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Child Sexual Abuse: The History, Current State of the Art and the Challenges for the Future: A Pediatric Perspective

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Handbook of Child Maltreatment

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Abstract

Chapter review of the evolution in the field of the diagnosis and management of possible child sexual abuse as referred from parents, law enforcement and social services. The review includes an overview of the importance of history, impact of testimony by both the child victim and the medical professional on the outcome of the legal intervention. Conclusions focused on the importance of outcomes for children and families and child protection as the most important measurement of effective and appropriate interventions as well as maintaining a professional, research-based foundation for diagnosis and treatment. Additional information is provided on the current standards for (1) Interviewing and (2) Medical diagnosis and includes a summary of the challenges to professionals as they continue to research and diagnosis cases of child sexual abuse.

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References

  • Adams, J. (2011). Medical evaluation of suspected child sexual abuse; 2011 update. Journal of Child Sexual Abuse, 20, 588–605.

    Article  Google Scholar 

  • Adams, J., & Knudson, S. (1996). Genital findings in adolescent girls referred for suspected abuse. Archives of Pediatrics & Adolescent Medicine, 150, 850.

    Article  Google Scholar 

  • Adams, J., Harper, K., & Knudson, S. (1992). A proposed system for the classification of anogenital findings in children with suspected sexual abuse. Journal of Pediatric and Adolescent Gynecology, 5, 73–75.

    Article  Google Scholar 

  • Adams, J., Harper, K., Knudson, S., & Revilla, J. (1994). Examination findings in legally confirmed child sexual abuse; It’s normal to be normal. Pediatrics, 94(3), 310–317.

    Google Scholar 

  • Adams, J., Botash, A., & Kellogg, N. (2004). Differences in hymenal morphology between adolescent girls with and without a history of consensual sexual intercourse. Archives of Pediatrics & Adolescent Medicine, 158(3), 280–285.

    Article  Google Scholar 

  • American Academy of Pediatrics (AAP), & Committee on Adolescence. (2001). Care of the adolescent sexual assault victim. Pediatrics, 107, 1476.

    Article  Google Scholar 

  • American Academy of Pediatrics (AAP), Committee on Child Abuse and Neglect, & Kellogg, N. (2005). Clinical report: The evaluation of sexual abuse of children. Pediatrics, 116(2), 506–512.

    Article  Google Scholar 

  • American Professional Society on the Abuse of Children (APSCA). (1990). Guidelines for the psychosocial evaluation of suspected sexual abuse in children. Chicago: APSAC.

    Google Scholar 

  • American Professional Society on the Abuse of Children (APSCA). (1995). Practice guidelines: Photographic documentation of child abuse. Chicago: APSAC.

    Google Scholar 

  • American Professional Society on the Abuse of Children (APSCA). (1998). Glossary of terms and the interpretations of findings for child sexual abuse evidentiary examinations. Chicago: APSAC.

    Google Scholar 

  • Berenson, A., Heger, A., & Andrews, S. (1991). Appearance of the hymen in newborns. Pediatrics, 87(4), 458–465.

    Google Scholar 

  • Berenson, A., Heger, A., Hayes, J., Bailey, R., & Emans, S. (1992). Appearance of the hymen in prepubertal girls. Pediatrics, 89(3), 387–394.

    Google Scholar 

  • Berenson, A., Somma-Garcia, A., & Barnett, S. (1993). Perianal findings in infants 18 months of age or younger. Pediatrics, 91(4), 838–840.

    Google Scholar 

  • Berenson, A., Chacko, M., Wiemann, C., Mishaw, C., Friedrich, W., & Grady, J. (2000). A case–control study of anatomic changes resulting from sexual abuse. American Journal of Obstetrics and Gynecology, 182(4), 820–834.

    Article  Google Scholar 

  • Berenson, A. B., Chacko, M. R., Wiemann, C. M., Mishaw, C. O., Friedrich, W. N., & Grady, J. J. (2002). Use of hymenal measurements in the diagnosis of previous penetration. Pediatrics, 109(2), 228–235.

    Article  Google Scholar 

  • Berkoff, M., Zolotar, A., Makoroff, K., Thackeray, J., Shapiro, R., & Runyan, D. (2008). Has this prepubertal girl been sexually abused? Journal of the American Medical Association, 300(23), 2779–2792. Retrieved from http://jama.amaassn,org/cgi/content/full/300/23/2779.

    Article  Google Scholar 

  • Berliner, L., & Barbieri, M. (1984). The testimony of the child victim of sexual assault. Journal of Social Issues, 1984(40), 125.

    Article  Google Scholar 

  • Bernier, L., Williams, R., & Zetzer, H. (1994). Efficacy of treatment for victims of child sexual abuse. The Future of Children, 1994(4), 156.

    Google Scholar 

  • Bond, G., Dowd, M., Landsman, I., & Rimsza, M. (1995). Unintentional perineal injury in prepubescent girls: a multicenter, prospective report of 56 girls. Pediatrics, 1995(95), 628.

    Google Scholar 

  • Boos, S. C. (1999). Accidental hymenal injury mimicking sexual trauma. Pediatrics, 103(6), 1287–1289.

    Article  Google Scholar 

  • Boos, S. C., Rosas, A. J., Boyle, C., & McCann, J. (2003). Anogenital injuries in child pedestrians run over by low-speed motor vehicles: Four cases with findings that mimic child sexual abuse. Pediatrics, 112(1), e77–e84. [Electronic Version], http://www.pediatrics.org/cgi/content/full/112/1/e77.

    Article  Google Scholar 

  • Bowen, K., & Aldous, M. (1999). Medical evaluation of sexual abuse in children without disclosed or witnessed abuse. Archives of Pediatrics & Adolescent Medicine, 153, 1160–1164.

    Article  Google Scholar 

  • Cantwell, H. (1981). Vaginal inspection as it relates to child sexual abuse in girls under thirteen. Child Abuse & Neglect, 7, 171–176.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention (CDC) (2010). Sexually transmitted diseases treatment guidelines, 2010. MMWR, 59, 1–110.

    Google Scholar 

  • Cheit, R., Shavit, Y., & Reiss-Davis, Z. (2010). Magazine coverage of child sexual abuse, 1992–2004. Journal of Child Sexual Abuse, 19, 99–117.

    Article  Google Scholar 

  • Christian, C., Lavelle, J., DeJong, A., et al. (2000). Forensic evidence findings in prepubertal victims of sexual assault. Pediatrics, 106, 100.

    Article  Google Scholar 

  • Cross, T. P., De Vos, E., & Whitcomb, D. (1994). Prosecution of child sexual abuse: Which cases are accepted. Child Abuse & Neglect, 19, 1431–1442.

    Article  Google Scholar 

  • DeLago, C., Deblinger, E., Schroeder, C., & Finkel, M. (2008). Girls who disclose sexual abuse; Urogenital symptoms and signs after genital contact. Pediatrics, 122(2), 281–286. Retrieved from http://www.pediatrics.org/cgi/content/full./122/e281.

    Article  Google Scholar 

  • Dowd, M., Fitzmaurice, L., Knapp, J., et al. (1994). The interpretation of urogenital findings in children with straddle injuries. Journal of Pediatric Surgery, 29, 7.

    Article  Google Scholar 

  • Dubowitz, H., Black, M., & Harrington, D. (1992). The diagnosis of child sexual abuse. American Journal of Diseases of Children, 146, 688–693.

    Google Scholar 

  • Emans, S., Woods, E., Flagg, N., et al. (1987). Genital findings in sexually abused, symptomatic and asymptomatic girls. Pediatrics, 79, 778.

    Google Scholar 

  • Emans, S. J., Woods, E. R., Allred, E. N., & Grace, E. (1994). Hymenal findings in adolescent women: Impact of tampon use and consensual sexual activity. Journal of Pediatrics, 125(1), 153–160.

    Article  Google Scholar 

  • Finkel, M. (1989). Anogenital trauma in sexually abused children. Pediatrics, 84(92), 317–322.

    Google Scholar 

  • Finkelhor, D., & Jones, L. (2011). Updated trends in child maltreatment, 2010. Durham: Crimes Against Children Research Center.

    Google Scholar 

  • Finkelhor, D., Ormrod, R., Turner, H., & Hamby, S. (2005). The victimization of children and youth: a comprehensive, national survey. Child Maltreatment, 10, 5–25.

    Article  Google Scholar 

  • Frasier, L. (1997). The pediatrician’s role in child abuse interviewing. Pediatric Annals, 26, 306.

    Google Scholar 

  • Gardner, J. J. (1992). Descriptive study of genital variation in healthy, nonabused premenarchal girls. Journal of Pediatrics, 120(2, Pt. 1), 258–260.

    Article  Google Scholar 

  • Heger, A. (1996). Twenty years in the evaluation of the sexually abused child: Has medicine helped or hurt the child and the family? Child Abuse & Neglect, 20(10), 893–897.

    Article  Google Scholar 

  • Heger, A., & Emans, S. (1990). Introital diameter as the criterion for sexual abuse. Pediatrics, 85, 222.

    Google Scholar 

  • Heger, A., & Emans, S. J. (1992). Evaluation of the sexually abused child: A medical textbook and photographic atlas. New York: Oxford University Press.

    Google Scholar 

  • Heger, A., Emans, S. J., & Muram, D. (Eds.). (2000). Evaluation of the sexually abused child: A medical textbook and photographic atlas (2nd ed.). New York: Oxford University Press.

    Google Scholar 

  • Heger, A. H., Ticson, L., Guerra, L., Lister, J., Zaragoza, T., McConnell, G., et al. (2002a). Appearance of the genitalia in girls selected for nonabuse: review of hymenal morphology and non-specific findings. Journal of Pediatric and Adolescent Gynecology, 15(1), 27–35.

    Article  Google Scholar 

  • Heger, A., Ticson, L., Velasquez, O., & Bernier, R. (2002b). Children referred for possible sexual abuse: Medical findings in 2384 children. Child Abuse & Neglect, 26(6–7), 645–659.

    Article  Google Scholar 

  • Heppenstall-Heger, A., McConnell, G., Ticson, L., Guerra, L., Lister, J., & Zaragoza, T. (2003). Healing patterns in anogenital injuries: A longitudinal study of injuries associated with sexual abuse, accidental injuries, or genital surgery in the preadolescent child. Pediatrics, 112(4), 829–837.

    Article  Google Scholar 

  • Herrmann, B., & Crawford, J. (2002). Genital injuries in prepubertal girls from inline skating accidents. Pediatrics, 110(2), 16. Retrieved from http://w2ww.pediatrics.org/cgi/content/full/110/2/e16.

    Article  Google Scholar 

  • Hobbs, C. J., & Wynne, J. M. (1987). Child sexual abuse; an increasing rate of diagnosis. Lancet, 1, 837–841.

    Article  Google Scholar 

  • Jones, L., Finkelhor, D., & Kopiec, K. (2001). Why is sexual abuse declining? A survey of state child protection administrators. Child Abuse & Neglect, 25, 1139.

    Article  Google Scholar 

  • Jones, J. S., Rossman, L., Hartman, M., & Alexander, C. C. (2003). Anogenital injuries in adolescents after consensual sexual intercourse. Academic Emergency Medicine, 10(12), 1378–1383.

    Article  Google Scholar 

  • Kellogg, N., & Parra, J. (1991). Genital anatomy in pregnant adolescents, “Normal” doesn’t mean “nothing happened”. Pediatrics, 113(1), 67–69. Retrieved from http://www.pediatrics.org/cgi/content/full/113/1/e67.

    Article  Google Scholar 

  • Kellogg, N. D., Parra, J. M., & Menard, S. (1998). Children with anogenital symptoms and signs referred for sexual abuse evaluations. Archives of Pediatrics & Adolescent Medicine, 152(7), 634–641.

    Article  Google Scholar 

  • Kempe, C. H. (1978). Sexual abuse, another hidden pediatric problem; the 1977 C. Anderson Aldrich lecture. Pediatrics, 62, 382–389.

    Google Scholar 

  • Krugman, R. (1988). It’s time to wave the yellow flag: Editorial. Child Abuse & Neglect, 12, 293–294.

    Article  Google Scholar 

  • Lamb, M., Orbach, Y., Hershkowitz, I., Esplin, P., & Horowitz, D. (2007). Structured forensic interview protocols improve the quality and informativeness of investigative interviews with children. Child Abuse & Neglect, 31, 1201–1231.

    Article  Google Scholar 

  • Landwirth, J. (1987). Children as witnesses in child sexual abuse trials. Pediatrics, 60, 585.

    Google Scholar 

  • Leder, M., Emans, S., Hafler, J., et al. (1999). Addressing sexual abuse in the primary care setting. Pediatrics, 104, 270.

    Article  Google Scholar 

  • Lyon, T. (2005). Selected writings, The Author, University of Southern California.

    Google Scholar 

  • McCann, J., & Voris, J. (1991). Perianal injuries resulting from sexual abuse; A longitudinal study. Pediatrics, 91(2), 390–397.

    Google Scholar 

  • McCann, J., Voris, J., Simon, M., & Wells, R. (1989). Perianal findings in prepubertal children selected for non-abuse: A descriptive study. Child Abuse & Neglect, 13(2), 179–193.

    Article  Google Scholar 

  • McCann, J., Voris, J., Simon, M., & Wells, R. (1990). Genital findings in prepubertal girls selected for non-abuse: A descriptive study. Pediatrics, 86(3), 428–439.

    Google Scholar 

  • McCann, J., Voris, J., & Simon, M. (1992). Genital injuries resulting from sexual abuse; A longitudinal study. Pediatrics, 89(2), 307–317.

    Google Scholar 

  • McCann, J., Miyamoto, S., Boyle, C., & Rogers, K. (2007a). Healing of hymenal injuries in prepubertal and adolescent girls; A descriptive study. Pediatrics, 119(5), 1094–1106.

    Article  Google Scholar 

  • McCann, J., Miyamoto, S., Boyle, C., & Rogers, K. (2007b). Healing of nonhymenal genital injuries in prepubertal and adolescent girls; A descriptive study. Pediatrics, 120(5), 1000–1011. Retrieved from http://www.pediatrics.org/cgi/content/full/120/5/e77.

    Article  Google Scholar 

  • Muram, D. (1989). Child sexual abuse: Relationship between sexual acts and genital findings. Child Abuse & Neglect, 13, 211–216.

    Article  Google Scholar 

  • Myers, J. E. B. (2010). The ASPAC handbook on child maltreatment. (3rd Ed.) Sage: Los Angeles.

    Google Scholar 

  • Myhre, A., Berntzen, K., & Bratlid, D. (2001). Perianal anatomy in non-abused preschool children. Acta Paediatrica, 90(11), 1321–1328.

    Article  Google Scholar 

  • Myhre, A., Berntzen, K., & Bratlid, D. (2003). Genital anatomy in non-abused preschool girls. Acta Pediatrica, 92(123), 1453–1462.

    Google Scholar 

  • Orr, D. P., & Prietto, S. V. (1979). Emergency management of sexually abused children. American Journal of Diseases of Children, 133, 628–631.

    Article  Google Scholar 

  • Palusci, V. J., Cox, E. O., Cyrus, T. A., Heartwell, S. W., Vandervort, F. E., & Potts, E. S. (1999). Medical assessment and legal outcome in child sexual abuse. Archives of Pediatrics & Adolescent Medicine, 153(4), 388–392.

    Article  Google Scholar 

  • Palusci, V., Cox, E., Shatz, E., & Schultze, J. (2006). Urgent medical assessment after child sexual abuse. Child Abuse & Neglect, 30(4), 367–380.

    Article  Google Scholar 

  • Paradise, J., Winter, M., & Finkel, M. (1999). Influence of the history on physicians’ interpretations of girls’ genital findings. Pediatrics, 103, 980.

    Article  Google Scholar 

  • Pierce, A. M. (2004). Anal fissures and anal scars in anal abuse – are they significant? Pediatric Surgery International, 20(5), 334–338.

    Article  Google Scholar 

  • Pokorny, S. F. (1987). Configuration of the prepubertal hymen. American Journal of Obstetrics and Gynecology, 157, 950.

    Article  Google Scholar 

  • Pugno, P. (1999). Genital findings in prepubertal girls evaluated for sexual abuse; a different perspective on hymenal measurements. Archives of Family Medicine, 8(5), 403–406.

    Article  Google Scholar 

  • Rimsza, M. E., & Niggermann, E. H. (1982). Medical evaluation of sexually abused children: a review of 311 cases. Pediatrics, 69, 8–14.

    Google Scholar 

  • Royal College of Paediatrics and Child Health (RCPCH. (2008). The physical signs of child sexual abuse (An evidence-based review and guidance for best practice). London: RCPCH.

    Google Scholar 

  • Runyan, D., Everson, M., Edelsohn, G., Hunter, W., & Coulter, M. (1988). Impact of legal intervention on sexually abused children. Journal of Pediatrics, 113, 647–653.

    Article  Google Scholar 

  • Sgroi, S. M. (1982). Handbook of clinical intervention in child sexual abuse. Lexington: DC Heath. 1982.

    Google Scholar 

  • Shapiro, R., & Makoroff, K. (2006). Sexually transmitted diseases in sexually abused girls and adolescents. Current Opinion in Obstetrics & Gynecology, 18, 492–497.

    Article  Google Scholar 

  • Stoltenborgh, M., van Ljzenbdoorn, M. H., Euser, E. M., & Bakermans-Kranenburg, M. J. (2011). A global perspective on child sexual abuse; meta-analysis of prevalence around world. Child Maltreatment, 16(2), 79–101.

    Google Scholar 

  • Teixeira, W. R. (1982). Hymenal colposcopic examination in sexual offenses. The American Journal of Forensic Medicine and Pathology, 2, 209–214.

    Google Scholar 

  • Woodling, B. A., & Heger, A. (1986). The use of the colposcope in the diagnosis of sexual abuse in the pediatric age group. Child Abuse & Neglect, 10, 111–114.

    Article  Google Scholar 

  • Wurtele, S. (2009). Preventing sexual abuse of children in the twenty-first century; preparing for challenges and opportunities. Journal of Child Sexual Abuse, 18, 1–18.

    Article  Google Scholar 

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Correspondence to Astrid Heppenstall Heger M.D. .

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Heger, A.H. (2014). Child Sexual Abuse: The History, Current State of the Art and the Challenges for the Future: A Pediatric Perspective. In: Korbin, J., Krugman, R. (eds) Handbook of Child Maltreatment. Child Maltreatment, vol 2. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7208-3_4

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