Listen to my play: Decoding the narratives and emotions of sexually abused children through a mixed-methods approach

Background Child sexual abuse (CSA) is a prevalent yet underreported problem, and reliable tools for assessing its psychological impact in children remain limited. Objective This study aimed to develop narrative story stems, identify core themes in children's narratives, develop an emotion-recording checklist, and compare emotional expressions between sexually abused and non-abused children. Participants and setting The study included 90 children aged 4–9 years living in Tehran, Iran. The quantitative phase included 30 sexually abused and 60 non-abused children. The qualitative phase included 40 children (20 abused and 20 non-abused), matched for age and gender. Methods Quantitative data were collected using the emotion-recording checklist while children completed narrative story stems. Qualitative data were analyzed using thematic analysis until thematic saturation was reached. The newly developed tools were evaluated for face and content validity and reliability. Results Narratives of abused children reflected themes of sexual content, death and murder, pervasive insecurity, low self-belief, post-abuse symptoms, and grooming strategies, whereas non-abused children commonly expressed developmentally appropriate fears, positive self-belief, and a greater sense of security. Across stories, abused children displayed significantly higher levels of anger and shame and fewer neutral emotional expressions than non-abused children. Conclusions Narrative story stems and the emotion-recording checklist show promise for assessing psychological functioning in children affected by sexual abuse; however, further studies in larger and more diverse samples are needed to establish their clinical utility.