Health care professionals must be alert to the high prevalence of low adherence to treatment during adolescence. Low adherence increases morbidity and medical complications, contributes to poorer quality of life and an overuse of the health care system. Many different factors have an impact on adherence. However, critical factors to consider in teens are their developmental stage and challenges, emotional issues and family dysfunction. Direct and indirect methods have been described to assess adherence. Eliciting an adherence history is the most useful way for clinicians to evaluate adherence, and could be the beginning of a constructive dialogue with the adolescent. Interventions to improve adherence are multiple - managing mental health issues appropriately, building a strong relationship, customizing the treatment regimen if possible, empowering the adolescent to deal with adherence issues, providing information, ensuring family and peer support, and motivational enhancement therapy. Evaluation of adherence at regular intervals should be an important aspect of health care for adolescents.

Sexual abuse is associated with a host of negative repercussions in adolescence. Yet, the possible mechanisms linking sexual abuse and negative outcomes are understudied. The purpose of this study was to investigate the relationships among self-blame, shame, coping strategies, posttraumatic stress disorder (PTSD), depressive symptoms, and suicidal ideation. The sample included 147 sexually abused adolescent girls between 14 and 18 years of age. A total of 66% of girls reached clinical score for PTSD and 53% reached clinical score for depressive symptoms. Close to half (46%) reported suicidal thoughts in the past three months. Shame was found to partially mediate the relationship between self-blame and PTSD. Shame and depressive symptoms were also found to partially mediate the relationship between self-blame and suicidal ideation. Results suggest that shame is a crucial target in interventions designed for sexually abused adolescent girls. KeywordsChild sexual abuse; attributions; stigma; coping strategies; depression; self-blame The consequences associated with child sexual abuse (CSA) have been studied for more than three decades now. The bulk of studies have shown more depressive symptoms, posttraumatic stress disorder (PTSD), and suicidal ideation (Hillberg, Hamilton-Giachritsis, & Dixon, 2011;Maniglio, 2009;Paolucci, Genuis, & Violato, 2001) among CSA victims than among the general population, especially during adolescence (Kendall-Tackett, Williams, & Finkelhor, 1993;Tyler, 2002). A recent review revealed a significant association between CSA and suicidal ideation or attempts in 49 out of 52 studies conducted with adolescents (Miller, Esposito-Smythers, Weismoore, & Renshaw, 2013). The risk for CSA increases substantially in late adolescence for girls with 36.8% of CSA occurring between their 15th and 17th birthday (Finkelhor, Shattuck, Turner, & Hamby, 2014 CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptAccording to Whiffen and MacIntosh (2005), now that the association between CSA and emotional distress has been documented, research should focus on identifying the underlying mechanisms involved in this link. In their review of the literature, shame, selfblame, and avoidance coping strategies were identified as crucial factors related to a heightened risk of emotional distress among victims of CSA. Yet, few studies have explored the impact of these factors on outcomes in sexually abused adolescents. The aim of the present study was to further investigate self-blame, shame, and coping strategies among sexually abused adolescent girls and their impact on PTSD, depression, and suicidal ideation by testing a mediational model. Self-blame and shameThe Traumagenic Dynamic of Stigmatization model proposed by Finkelhor and Browne (1985) was the first to emphasize the role of shame and self-blame in the symptomatology of sexually abused youth. According to these authors, the negative connotations surrounding sexual abuse (taboo, shame, guilt, blaming the victim) are communicated to th...

Participants in the ESPACE sexual abuse prevention workshop were in grades 1 through 4 and attended three Montreal, Canada, public schools in low socioeconomic areas. The sample was culturally diverse, with half born outside of Canada. An evaluation was conducted to explore the effects associated with participating in the workshop and the effects of booster sessions conducted two years later. Outcomes included knowledge gained, the ability to offer behavioral responses to abusive situations, peer victimization, sense of safety, empathy, self-efficacy, and support. Results revealed that participants in this sample obtained low scores on measures of sexual abuse knowledge and that short booster sessions that elicit children's recall of the learned material might produce greater improvements.