Child Sexual Abuse and Its Long Term Effects

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QUESTIONNAIRE ON CHILD SEXUAL ABUSE
Completing the article: Prevalence of child sexual abuse among adolescents in Geneva: results of a cross sectional survey (1996). Halpérin D.S., Bouvier P., Jaffe P. D., Mounoud R-L., Pawlak C.H., Laederach J., Rey Wicky H. British Medical Journal; 312: 1326-1329

Q1:

How old are you ?

years and

months

Q2:

Are you a girl or a boy ?

girl

boy

Q3:

Who do you live with ?
(several answers are possible)

father
mother

stepfather
stepmother
other :

(specify..............................................)

Q 4:

Here are some general statements on child sexual abuse.
Do you rather agree or rather disagree with these statements ? Agree

a.

Some children are sexually abused
by older children

b.

Most people who sexually abuse children
do not belong to the child's family

c.

Most of the time children are sexually abused
when they are alone, at night, and outside their home

d.

Only girls are victims of sexual abuse

e.

Sexually abused boys are
usually not homosexual

f.

Children from reputable families are not
victims of sexual abuse

g.

Children who report being victims of sexual
abuse are not necessarily placed in foster care
following these revelations

h.

Few children are victims of sexual abuse

i.

Only young children are victims of
sexual abuse

j.

Boys are not sexually abused

k.

A majority of sexual abuse perpetrators
are retarded or mentally ill

l.

Even if one lets a year go by before talking about a sexual
abuse situation, it is still possible to do something about it

m.

In sexual abuse cases, the child him/herself
is never responsible

© Daniel S. Halpérin et al., Geneva, 1996

Disagree

I don't
know

Page 1

© Daniel S. Halpérin et al., Geneva, 1996

Q5:

Have your parents ever talked with you about child sexual abuse ? no
yes
If they have, please answ er questions
5b to 5d:
Q 5b : Which parent ?

father
mother
both

Q 5c : Did they explain that children may
be sexually abused by family friends
or family members ?

yes
no
I don't remember

Q 5d : Did they tell you to let an adult know
if it happened to you ?

yes
no
I don't remember

Q 6 a : Did you take part in the information session before today's questionnaire ?

yes
no

6 b : Before the information session, were you ever told about sexual abuse at school, for example during Facts of Life classes, or in a play, a movie or an exhibit ?

yes
no
I don't remember

Q7:

Were you told about sexual abuse somewhere else (i.e., outside of home and school) ?

yes
no
I don't remember

If so, please specify who told you about it (e.g., friend, scout, doctor, etc.) : ............................................................................................................................... ...............................................................................................................................

Page 2

© Daniel S. Halpérin et al., Geneva, 1996

Q8 :

Has an adult or an older child ever not respected you
by demanding you or forcing you to...
Yes

No

I don't w ant to
answ er

a) look at his/her genitals ?
b) undress and show him/her your genitals ?
c) watch him/her masturbate ?
d) undress with another child and fondle each other
in front of him/her ?
e) be fondled (caresses, rubs, kisses
on the whole body and/or your genitals) ?
f) fondle him/her (caresses, rubs, kisses
on the whole body and/or his/her genitals) ?
g) look at pornographic pictures, drawings, films,
videotapes or magazines ?
h) be naked and to expose your genitals
for picture taking or filming ?
i) submit to full sexual intercourse with penetration ?
j) submit to having his/her fingers or an object introduced
in your body ?

You may wish to give a more detailed answer. Here is some space you may use to comment......
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