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1.
Ten children, ages five through eleven, who had been sexually abused, were seen for diagnostic evaluations. The children represented a wide spectrum of sexual abuse. Nine of the children had numerous behavioral symptoms, the most frequent of which were sleep disturbances and school problems. Nine of the families were viewed as dysfunctional. The children displayed similar psychodynamic themes and were preoccupied in obtaining adequate parental care and affection of which they were deprived. The presence of unmet affectional needs in the child cut across all types of sexual abuse giving rise to the conclusion that a child with unmet affectional needs is at high risk for sexual abuse.Evaluations of sexually mistreated children should focus on family dynamics. The Kinetic Family Drawing test and the Conger Sentence Completion test are effective diagnostic tools. All children who have been sexually abused should be carefully evaluated and provided with appropriate treatment in their own right.  相似文献   

2.
OBJECTIVE: This study compares abnormal genital examination findings made by pediatric emergency medicine (PEM) physicians to examinations by physicians with training in child sexual abuse in the evaluation of prepubertal girls for suspected sexual abuse. METHOD: A prospective study was performed following the genital examination by a PEM physician of prepubertal girls suspected of being sexually abused. A physician with training in child sexual abuse re-examined those girls whose examinations were interpreted as abnormal by the PEM physicians. The findings and interpretations of the PEM physician were then compared to those by the physicians with training in child abuse. RESULTS: Between October 1994 and October 1998, 46 patients diagnosed by PEM physicians with nonacute genital findings indicative of sexual abuse were re-examined by a physician with training in child abuse. The follow-up examinations were done 2 days-16 weeks (mean 2.1 weeks) after the emergency department visit. The physicians with training in child abuse concluded that only eight of these children (17%) showed clear evidence of abuse. Normal findings were noted in 32 children (70%), nonspecific changes were noted in 4 children (9%), and 2 children (4%) had findings that are more commonly seen in abused children than nonabused children but are not diagnostic for abuse (concerning for abuse). CONCLUSIONS: There was poor agreement between the pediatric emergency medicine physicians and the physicians with training in child sexual abuse. This study suggests that emergency medicine physicians should consider additional training in this area. In addition, all children with abnormal ED examinations should have follow-up examinations by a child abuse trained physician.  相似文献   

3.
As reports of the sexual abuse of preschool-aged children increase and the number of children in day care expands, it is important to recognize child care workers as potentially important resource persons for sexually abused preschoolers. Although they are potential resources for abused children, they may fail to report suspected abuse if they do not know their legal responsibilities and their rights and protections under the law. The purpose of this study was to determine child care workers' knowledge about their reporting rights and responsibilities. Relative to child sexual abuse experts, day care personnel knew significantly less about the procedures for reporting suspected abuse and their protection under the law. Suggestions for improving child care workers' knowledge about reporting suspected sexual abuse cases are provided.  相似文献   

4.
OBJECTIVES: The two aims of this study were to: (1). describe the prevalence and characteristics of domestic adult and child physical violence in the homes of children and adolescents evaluated in a specialized sexual abuse clinic and (2). describe parent or caretaker responses to domestic adult and child violence and child sexual abuse, including tendencies to report or seek medical care. METHOD: A consecutive sample of 164 subjects (ages 7-19) were interviewed in a sexual abuse clinic regarding in-home violent or abusive experiences among family members that had occurred at any time during their childhood. RESULTS: Fifty-two percent of these children and teenagers reported spousal violence in their home. Fifty-eight percent of child sexual offenders who were in-home males also physically abused their adult female partner. Half of in-home males who were physically violent to children also sexually abused them. In 86% of homes with partner violence, the children were also physically assaulted. There was no difference in sexual abuse disclosure rates or patterns for children living with or without adult violence. CONCLUSIONS: Sexually abused children should be questioned about physical abuse and the presence of violence among adults in their home. Safety plans for sexually abused children should incorporate screening for family violence and safety plans for parents and siblings of child victims, when appropriate.  相似文献   

5.
Several behavioral and emotional indicators of child sexual abuse were compared for both sexually (n = 29) and physically abused (n = 52) children from a sample of 103 hospitalized psychiatric patients. The measures included (1) scores from a factor-analyzed sexual abuse symptom checklist covering home/community behavior that was rated by parents during a clinical interview and (2) frequency counts of psychological symptoms exhibited by the children during a 3-week period of hospitalization. Results of a 2 (sexual abuse status) X 2 (physical abuse status) X 2 (gender) Multivariate Analysis of Variance indicated that sexually abused children exhibited greater sexual behavior, fear/mistrust/anxiety, and withdrawal at home, and greater sexual behavior, fear/anxiety, and sadness in the hospital than nonabused children. In contrast, there were no significant differences between physically abused and nonabused children, and no significant interactions. Few significant correlations were found between symptoms exhibited at home and in the hospital.  相似文献   

6.
A retrospective overview of 28 sexually-abused children evaluated at a university-based child guidance clinic is reported. These 28 cases are scrutinized and empirical data are culled on the following sociodemographic and clinical variables: age, gender, race, family composition, referral source, presenting complaints, type of referral, psychiatric history of the child and family, diagnosis, disposition, type and duration of treatment, and a severity rating (done by parents) of the child's behavioral maladjustment. Historical information about the sexual abuse is presented: molester, type of abuse, duration of abuse and recency of sex abuse. The sociodemographic findings reveal the sex-abused child prototype to be a white girl, 9 years old, from a working class family headed by both parents or by mother alone. She was abused by an adult male relative. If a boy, abuse was by a male age-mate. Genital abuse was the most frequent type with sexual intercourse of very high frequency for children of all ages. Many psychiatric difficulties were reported in the families of these children. Some children had more than one molester. The clinical findings show psychic suffering among all studied children—most of moderate levels, behavior reactions. All but 3 children had therapy recommended to them. Presenting difficulties were for sexual abuse per se and/or for a wide-ranging variety of symptom complaints. The socioclinical overview of sexually molested children compells researchers to look closer at broader, extra-familial, cultural and socio-economic issues in the lives of these children and not just at psychopathologies of individual molesters and family units.  相似文献   

7.
OBJECTIVE: This study examined the utility of sexual behavior problems as a diagnostic indicator of sexual abuse. The hypothesis was that sexual behavior problems are multiply determined and consequently are variably related to sexual abuse in a clinical sample. METHOD: A sample of 247 children evaluated for sexual abuse at a multidisciplinary forensic child abuse evaluation clinic were included. Results from the Child Behavior Checklist (CBCL) and the Child Sexual Behavior Inventory (CSBI) were analyzed and compared to the results of a structured abuse assessment performed independent of these scores. RESULTS: The forensic team assessment found evidence of sexual abuse in 25% of cases, and no evidence in 61%. Children in this sample exhibited an elevated level of both sexual and nonsexual behavior problems. However, considerable variability was noted in sexual behavior problem scores. Thus, in this study a high score or a low score had no relationship to the diagnosis of sexual abuse. Indeed, nonsexually abused children were just as likely to have high CSBI scores as sexually abused children. CONCLUSIONS: This study found no significant relationship between a diagnosis of sexual abuse and the presence or absence of sexual behavior problems in a sample of children referred for sexual abuse evaluation. The finding suggests that community professionals should use caution in relying on sexual behavior problems as a diagnostic indicator of abuse.  相似文献   

8.
OBJECTIVE: The goal of this study was to compare rates of positive medical findings in a 5-year prospective study of 2384 children, referred for evaluation of possible sexual abuse, with two decades of research. The prospective study summarizes demographic information, clinical history, relationship of perpetrators, nature of abuse, and clinical findings. The study reports on the results by patterns of referral and the medical examination. RESULTS: There were 2384 children evaluated in a tertiary referral center between 1985 and 1990 for possible sexual abuse. Children were referred after they disclosed sexual abuse, because of behavioral changes or exposure to an abusive environment, and because of possible medical conditions. A total of 96.3% of all children referred for evaluation had a normal medical examination; 95.6% of children reporting abuse were normal, 99.8% who were referred for behavioral changes or exposure to abuse were also normal. Of the 182 children referred for evaluation of medical conditions, 92% were found to be normal at the time of examination by the Child Advocacy Center. The remaining 15/182 (8%) that were found to be abnormal were diagnosed with sexually transmitted diseases, acute or healed genital injuries, and were 17% (15/88) of the total cases found to have medical findings diagnostic of abuse. Interviews of the children indicated that 68% of the girls and 70% of the boys reported severe abuse, defined as penetration of vagina or anus. Penetration was associated with a higher percentage of abnormal findings in girls (6%) compared to 1% of the boys. The relationship of the abuser impacted on the severity of the abuse. CONCLUSION: Research indicates that medical, social, and legal professionals have relied too heavily on the medical examination in diagnosing child sexual abuse. History from the child remains the single most important diagnostic feature in coming to the conclusion that a child has been sexually abused. Only 4% of all children referred for medical evaluation of sexual abuse have abnormal examinations at the time of evaluation. Even with a history of severe abuse such as vaginal or anal penetration, the rate of abnormal medical findings is only 5.5%. Biological parents are less likely to engage in severe abuse than parental substitutes, extended family members, or strangers.  相似文献   

9.
《Child abuse & neglect》2014,38(10):1636-1646
This paper investigates how adults respond to sexual behavior among children in child care. Culturally, childhood sexuality is variously understood as natural curiosity, a sign of sexual abuse, or a symptom of a sex-offender in the making. Given these competing cultural meanings, how are sexual-like behaviors by children managed by the adults who care for them? An analysis of qualitative data from Special Investigation Reports by childcare licensing consultants in the state of Michigan is used to examine how parents, child care providers, and child care licensing consultants manage and respond to sexual behavior between children in the context of child care. How sexual behavior is responded to depends primarily on who is doing the responding – parent, childcare provider, or state licensing consultant – rather than what type of behavior is being responded to. Parents respond to a wide range of behaviors between children as if they are incidents of sexual abuse. Childcare providers respond to many of those same incidents as misbehavior. Licensing consultants understand these incidents as violation of rules of supervision, but they were also the only group to ever ask if children's sexual behavior was potentially a sign of a child having been sexually abused in another setting. Providers and parents need more education about what kinds of sexual behavior to be concerned about and what kind to understand as common. More education that sexuality that is “rare” and persistent could be a sign of sexual abuse is needed by all parties.  相似文献   

10.
OBJECTIVE: To determine the demographic and psychosocial correlates of physical and sexual abuse among children with autism. METHODS: Data collected from 1997 to 2000 through the national evaluation of the Comprehensive Community Mental Health Services for Children and their Families Program on 156 children with autism were used. Data included a baseline assessment of child and family psychosocial experiences and presenting problems associated with referral into system-of-care service, demographic information, and a clinical record review to obtain psychiatric diagnosis. Binary and multinomial logistic regression was used to determine the association of different characteristics of children who were abused compared with those who were not abused. RESULTS: Caregivers reported that 18.5% of children with autism had been physically abused and 16.6% had been sexually abused. Physically abused children more likely had engaged in sexual acting out or abusive behavior, had made a suicide attempt, or had conduct-related or academic problems. Sexually abused children more likely had engaged in sexual acting out or abusive behavior, suicidal or other self-injurious behavior, had run away from home, or had a psychiatric hospitalization. In adjusted multivariate models, the relationship between sexual abuse and sexual acting out, running away from home and suicidal attempts persisted. CONCLUSION: Based on the prevalence of abuse and its association with various behaviors, clinicians should be as attuned to the psychosocial histories of children with autism as they are for other children, and consider the potential of abuse when these behaviors are observed.  相似文献   

11.
OBJECTIVE: To provide reliable measures of the prevalence of all forms of child maltreatment in the UK that will be robust in the context of social and cultural differences due to social class, ethnicity and, region. METHODS: Two thousand eight hundred sixty-nine (2,869) young adults aged 18=-24, obtained by random probability sampling throughout the UK, were interviewed face to face by trained interviewers. Maltreatment was defined using a post hoc assessment of a range of experienced behaviors and treatments while the respondents were aged 16 or under. RESULTS: Over 90% of respondents reported that they came from a warm and loving family background. Maltreatment (both intra and extrafamilial) was experienced by 16% of the sample. Serious maltreatment was experienced by 7% of respondents for physical abuse, 6% for emotional abuse, 6% for absence of care, and 5% for absence of supervision, and 11% reported sexual abuse involving contact. Attitudes to maltreatment were explored through the examination of respondents' views of different behaviors and experiences that children may have been exposed to. CONCLUSION: The maltreatment of children in the UK today remains an extensive social problem. Prevalence data reveal that children are most at risk in the home for physical and emotional abuse and neglect. They are at greater risk of sexual abuse outside the home, particularly in dating relationships.  相似文献   

12.
A review of the short-term effects of child sexual abuse   总被引：6，自引：2，他引：6  
This is the first of a two-part report that critically evaluates empirical studies on the short- and long-term effects of child sexual abuse. With the exception of sexualized behavior, the majority of short-term effects noted in the literature are symptoms that characterize child clinical samples in general. Among adolescents, commonly reported sequelae include sexual dissatisfaction, promiscuity, homosexuality, and an increased risk for revictimization. Depression and suicidal ideation or behavior also appear to be more common among victims of sexual abuse compared to normal and psychiatric nonabused controls. Frequency and duration of abuse, abuse involving penetration, force, or violence, and a close relationship to the perpetrator appear to be the most harmful in terms of long-lasting effects on the child. The high prevalence of marital breakdown and psychopathology among parents of children who are sexually abused makes it difficult to determine the specific impact of sexual abuse over and above the effects of a disturbed home environment. Given the broad range of outcome among sexual abuse victims, as well as the methodological weaknesses present in many of the studies reviewed, it is not possible at this time to postulate the existence of a "post-sexual-abuse-syndrome" with a specific course or outcome.  相似文献   

13.
Female child perpetrators: children who molest other children   总被引：1，自引：0，他引：1  
Little is known about sexual perpetration by females or by young children. This paper describes the sexual perpetration behavior of 13 female child perpetrators between 4 and 13 years of age. These children were treated in a specially designed program for child perpetrators, the Support Program for Abuse-Reactive Kids (SPARK) at Children's Institute International of Los Angeles, California. All of these girls used force or coercion to gain the compliance of the other child or children. Of these child perpetrators, 100% had been previously sexually abused; 31% had been physically abused; 85% were molested by family members; 77% of the girls chose a victim in their family (the other 3 girls had no available family members). The mean age of their first known perpetration was 6 years, 9 months. The average age of their victims was 4 years, 4 months. The average number of victims of these girls was 3.5 with a range of 1 to 15. The girls victimized two times more boys than girls. There was a history of sexual, physical, and substance abuse in the families of these children. Hypotheses regarding the genesis of the sexually abusive behavior in these female child perpetrators are explored.  相似文献   

14.
Although the amount of research dealing with child sexual abuse is rapidly increasing, there have been very few attempts to identify and compare variables that characterize differences between female and male victims. To address this void, 25 substantiated cases of sexual abuse involving male children were compared with 180 substantiated cases of sexual abuse of female children. Significant differences between female and male victims were observed in the following areas: family composition, the perpetrator of the abuse, variables contributing to the continuation of the abusive situation, and the type of services provided to the sexually abused child and family. Implications for treatment are offered.  相似文献   

15.
OBJECTIVE: To determine the incidence of re-abuse in children known to have been sexually abused and to find factors that increase the risk of re-abuse. METHOD: The study group consisted of 183 children with substantiated sexual abuse who presented to two children's hospitals' Child Protection Units in Sydney, Australia during 1988 through 1990. At intake, when the children were aged between 5 years and 15 years, data about the child, the family, and the nature of the index sexual abuse were collected. Six years after presentation for the abuse, records of the Department of Community Services were checked to see if any of the young people had been the subject of substantiated notifications for abuse/neglect before and after intake to the study. Predictors of notifications for abuse/neglect after presentation for the index sexual abuse were identified. RESULTS: Of the sexually abused young people, nearly one in three were the subject of subsequent substantiated notifications to the Department of Community Services for some form of child abuse and neglect or behavior which placed them at risk of harm. Later notifications for abuse/neglect were predicted by notifications for emotional abuse before the index sexual abuse (adjusted RR = 4.88, CI: 1.43 to 16.65), severity of the index sexual abuse (p = .03), and the number of changes in the child's primary caregivers before intake (p = .03). Approximately one in six of the sexually abused young people were notified for sexual abuse after intake to the study. One in 10 also had prior notifications for sexual abuse. Sexual abuse notifications after study intake were predicted by caregiver changes before intake (p = .01) and whether or not there were notifications for emotional abuse before the index sexual abuse (adjusted RR = 3.40, CI: 1.05 to 11.02). CONCLUSIONS: Revictimization of children appears to be a marker of ongoing family dysfunction. Intervention in child sexual abuse needs to consider a range of risk factors associated with re-abuse and, in particular, should focus on family functioning if further abuse is to be prevented.  相似文献   

16.
The dramatic increase in reports of sexual abuse has resulted in increasing referrals to physicians for medical evaluation and has placed demands on physicians to adequately and expertly assess these children. High quality, close-up photographs of significant lesions can be an important part of this evaluation. Camera systems recommended vary from colposcopes to close-up 35-mm systems to instant cameras. Physicians who examine sexually abused children should have ready access to an adequate photographic system, as well as basic knowledge of camera operation, film procedures, and medicolegal implications. Case studies and discussion are used to review colposcopic and close-up 35-mm camera techniques available to the physician to photograph the sexual abuse victim.  相似文献   

17.
OBJECTIVE: This study examined whether children who received child welfare services (e.g., in-home or out-of-home placement) were more or less likely to become incarcerated as serious and violent youthful offenders than those children who were investigated as victims of abuse and neglect but received no further child welfare intervention. METHOD: Administrative data on child abuse reporting, foster care, birth records, and juvenile corrections (CYA) were linked to prospectively examine the risk of incarceration as an adolescent following an investigation of abuse or neglect after age 6. The 10 county California sample included 159,549 school-aged children reported for abuse and neglect after 1990. RESULTS: About 8 per 1,000 children in the sample were later incarcerated in CYA. African American and Hispanic children who received in-home or foster care services after the index investigation event had a lower risk of incarceration than those whose cases were closed after the investigation. Among females, the rate of incarceration was highest for those who experienced foster or group care placements. Children initially reported for neglect were more likely to be incarcerated than those reported for physical or sexual abuse. CONCLUSIONS: Public child welfare services have rarely been assessed in terms of future negative child outcomes. This study finds that one serious negative outcome, CYA involvement, can only be understood when a number of factors are considered. The importance of understanding the differences between how different subpopulations respond to services is highlighted. Specifically, our findings suggest that more attention should be focused on children who are now receiving no services after an investigated child abuse and neglect report, on females, and on victims of child neglect.  相似文献   

18.
It has been recommended that all children suspected of being sexually abused should have medical evaluations. To better understand practices and perceptions of child sexual abuse medical evaluations, a survey was conducted of 579 professionals attending educational programs on child sexual abuse; 85.8% (N = 497) responded. Half (50%) of the respondents reported no previous training in child sexual abuse. Of the 336 nonphysician professionals, 194 (57.7%) were in positions where they make referrals of the victims, and 69% of these did not refer all of the children they saw for medical evaluations. The first referral choice for medical evaluation was most often to the victim's primary physician (57%). For those professionals who did not refer all alleged victims for medical evaluation, neither the victims' age, gender, nor accessibility to care were generally considered relevant in determining the decision to refer. However, the type of abuse and presence of physical and psychological symptoms were considered relevant in making the decision. The majority indicated that the findings of the medical exam were very useful in substantiating or refuting the allegation of abuse. Further training for both medical and nonmedical professionals is needed to increase awareness of the need for and implications of the medical evaluation if children are to receive comprehensive assessments. Physicians may play an active role in this process through education of professionals and provision of care.  相似文献   

19.
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20.
OBJECTIVE: There have recently been many debates in the UK about how to provide good care for children placed away from home. Professionals have realized that the level of child abuse in foster care and children's homes is high. This research examines the characteristics of physical and sexual abuse of children in foster and residential care in a city in England. The number of cases of abuse reported by pediatricians in this group was compared to the number reported by the same pediatricians for the population of Leeds as a whole. METHOD: This is a retrospective study of 158 children, fostered or in residential care who were involved in 191 episodes of alleged physical and/or sexual abuse assessed and reported by pediatricians over a 6 year period from 1990 to 1995 in Leeds, England. Details of the child including the reason for placement in care, their physical and mental health, abuse characteristics, including perpetrator and case management were studied. RESULTS (see Table 1): 158 incidents of abuse in 133 children in foster/residential care are described. In foster care, 42 children were physically abused, 76 were sexually abused, and 15 experienced both forms of abuse. In residential care, 12 children were physically abused, 6 were sexually abused, and 6 experienced both forms of abuse. In foster care 60% of sexual abuse involved girls and 60% of physical abuse involved boys. In residential care almost twice as many boys as girls were reported to be abused. Foster carers perpetrated the abuse for 41%, natural parents on contact for 23%, and children 20% of incidents. A significant proportion of abuse was severe with 1 death, 8 children with burns, 18 with genital, and 34 with anal penetration. Long-standing emotional, behavioral and learning difficulties were common. Most children (80%) had been abused prior to entry into care. Foster children were 7-8 times and children in residential care 6 times more likely to be assessed by a pediatrician for abuse than a child in the general population. CONCLUSIONS: Children in foster or residential care form an at risk group for maltreatment. Their special needs include additional measures to protect them from abuse.  相似文献   

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