The Relationship between Knowledge and Child and Caregiver Distress during the Medical Examination for Child Sexual Abuse

Rheingold, Alyssa A.; Davidson, Tatiana M.; Resnick, Heidi S.; Self-Brown, Shannon; Danielson, Carla Kmett

doi:10.1080/10538712.2013.800937

Cited by 8 publications

(7 citation statements)

References 30 publications

(57 reference statements)

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“…Several studies evaluating the distress perceived by children examined for alleged CSA [ 15 , 19 , 26 , 27 ] are published. Marks and colleagues (2009) investigated the psychological stress in a sample of mainly girls and their caretakers before and after a physical examination.…”

Section: Discussionmentioning

confidence: 99%

“…As opposed to the study from Marks and colleagues, other studies found that anogenital exams are not re-traumatizing or perceived as “strongly negative” [ 15 , 27 ]. Anxious feelings prior to the examination seem to increase anxious behaviors during the examination [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Literature shows that children who have some understanding of the examination report less symptoms of anxiety during the examination [ 26 , 29 ]. Therefore, it is very important that the examination is carefully explained.…”

Section: Discussionmentioning

confidence: 99%

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Physical symptoms in very young children assessed for sexual abuse: a mixed method analysis from the ASAC study

et al. 2017

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So far, a recognizable pattern of clinical symptoms for child sexual abuse (CSA), especially in young male children, is lacking. To improve early recognition of CSA, we reviewed physical complaints, physical examination, and tests on sexually transmitted infections (STIs) in confirmed victims (predominantly preschool boys) of CSA from the Amsterdam sexual abuse case (ASAC). We retrospectively analyzed the outcomes of the primary assessment using mixed methods: descriptive analysis of physical complaints, physical exams, and STI tests from medical files and a qualitative analysis on expert’s interpretations of physical complaints and children’s behavior during physical examination. We included 54 confirmed CSA victims, median age 3.2 (0–6) years, 43 boys (80%), and 11 girls (20%). Physical complaints were reported in 50%, of which gastrointestinal and anogenital complaints were most common. None of the children showed CSA-specific genital signs at physical examination. Most prominent finding during physical examination was a deviant behavioral response (anxiety, withdrawal, too outgoing) in 15 children (28%), especially in children who experienced anal/vaginal penetration. Testing for STIs was negative. Conclusion: Physical complaints and physical signs at examinations were non-specific for CSA. Deviant behavioral reactions during physical examination were the most prominent finding. Precise observation of a child’s behavior during physical examination is needed. What is known • Child sexual abuse (CSA) affects many children on both the short and the long term but remains unrecognized in most cases. • So far, there is a lack of studies on symptom patterns of CSA in male, preschool children. What is new • None of the children showed CSA-specific findings at physical and anogenital examination; STIs were not found in the confirmed victims of CSA. • The most prominent finding was the deviant behavioral response of the children examined, especially in children who experienced anal/vaginal penetration; therefore, precise observation of a child’s behavior during physical examination is a crucial part of the evaluation of suspected CSA. Electronic supplementary materialThe online version of this article (10.1007/s00431-017-2996-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Physical symptoms in very young children assessed for sexual abuse: a mixed method analysis from the ASAC study

et al. 2017

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“…Two other studies found that the anogenital examination was not perceived negative by the examined children [ 32 , 42 ]. Children with anxious feelings prior to the examination seem to experience more anxious feelings during the examination [ 39 ]. Careful explanation of the examination can decrease symptoms of anxiety during the examination [ 39 , 50 ].…”

Section: What Makes It So Difficult To Recognize Csa In Children?mentioning

confidence: 99%

“…Children with anxious feelings prior to the examination seem to experience more anxious feelings during the examination [ 39 ]. Careful explanation of the examination can decrease symptoms of anxiety during the examination [ 39 , 50 ].…”

Section: What Makes It So Difficult To Recognize Csa In Children?mentioning

confidence: 99%

Clinical practice: recognizing child sexual abuse—what makes it so difficult?

et al. 2018

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Recognizing child sexual abuse (CSA) in children is difficult, as there can be many hurdles in the assessment of alleged CSA. With this paper, we try to improve the recognition of CSA by discussing: (1) the difficulties regarding this matter and (2) the diagnostic evaluation of alleged CSA, combining both practical clinical recommendations based on recent research. Children are restrained to disclose CSA due to various reasons, such as fears, shame, and linguistic or verbal limitations. Associations between CSA and urogenital or gastrointestinal symptoms, internalizing and externalizing behavioral problems, post-traumatic stress symptoms, and atypical sexual behavior in children have been reported. However, these symptoms are non-specific for CSA. The majority of sexually abused children do not display signs of penetrative trauma at anogenital examination. Diagnosing a STI in a child can indicate CSA. However, other transmission routes (e.g., vertical transmission, auto-inoculation) need to be considered as well.Conclusion: The assessment consists of medical interview and child interview (parents and child separate and together) with special attention to the child’s development and behavior (problems), psychosocial situation and physical complaints, the child’s mental health, and the child’s trauma history; anogenital examination should be done in all cases of alleged CSA. The examination should be documented by photo or video graphically. Recent research suggests that videography may be the preferred method, and testing on STIs. The assessment should be done multidisciplinary by experienced professionals. Health-care professionals who care for children need to know how child protective agencies and law enforcement are organized. In case there are concerns about a child’s safety, the appropriate authorities should be alarmed.What is Known:• Sexual abuse in children often remains unrecognized in the majority of cases.What is New:• Research suggests that videographic documentation is preferred above photographic documentation for anogenital examination; observations of children’s behavioral reactions during examinations might be valuable in the evaluation of suspected sexual abuse; nucleic acid amplification testing can be used on vaginal swabs or urine samples for chlamydia and gonorrhea; the CRIES-13 and the CAPS-CA can be used to assess trauma-symptoms in children after sexual abuse.

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Forensic medical examinations: The body as gateway to healing after child sexual abuse

Keeffe

McElvaney

2022

Child Abuse Review

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Despite consensus that the forensic medical examination is an integral component to a comprehensive response to child sexual abuse (CSA), concerns have been expressed about the impact of these examinations on children and young people. A small-scale survey was conducted with a group of CSA professionals (n = 19), followed by semi-structured interviews with six adolescents, accessed through CSA specialist units in Ireland. While concerns were expressed about the examination, overall, professionals were in favour of it as part of a holistic therapeutic response to CSA. Five themes were identified from the interviews with adolescents: the experience of the examination as an imposition, the unknown nature of the examination, the focus on the body itself, feeling exposed and having a say. Findings highlight how a trauma-informed approach, with emphasis on information sharing and supporting the autonomy of the young person's voice and choice throughout the process, could provide a transformative experience for young people, helping them integrate their psychological and physical sense of themselves. The forensic medical examination can facilitate the healing and recovery process by bringing into awareness many of the anxieties that, due to shame or inability to tolerate associated emotional pain, remain unspoken and unspeakable following CSA.

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The Relationship between Knowledge and Child and Caregiver Distress during the Medical Examination for Child Sexual Abuse

Cited by 8 publications

References 30 publications

Physical symptoms in very young children assessed for sexual abuse: a mixed method analysis from the ASAC study

Physical symptoms in very young children assessed for sexual abuse: a mixed method analysis from the ASAC study

Clinical practice: recognizing child sexual abuse—what makes it so difficult?

Forensic medical examinations: The body as gateway to healing after child sexual abuse

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