title: Ethical dilemmas in online research and treatment of sexually abused adolescents.
abstract: BACKGROUND
  In a recent uncontrolled trial of a new therapist-assisted Web-based treatment of adolescent victims of sexual abuse, the treatment effects were found to be promising. However, the study suffered a large pretreatment withdrawal rate that appeared to emanate from reluctance among the participants to disclose their identity and obtain their parents' consent.
  
  
  OBJECTIVE
  Our objectives were to confirm the effects of the online treatment in a controlled trial and to evaluate measures to reduce pretreatment withdrawal in vulnerable populations including young victims of sexual abuse.
  
  
  METHODS
  The study was designed as a within-subject baseline-controlled trial. Effects of an 8-week attention-placebo intervention were contrasted with the effects of an 8-week treatment episode. Several measures were taken to reduce pretreatment dropout.
  
  
  RESULTS
  Pretreatment withdrawal was reduced but remained high (82/106, 77%). On the other hand, treatment dropout was low (4 out of 24 participants), and improvement during treatment showed significantly higher effects than during the attention placebo control period (net effect sizes between 0.5 and 1.6).
  
  
  CONCLUSIONS
  In treatment of vulnerable young populations, caregivers and researchers will have to come to terms with high pretreatment withdrawal rates. Possible measures may reduce pretreatment withdrawal to some degree. Providing full anonymity is not a viable option since it is incompatible with the professional responsibility of the caregiver and restricts research possibilities.
authors.affiliation: Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands. a.lange@uva.nl
authors.forename: Alfred
authors.initials: A
authors.lastname: Lange
authors.forename: Jeroen
authors.initials: J
authors.lastname: Ruwaard
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology / Q000628:therapy*; D003219:Confidentiality; D019548:Crime Victims / Q000523:psychology* / Q000534:rehabilitation; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D008297:Male; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011369:Professional-Patient Relations / Q000941:ethics*; D013813:Therapy, Computer-Assisted / Q000941:ethics* / Q000379:methods; D035862:Vulnerable Populations / Q000523:psychology