but I said no for some reason. And they didn’t ask again after that.” As Lilly remembers it, her sister understood something was bothering Lilly and even asked about it, but Lilly did not accept the invitation to tell. She found it hard to disclose and maybe the family conflict contributed to the disclosure barriers she felt. Moreover, it appears, from what Lilly reported, that her sister only asked once, not giving her new opportunities to share her experiences. Research has shown that families in which conflict arises are less inviting when it comes to disclosures of abuse, also, repeatedly asking when suspecting abuse has been highlighted as important to create an inviting environment for disclosures (e.g. Brennan & McElvaney, 2020).

Although family turmoil and conflict are known, and child protection agencies can provide certain services, disclosing abuse seems difficult. Rita (12) described an upbringing characterized by psychological and physical abuse by her parents. Like other physically abused children both in the present study and in research, fear of sanctions toward the parents kept children from disclosing. “ … Because I lied, I didn’t tell the police that they [my parents] hit me because I was afraid they [my parents] would go to jail.” Children who witnessed family violence reported they feared not seeing their abusive parent, but when the situation worsened and being with the abusive parent felt unsafe and threatening, disclosure became necessary. This is in line with what Thulin et al. (2019) found when interviewing children in out-of-home placement due to an abusive home environment.

Ambivalence in Own and Others’ Reactions

When talking about disclosure experiences, most participats mentioned peer and family reactions. Although most individuals received support, adolescents having experienced sexual abuse by a peer reported negative reactions as well. For instance, they reported fractioning within their peer group, representing those supporting and those disbelieving the abused individual. The negative feedback exacerbated the adolescents’ abusive experiences. Anni described, “Many reactions made it worse, such as others being mad at me and didn’t want to have anything to do with me. (…) Then it was either team me or team him.” The less anticipated negative reactions from peers evolved gradually and added a new dimension of the conflict and negative feelings. In retrospect, some regretted telling certain friends.

A striking difference among the participants was that children exposed to family violence reported exclusive support from their peers. Although they expressed not wanting to be pitied, support was important to them. John, a 16-year-old boy who witnessed domestic violence and emotional neglect throughout almost his entire upbringing, expressed the importance of peers. According to John, his peers’ degree of understanding outperformed the help from health professionals.

Talking with adolescents is actually very advanced and difficult. To get into an adolescent’s head, because an adolescent may compart so many things in his head. And it is actually very, very hard for an adolescent to open up … Because I feel that a person will open up if he meets people with the same experiences because they will understand a lot better.

Although John had frequent and positive encounters with health-professionals and his teacher, he underscored the importance of friends. Overall, it appeared that participants shifted between the feeling of wanting to talk and being listened to, but not being alienated, causing worry, or be judged by parents. For instance, as Johanna a 17-year-old girl who had been filmed during sexual interactions at a party, discussed.

… But it would have probably been nice if my mother had asked ‘hey, how are you?’ Because she doesn't know what, exactly what I have been through, how I felt about it. So we haven’t really sat down and talked about it, or I have said ‘think about how it would have been if it was you,’ because everyone hates me in a way. But, if I want to talk about it, discuss it with my mother, I know that she’s there to listen. And I know her very, very well, she was very similar to me when she was young. So, she understands me very well. But she hasn’t asked, but if I want to talk I know she’s there to listen. But I haven’t felt the need for it, not very much at least.

This passage shows ambivalence toward her mothers’ support and her desire to talk to her mother. She wants to talk to her and at the same time express self-reliance and avoidance.

Disclosing to Health Professionals

Adolescents confirmed they had contact with health professionals or talked to professional assistants at school before disclosing abuse. Often, health services need was associated with behavioral or emotional problems due to other difficulties in the adolescents' life such as bullying, divorce, or instability at home. Others had somatic conditions, either diagnosed or non-specific, that led to consultations with GPs or other medical experts. Some interviewees had seen health professionals or other professional helpers before disclosing abuse, continuing to see the same or other helpers after disclosing. However, none of the interviewees first disclosed to these professional helpers, even if some had asked the adolescent directly about abuse experiences.

Missed Opportunities

Disclosing to professionals was another dimension of sharing abuse experiences. In some instances, a professional, such as a teacher was the first to know. More often, health care providers, such as GPs, school nurses, and psychologists were the last to know, often after the police became involved. Some adolescents explained they did not have a close relationship with the healthcare provider, or that they sought help for something else, not realizing the possible link between emotional or somatic complaints and the abusive experiences. A perceived distance between the health practitioner and adolescent was one reason adolescents did not accept an invitation to reveal abuse experiences.

Laura:

“Eh, I sort of didn’t have a close relation to my GP, so I told my GP after I had told the police because my mom thought it would be the right thing to do. I think I would never tell her [GP] if I hadn’t told anyone else first.”

Interviewer:

“No, it was safer with the teacher that you knew?”

Laura:

“Yes, it felt safer with my teacher.”

For instance, Laura (16), was sexually abused by a former boyfriend, and felt that disclosing to her teacher was safer than telling a GP, explaining it as a matter of contact frequency. Laura was lucky to be asked directly by both her teacher and GP. Although choosing to disclose to her teacher first, this may serve as an example of the importance of being asked, maybe even repeatedly. This is important because others had seen health professionals regularly, but never been asked about potential abusive experiences related to their health complaints. Lilly, who experienced the latter, thought that if she had been asked, she would have disclosed earlier.

I saw a psychologist at school … But I didn’t, I never managed to tell her … Or yes, I didn’t think it was important either. It didn’t really have anything to do with my situation. So I didn’t say anything. But after I came home from [parent’s country of origin], I told her. And she gave me a sheet [for] listing things that I am afraid of, traumatic events or something like that … One of the questions was if someone had sexually abused you or something like that. If she had given me that sheet earlier, I would have answered (Lilly).

Lilly felt ambivalence toward the abuse and the need to disclose it. Disclosure at some level confirmed her previous experiences were abusive. Moreover, she did not link the emotional difficulties she experienced at the time with the now-terminated abuse she experienced as a young child.

The Aspect of age in Help-seeking Experiences

A pattern reflected in the interviews was the association between the adolescents’ age and the ability to evaluate or reflect on the help they received after disclosure. Younger (i.e. late primary-school-/early middle-school-aged) participants communicated more confusion regarding disclosure to health-professionals and subsequent involvement of the health care providers. For instance, David, a 13-year-old boy, was confused as to who would follow up with him after disclosing abuse.

But then there was some talking and some more talking, and more meetings, and then CAMHS [child and adolescent mental health services] concluded that what happened was not serious enough because the Barnahus is involved, and CAMHS cannot do much about it, they [CAMHS] can only continue to talk about it, while Barnahuset can do it.

Older adolescents took a more reflective stand, and several expressed disappointment in how health care was provided. Johanna (16) expressed disappointment and confusion regarding her therapists’ actions, and perhaps her psychologist had not communicated clearly why she wanted to change the topics discussed in therapy.

To start with it helped. After a while, eh, my psychologist changed her strategy and wanted to talk about something completely different from what had happened, and not about what had happened. So I feel that it is not recognized by very many, few really want to listen.

In all, there is a different reflection level in the older group of interviewees. Older middle- and high-school-aged adolescents in the present study reflected on the type of therapy they received, how they perceived that communication was facilitated or debilitated by help-providers and whether they met their needs. This was in contrast to younger participants who seemed more confused about assistance and how it aids in mitigating negative thoughts and emotions.

Variability in Expressed Need for Psychosocial Support

A pattern was the division between those who sought minimal or no help, and those actively seeking help and guidance from several adults, not exclusively health service providers. Such help could range from peers and parents to teachers, counselors, school, and community health care services. Those actively and regularly seeking help expressed almost solely positive experiences with the help they received. However, a description of exactly what was helpful, other than the opportunity to talk about their feelings and experiences, was lacking.

The group who described no or minimal help from health services or other professionals expressed either no need for help after abuse or had experienced poor help and support, which decreased help-seeking behavior motivation. Some did not exclude the probability of future help-seeking, whereas others expressed direct disappointment. This is illustrated by what Laura (16) is describing in the passage below.

I felt that seeing the psychologist didn’t help that much when she didn’t want to focus on what I felt I needed help for. So right now, no, I am not receiving any help. But that doesn’t mean that I will not need it in the future.

Discussion

All adolescents in the present sample, with the help of their parents or other adults, filed a police report and participated in forensic interviews. Thus, the decision to disclose had far-reaching, and for several adolescents, unforeseen consequences. Nevertheless, the main findings illustrated that from a highly selective sample of adolescents the process of disclosure and associated reactions, confirmed what has been reported from other studies on adolescents’ abuse disclosures (e.g. Brennan & McElvaney, 2020; Cossar et al., 2019; Lemaigre et al., 2017; Thulin et al., 2020). Following Brennan and McElvaney’s (2020) meta-analysis of qualitative studies on disclosures after abuse, the pressure cooker effect (i.e. a disclosure is inevitable due to the adolescents’ degree of distress) is a pattern recognized in the present study as well. Almost all adolescents disclosed to friends, either as their first disclosure or to explain their reactions and feelings in certain situations. This finding maps nicely onto the literature holding that friends gradually become more important than parents and other trusted adults for confiding in about private matters (Dubow et al., 1990). This was in line with the present finding that almost all interviewees characterized friends as their strongest source of support, except the youngest participants who mainly disclosed to parents or adults. However, some adolescent victims of peer abuse also experienced disbelief, threats, and other negative reactions from peers. Distressing experiences exacerbated the burden of the abusive experiences, the disclosure process, and the period following the police investigation.

Disclosures to adults were contemplated for a longer time or made unintentionally. Disclosure reluctance due to fear of sanctions or parental reactions was the main reason for non-disclosures, a pattern described in previous research as an important motivational factor (Arata, 1998; Foynes et al., 2009; Goodman-Brown et al., 2003; Kogan, 2004). Another factor ascribed to disclosure delay was the lack of knowledge about the experience being abnormal, a finding confirmed in other studies on abuse disclosure (Brennan & McElvaney, 2020; Jensen et al., 2005). However, another reason for not disclosing was the lack of invitation to do so in trusting relationships (e.g. Brennan & McElvaney, 2020; Cossar et al., 2019).

Importantly, professional helpers did not consistently address trauma and negative experiences in a way that prompted the adolescents to disclose to health-care providers. Some received medical or psychological consultations, either for symptoms related to the abuse or related to other medical conditions or psychological distress due to other stressors. In these consultations, just a few were directly asked about abusive experiences, and just a few reported the health services provider was informed after disclosure. Overall, some girls expressed disappointment regarding the post-disclosure help, while others were satisfied; most often, the ones who were satisfied sought several adult sources for support. For the youngest participants, the health and social services they received appeared difficult to grasp and evaluate.

Others’ reactions toward disclosures appeared as an important topic for interviewees. Anticipated reactions were important to them before deciding to disclose (e. g., Cossar et al., 2019), and discussing others’ reactions was done with little or no prompting from the interviewer. Given the vulnerable phase adolescence constitutes when it comes to others’ evaluations, it was not surprising that responses to their abuse histories were a significant aspect of disclosing and the finding is in line with other studies on disclosures (Ullman, 2002). Discerning is therefore the fact that peers showed disbelief and discredited some adolescents’ sexual abuse accounts. At the same time, some children described their parents as more supportive than initially feared.

Implications for Practice

The present findings may inform practice highlighting how children participating in forensic interviews experienced the disclosure process. It was apparent that unintentional and delayed disclosures were common. Children’s rationale for or against disclosures is important. Adolescents in the present study were very sensitive to others’ reactions and often described them without interviewer prompting. Accounts regarding help-seeking behaviors revealed that few adult helpers asked adolescents directly about abuse, even when adolescents showed symptoms that commonly manifest after abuse experiences (cf. Rueness et al., 2020). At the same time, when adolescents were asked directly, not all felt comfortable disclosing to a health professional. However, although asking children directly about abuse experiences did not always lead to disclosures, it may facilitate some disclosures. Thus, school staff and health practitioners frequently seeing adolescents should be aware of their potential role in facilitating abuse disclosures in youth and thereby enabling them to receive appropriate help and support. The present findings suggested some adolescents sought out a lot of help and professional assistance to process abuse experiences and associated emotions and distress. Another group were adolescents who had little to no help-seeking experience and described no need or poor experiences with professional support after abuse. It is important for practitioners and researchers alike to better understand the reasons some abused adolescents felt less understood, not aided, or reluctant to seek and receive help from professionals. It has been suggested, that like adults, children and adolescents prefer being kept informed and consulted when receiving health care services (Haller et al., 2007; Leavy et al., 2011). This may have been the case for some of the adolescents in the present study. For the youngest participants, it seemed they had a very poor understanding of the help they have received and why. Based on these answers it seemed as if there was great potential in age-appropriate information and reflection with adolescents about the help they received. User involvement and planned joint reflections on help received may keep maltreated youths, who need clinical intervention, in therapy as long as necessary (see Table 1).

Table 1. Main findings important for practice.

Disclosures	Disclosing to friends first is normal.
	Disclosing to trusted adults is frequent.
	Delayed disclosures are common.
	Disclosures to health professionals are rare.
	Health professionals should explore abuse experiences in young clients.
Help-seeking	Questions about abuse can facilitate disclosure, especially if children are asked more than once.
	Age-appropriate information and opportunities for reflection are important to keep adolescents in care after abuse disclosures.

Although important implications for practice were revealed in the present study, it is important to remember that the present sample consisted of 13 adolescents. Child victims of violence and abuse are a heterogeneous group, and with a limited sample, the findings cannot be generalized to youth victims of child abuse. Nevertheless, the main findings resemble previous findings in the literature on child abuse disclosures.

Conclusion

The present study uniquely addressed how children who experienced abuse reached the abuse disclosure stage. Although findings closely mapped with those reported in previous studies on maltreated adolescents’ disclosure process, this was the first study investigating these issues in a sample of maltreated youth at the time their case was investigated by the police. This highly selective sample is rarely found in. They represent an important sub-sample among abused individuals, and it is important to acquire more knowledge about them to detect and stop abuse and future suffering. The present study is a step in this regard, understanding the process by which adolescents explain their disclosure process and experiences with health care services.

Acknowledgements

We would like to thank the children and adolescents agreeing to meet with us to talk about highly stressful and private experiences in their young lives.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Data Availability Statement

The data that support the findings of this study are available on request from the study principal investigator and second author of this paper, M.C.M.. The data are not publicly available due to their containing information that could compromise the privacy of research participants. Ethical approval from a Norwegian Institutional review board is a prerequisite.

Additional information

Funding

This work was supported by the Norwegian Directorate of Health.

Notes on contributors

Else-Marie Augusti

Else-Marie Augusti holds a PhD in developmental psychology from the University of Oslo. She has studied child victims of violence and abuse and their development within the domains of cognition, memory, and mental health. She has also worked on studies investigating decision- making processes in the child protective services and most recently on a large epidemiological study on child abuse and neglect in Norway.

Mia Catherine Myhre

Mia Catherine Myhre is a pediatrician (M.D.) at the Oslo University Hospital with a PhD on child physical abuse. She has conducted research on child physical abuse and risk factors for injuries in children. She has also worked on large epidemiological studies on the prevalence of violence and abuse against adolescents, young adults and adults in Norway. She is the principal investigator of the project on which the present study is based.