The sexually abused battered child.

A total of 130 children were identified in whom both evidence of sexual abuse and non-accidental, non-genital physical injuries (bruises, fractures, scratches, burns and scalds, including failure to thrive) were found. There were 77 girls and 53 boys with mean ages 5.7 and 6.8 years respectively and the peak age between the second and seventh birthdays; this reflects previous reports indicating that physical and sexual abuse predominantly involves young children. Patterns of injury that suggested sexually motivated assault included bruises, scratches, and burns around the lower trunk and genitalia, thighs, buttocks, and upper legs including knees. Pinch and grip marks were found where the child was held. The sexual abuse often involved attempted or achieved penetration of mouth, vagina, or anus, and physical signs were seen relatively more often than in sexually abused children as a whole. Four children died and sexual aggression and child death in the domestic setting may be linked. One in six of 769 physically abused children (16.9%) and one in seven of 949 sexually abused children (13.6%) have suffered both forms of abuse.     

Somatic and psychological problems in a cohort of sexually abused boys: a six year follow up case-control study

Aims: To obtain information about the health and well being of 108 boys six years after their involvement with the same paedophile. Methods: Case–control study of the health records of 93 male victims of a major episode of school based child sexual abuse and 93 matched controls. Interviews with a sample of their general practitioners. Results: The number and frequency of reported health problems were similar in both cases and controls. However, abused boys were more likely than controls to present with symptoms that persisted for more than a year (31 cases compared with 10 controls). Conclusions: Boys who have previously suffered sexual abuse at school did not utilise primary health care services more than a group of age matched controls. They did not present with psychological or somatic problems different from those presented by non-abused boys. However, abused boys were more likely to complain of persistent somatic or psychological problems lasting more than a year. This pattern appeared to persist after the abuse had stopped and the perpetrator imprisoned.     

Somatic and psychological problems in a cohort of sexually abused boys: a six year follow up case-control study.

AIMS: To obtain information about the health and well being of 108 boys six years after their involvement with the same paedophile. METHODS: Case-control study of the health records of 93 male victims of a major episode of school based child sexual abuse and 93 matched controls. Interviews with a sample of their general practitioners. RESULTS: The number and frequency of reported health problems were similar in both cases and controls. However, abused boys were more likely than controls to present with symptoms that persisted for more than a year (31 cases compared with 10 controls). CONCLUSIONS: Boys who have previously suffered sexual abuse at school did not utilise primary health care services more than a group of age matched controls. They did not present with psychological or somatic problems different from those presented by non-abused boys. However, abused boys were more likely to complain of persistent somatic or psychological problems lasting more than a year. This pattern appeared to persist after the abuse had stopped and the perpetrator imprisoned.     

Sexually abused children 5 years after presentation: a case-control study

OBJECTIVE: A total of 68 sexually abused children and their nonoffending parents were reassessed 5 years after presentation and were compared with a cohort of children of similar age and sex who were not known to have been abused. METHOD: Outcome measures were behavior, depression, self-esteem, anxiety, eating problems, drug use, suicide attempts, self-injury, running away, criminal activity, and attributional style. Recent life events, demographics, family functioning, and mothers' mental health were taken into account when examining outcome. RESULTS: Although the abused children had experienced more negative life events, were from lower socioeconomic groups, had more changes in parent figures, and had mothers who were more psychologically distressed, multiple regression analysis showed that after allowing for these and other demographic factors, there were still significant differences between the groups after the 5 years. The abused children displayed more disturbed behavior, had lower self-esteem, were more depressed or unhappy, and were more anxious than controls. Sexually abused children had significantly higher levels of bingeing, self-injury, and suicide attempts. CONCLUSIONS: It is clear that many children who are sexually abused have ongoing problems. Their ongoing problems may be indicative of false beliefs about themselves and the sexual abuse experience.     

Sexually transmitted diseases in sexually abused children

Over a 4-year period, 409 cases of suspected sexual abuse of children were reviewed to study sexually transmitted disease (STD). Sexually transmitted disease was identified in 54 (13%) of the 409 children: 46 cases of gonorrhea, six cases of syphilis, four cases of trichomoniasis, and three cases of condyloma acuminata. Nine of the 46 children with cultures positive for gonorrhea did not have a history of discharge. Four of the six children with syphilis also had a gonococcal infection. One child with syphilis had condyloma. Only one child had clinical features of syphilis. Sexually transmitted disease was more likely to be transmitted by an extended family member or a nonfamily member than by a father/stepfather (P less than .001). Laboratory tests that identify sexually transmitted disease may aid in the diagnosis of sexual abuse.     

Prevalence and characteristics of sexual abuse in a national sample of Swedish seventeen-year-old boys and girls

The aims of this study, which was part of a survey on adolescent sexual behaviour, were to investigate adolescents' experience of child sexual abuse and to present possible abuse-related problems. Representative samples of 2% of Sweden's 17-y-old male and female students and school non-attenders were selected in a two-step procedure. In all, 1943 students and 210 school non-attenders answered a self-administered anonymous questionnaire, distributed by school nurses. Six out of 170 questions dealt with personal experiences of child sexual abuse, i.e. age at onset, frequency of abuse and relationship to the offender. Peer abuse was excluded by the definitions used. The overall response rate was 92.2% for students and 44.2% for school dropouts. Among male and female students, 3.1% and 11.2%, respectively, acknowledged sexual abuse, 2.3% and 7.1%, respectively, when exhibitionism was excluded. Mean age at onset was 9.1 y (SD 4.3) for boys and 9.0 y (SD 3.9) for girls; 1.2% of the boys and 3.1% of the girls reported abusive oral, vaginal and/or anal intercourse. Suicide attempts or other acts of self-harm were reported by 33.3% of the male students reporting abuse and by 5.1% (p < 0.001) of those who had not been abused, and by 30.4% of the abused student girls compared to 9.1% of the non-abused (p < 0.001). Sleep and eating disorders, use of alcohol at an early age and/or experimentation with illicit drugs and consensual coitarche before age 15 y was reported significantly more often by abused than non-abused girls (p < 0.001, differences not found among the student boys). Of school non-attenders, 4% of the boys and 28% of the girls reported sexual abuse. Of the abused girls, 49% reported abusive vaginal intercourse and 64% reported self-destructive behaviour or suicide attempts. No abused boys and few abused girls had confided in a teacher, health professional or social worker. Results from the student sample should be interpreted as markers of "minimum prevalence", as female school non-attenders report significantly higher prevalence of sexual abuse. Potential high-risk groups are better included in prevalence investigations of child sexual abuse. The fact that so few adolescents confided in "professionals" about the abuse, despite having severe symptoms and signs of distress, underlines the need to address sexual abuse when recording the social, medical and psychiatric histories of adolescents.     

Vulnerability or resilience to intergenerational sexual abuse: the role of maternal factors

This study examined vulnerability or resilience to intergenerational sexual abuse. The sample included 196 African American mothers and their children of which 96 were sexually abused and 100 had no reported incidents of abuse. Four groups were formed based on maternal report of a history of childhood sexual abuse and the child's abuse status: (a) sexually abused mothers of children who were not sexually abused, (b) sexually abused mothers whose child was sexually abused, (c) mothers with no history of sexual abuse whose children had no history of sexual abuse, and (d) mothers with no history of sexual abuse who had a sexually abused child. The findings indicate that mothers who break the cycle of abuse were functioning as well as the nonsexually abused mothers in the study. Furthermore, sexually abused mothers with abused children evidenced significantly more disturbed functioning than the other three groups of mothers, particularly in their attachment relationships.     

Prevalence and pattern of child abuse and associated factors in four secondary institutions in Enugu,Southeast Nigeria

In our society, child abuse is most often not recognized. In addition, little attention is focused on child abuse due to the menace of severe acute malnutrition and infections, which are the major pediatric problems in our setting. There is need therefore for public awareness of the existence of the various forms of child abuse in the society. The objective of this study is to determine the prevalence, pattern, socioeconomic implication, and factors associated with child abuse among secondary school students attending four secondary schools in Enugu. This is a prospective study where cases of child abuse were investigated using a convenience sampling of students attending four secondary schools in Enugu. A total of 372 subjects participated in the study comprising 192 (51.6 %) females and 180 (48.4 %) males (χ ²?=?7.74, p?=?0.38). Their median age was 15.0 (12–18)?years. One hundred and sixty-six of 370 (44.8 %) made up of 85 (51.2 %) females and 81 (48.8 %) males reported that they had been hit repeatedly with an implement, showing no significant difference in the gender of respondents physically abused. Thirty-eight (10.2 %) respondents admitted that they have been forced or persuaded to have sexual experience against their wish as teenagers. A total of 58/346 (16.8 %) respondents admitted that they have been abused emotionally in one way or the other by either birth parents or other relatives who brought them up. Conclusions: Child abuse is a notable problem among secondary school students and adolescents, though this is highly underreported as seen in this study.     

Medical evaluation of abused and neglected children

Children who have been abused and neglected may have a variety of medical problems not apparent to a social worker or other nonmedical professional investigating the allegations. A joint project between a state child protective agency and an urban teaching hospital was undertaken to provide for the systematic medical screening of all children brought to the agency before their placement in foster care. These children received a complete medical evaluation with emphasis on documenting the abuse and neglect and also were screened for other medical problems. A total of 5181 children were evaluated. Forty-four percent of these children had some medical problem, including anemia, otitis media, sexually transmitted infections, and lead poisoning. Additional instances of abuse and neglect were identified and documented. This systematic evaluation allows for the optimal identification, documentation, and treatment of abuse, neglect, and other medical problems that may affect a child's outcome and adaptation.     

Predictors of attributions of self-blame and internalizing behavior problems in sexually abused children

BACKGROUND: The purpose of the present study was to identify predictors of two potential sequelae of child sexual abuse, self-blame attributions and internalizing behavior problems. METHODS: In the study, detailed information was collected on 218 victims of sexual abuse aged 4 to 17, involved in criminal cases, about their background, the abuse, and their mother's reaction following discovery of the abuse. RESULTS: Increased attributions of self-blame were predicted by the child having a close relationship with the perpetrator, experiencing severe sexual abuse (e.g., long-lasting abuse that involved penetration), perceiving the abuse as disgusting, and coping with the abuse by pretending it was not happening. Similar factors did not emerge as predictors of internalizing behavior problems. CONCLUSIONS: Results suggest that different child and abuse characteristics predict the two sequelae often associated with childhood sexual abuse. Thus, although self-blame attributions and behavior problems are often considered similar consequences of sexual abuse, there appears a need to distinguish the two types of outcomes following sexual victimization in childhood.     

Adult sexual revictimization among black women sexually abused in childhood: a prospective examination of serious consequences of abuse

This study is a prospective investigation of adult sexual revictimization among 113 Black women with documented histories of childhood sexual abuse. The purpose was to obtain information on the frequency of sexual abuse in both childhood and adulthood and to determine which characteristics of the child sexual abuse were predictive of revictimization. Thirty percent of the participants were revictimized and physical force predicted subsequent victimization. This study also investigated possible sexual behavioral correlates of revictimization. Revictimized women reported more involvement in prostitution and partner violence. Finally, the present study considered the reproductive and sexual health correlates of revictimization. When compared to women abused in childhood only, revictimized women experienced more problems conceiving, repeated vaginal infections, sexually transmitted diseases, and painful intercourse. Suggestions for intervention are discussed.     

Guardian support of sexually abused children: a study of its predictors

The purpose of this article is to present a study of intervening variables for guardian support. It is this article's thesis that guardian support is better conceptualized as a complex reaction to the disclosure of abuse that is shaped by a number of factors, some of the most important of which are the stressors impinging on guardians and their previous patterns of relating within the family. The sample included 92 guardians of sexually abused children presenting at a medical center for a sexual abuse medical and forensic evaluation. This study found that the most important intervening variables for guardian support in multivariate analysis were the attachment/relationship style of child and guardian and whether a second guardian accompanied the child to the hospital. This study highlights the importance of relational considerations between the child and nonoffending guardian as well as the importance of using more than a single nonoffending caregiver.     

Suicide risk following child sexual abuse.

OBJECTIVE: To determine the suicide rate and prevalence of suicide attempts and suicidal ideation in 183 young people who had experienced child sexual abuse and to examine variables related to the abuse, which may correlate with suicide attempts or suicidal ideation. METHODS: Adolescents and young adults who had experienced child sexual abuse and individuals from a nonabused comparison group were asked about suicide attempts and suicidal ideation 5 and 9 years after intake to the study. Nine years after the abuse, a national death search was carried out to ascertain the number and causes of death in the 2 groups. Logistic regression was used to assess information on demographic and family functioning variables, the sexual abuse, notifications for other child abuse, criminal convictions, and out-of-home placements that were related to the outcome variables. RESULTS: Young people who had experienced child sexual abuse had a suicide rate that was 10.7 to 13.0 times the national Australian rates. There were no suicides in the control group. Thirty-two percent of the abused children had attempted suicide, and 43% had thought about suicide since they were sexually abused. CONCLUSIONS: Little information seems to be available to clinicians at the time of investigations for child sexual abuse in children that may identify those who are at increased risk of suicide. Abuse by an acquaintance, parental denial, or being angry with the child and not the abuser may predispose to suicide attempts but not necessarily to a completed suicide.     

Sexual abuse at a Swedish daycare centre: allegations, confessions and evaluations

In September 1997, sexual abuse at a Swedish daycare centre was disclosed. The suspect, a male member of the staff, admitted having abused six children. A total of 30 children were included in the police investigation. In this study, these cases were evaluated individually using a child psychiatric method. Information was collected from the police investigation and from interviews with parents. The conclusions--categorized as "abuse likely", "abuse conceivable" or "abuse uncertain"--were compared with the children's own reports, the legal evaluations and the confessions of the suspects. CONCLUSIONS: The correspondence of child reports with child psychiatric evaluations was fairly high, indicating that child reports may serve as a good screening indicator of abuse. There was little agreement between child psychiatric evaluations and legal decisions, which were based on the reports of suspects. Some differences may be explained by varied methodology, definitions and criteria. Others reflect real differences in opinion. Our study illustrates the need to establish legal criteria for statements from pre-schoolers if such evidence is to constitute the basis of a ruling without a confession. Studies comparing professional psychological assessments of children's statements about sexual abuse with independent data stand out as an important line of research for the future.     

Anatomically correct dolls used in interviews of young children suspected of having been sexually abused

To determine the value of using anatomically correct dolls in diagnostic interviews of young children suspected of being sexually abused, the records of 83 children who were less than 7 years of age and who were evaluated at Yale-New Haven Hospital because of a suspicion of sexual abuse were reviewed. The dolls were used in 60 cases (72%). When the dolls were used, children provided significantly more information than by interview alone about what had happened and about the identity of the suspected perpetrator. Children less than 3 years of age, however, were unable to provide details about the abuse despite the use of the dolls. The ratings of the likelihood that sexual abuse had occurred were based on all of the information in the case including that obtained through the diagnostic interview with the dolls. When these ratings were compared with the ratings based on evidence obtained solely from noninterview data, the likelihood of abuse was higher in 35% of the cases. It was concluded that substantially more information is provided by young children when anatomically correct dolls are used and that the likelihood of detection of abuse is increased when information from the child is included in the assessment.     

Frequency and significance of physical evidence in legally proven cases of child sexual abuse

Clinicians have long recognized and attorneys have disputed that physical evidence of injury, sexually transmitted diseases, and seminal fluid are often absent in cases of child sexual abuse. To determine the frequency and significance of physical evidence in legally "proven" felony cases with penetration, a retrospective review of sexual abuse court records was done. A total of 45 randomly selected cases were reviewed; 39 (87%) had resulted in conviction of the perpetrator for felony. Charges of vaginal rape were made in 32 cases, and charges of oral and/or anal sodomy in 23 cases. No significant difference in rate of felony conviction was found in cases with or without physical evidence. Of 32 cases without physical evidence, 30 (94%) resulted in felony convictions, whereas only 9 of 13 cases (69%) with physical evidence resulted in a felony conviction. Multiple variables describing the abuse situation were not shown to effect the legal outcome of the cases. Of cases that resulted in felony convictions, physical evidence was present in only 23% (9 of 39). These results should be helpful for the clinician in counseling the family of the sexual abuse victim and the attorney who prosecutes child sexual abuse cases.     

Les abus sexuels à Kër Xaleyi : aspects sociodémographiques et contexte d’interventions

Child psychiatry treatments in sexual abuses are recently considered in Senegal. The child psychiatrist is frequently through contradictions and impasses because reactions of jurists in one part and family in another part. The place of justice in childcare becomes an acute question and determines the health's professional attitudes and behaviors. In this article, authors have tried, for one part, to determine the sociodemographic aspects of child sexual abused. In another part, they have serried several positions of generalists, pediatricians, gynecologists and men of law in position of suspicion or allegation of sexual abuse involving minor age (0-18). The study data is received from child psychiatry's unity ‘Kër Xaleyi’ in Dakar, between February 2000 and December 2008, as well as interviews with children of pediatricians, gynecologists and men of law (policemen, prosecutors, judges…). Fifty-nine cases of child victims of sexual abuse are listed on 4327 (1.36%). The majority of victims are girls (84.70%), are between 6 to 10 years (45.50%), are abused by men (teenagers or young adults [86.40%], neighbours or friends of the family [62.70%]). Only 44.10% of cases have been reported to the judicial authorities. Among the abused children, 55.90% are referred to ‘Kër Xaleyi’ by doctors and 15.30% of cases have desired a medical certificate. Rape (59.30%) is the mode most commonly used in sexual abuse and the behavior disorders are the most observed events in victims (58.20%). Tracking is generally very brief (approximately one or two interviews): 69.50% of cases. Some causal factors are frequently encountered: entrusted children, deficient or psychiatric parents, conflict families, promiscuity and socio-economic precariousness. Severe organic lesions and deaths of abused children have not been listed. The majority of workers feels distressed and thinks not being able to act in the best way except improvement of the professional context.     

Sexually transmitted organisms in sexually abused children

OBJECTIVE: To establish the prevalence of sexually transmitted organisms and other genital organisms in potentially sexually abused children. DESIGN: Prospective study of children attending an inner London department of community paediatrics for evaluation of possible sexual abuse. SUBJECTS: Children under 16 referred for evaluation of possible sexual abuse. OUTCOME MEASURES: Prevalence of sexually transmitted organisms in relation to age, symptoms, and type of abuse. RESULTS: Swabs were taken from 159 of 242 girls evaluated. The overall prevalence of sexually transmitted organisms was 3.7%: three girls were infected with gonorrhoea, four with Trichomonas vaginalis, and two with Chlamydia trachomatis. One girl had all three infections plus mycoplasmas. Mycoplasmas were identified in 22% of girls swabbed. Of 30 boys swabbed, none yielded a sexually transmitted organism. CONCLUSIONS: There is a low prevalence of definitely sexually transmitted organisms in children who might have been abused. Other organisms possibly associated with sexual activity can be identified in this population. Screening for infection should be mandatory in presumed sexually abused girls with vaginal discharge and ideally should be undertaken in all children attending for evaluation of sexual abuse.     

Urinary tract infection in sexually abused children

Because urinary tract infections have been considered to be related to sexual abuse and proposed as an indicator of sexual abuse, a group of children reported as suspected victims of sexual abuse was studied. Clean-catch urine specimens were obtained at the time of their initial medical evaluations for sexual abuse. Results indicated that urinary tract infections were not present in this group of sexually abused children at rates substantially higher than the general population. The findings do not support routine screening of sexually abused children for urinary tract infection, and suggest that further study is indicated if urinary tract infection is to be considered an indicator of abuse.