Resident documentation of diagnostic impression in sexual abuse evaluations

In sexual abuse evaluations, the documentation of the examiner's diagnostic impression is essential. If the diagnostic impression is not documented, the examiner will have to rely on memory rather than the medical record when called to testify. The purpose of this study was to determine whether pediatric residents adequately document their diagnostic impression in child sexual abuse evaluations. We performed a three-year retrospective chart review from patients 0-17 years of age who were evaluated at our emergency room for suspected sexual abuse. We reviewed 1,487 charts for historical information, physical findings, and diagnostic impression. Physical findings were categorized as normal, nonspecific, suggestive, or indicative of penetration. In 77% of cases (N = 256) with hymenal findings indicative of penetration and 84% of cases (N = 31) with vaginal findings indicative of penetration, residents recorded no impression or a nonspecific impression. Results were similar for vulvar and rectal findings indicative of penetration. Residents fail to document an adequate interpretation of their physical examinations in sexual abuse evaluations.     

Child sexual and physical abuse and alcoholism: a review

OBJECTIVE: To examine possible relations between child sexual or physical abuse and adult alcoholism. METHOD: Studies reviewed included prospective studies, retrospective studies on the prevalence of child sexual or physical abuse in alcoholics and nonalcoholics, and retrospective studies in mental health clients and in population samples comparing the prevalence of alcohol use disorders in abused and nonabused subjects. RESULTS: Prospective studies do not indicate a significant association between child sexual or physical abuse and alcoholism. In contrast, studies among alcoholic women do suggest a relationship. Also, a significantly higher prevalence of alcohol problems in abused women than in nonabused women is found in population samples. The results of studies among mental health clients are inconclusive. In addition, several methodological limitations should be taken into consideration when evaluating results of the available studies. CONCLUSIONS: Current evidence is insufficient to draw conclusions about relationships between child sexual or physical abuse and alcoholism among men. Among females, however, there is a higher likelihood of alcohol problems if they were sexually or physically abused as children.     

Child extrafamilial sexual abuse: predicting parent and child functioning

OBJECTIVE: This study evaluated the emotional and behavioral adjustment of parents and children within 3 months and 1 year after the discovery of child extrafamilial sexual abuse. METHOD: Ninety-two case parents (63 mothers, 29 fathers) and 56 children were compared to a nonclinical comparison group of 136 parents (74 mothers, 62 fathers) and 75 children. Parent adjustment was assessed using self-report measures while child functioning was assessed using a combination of child-, parent- and teacher-report measures. RESULTS: Mothers, fathers and sexually abused children experienced clinically significant effects both initially and at 12 months post-disclosure. Children's perceptions of self-blame and guilt for the abuse and the extent of traumatization predicted their self-reported symtomatology at 3 months and 1 year post-disclosure. Child age and gender also significantly contributed to the prediction of many of the child outcome measures. No abuse-related variable was related to any child self-report measure. Mothers' satisfaction in the parenting role, perceived support and intrusive symptoms predicted their initial emotional functioning. Avoidant symptoms, child's internalizing behavior and mothers' initial emotional functioning were significant predictors of longer-term emotional functioning. CONCLUSIONS: Results emphasize the need to address children's abuse-related attributions and underscore the need to expand our focus beyond the child victims to the traumatized families.     

Child sex abuse: pretext to a return of sexual repression

This article is based on observations and thoughts during intensive psychotherapeutic work with 997 sexually abused children and their parents after they had been reported to the Confidential Doctor Center Kind in Nood of the VUB (between 1986 and 1994). Without denying the existence of sexual abuse of children, it is important not to exaggerate this phenomena, which can be described as the Child Sexual Abuse Panic Syndrome. Doing this only gives way to denial and indignation or scandalization and revenge, and certainly does not lead to a clear analysis of the problem. Accurate observation enables some existing myths to become unravelled: abusive fathers are seldom power robots, mothers are not always warm-hearted, innocent creatures and children are not black boxes without feeling and sexual desires. The underlying message is about the bitter fight against modernization of sexuality, which seems again experienced as dangerous. However it is fear for a free, adult sexuality that is at the core of sexual exploitation of children, which should encourage caution in professional answers to this delicate issue.     

Children with anogenital symptoms and signs referred for sexual abuse evaluations

Germ cell tumors (GCTs) are the most frequent cancer in men aged 15 to 34 years. These tumors are highly responsive to therapy with platinum-containing regimens, and 80% of cases so treated can be considered cured. Cytogenetically, 80% of GCTs have an i(12p) regardless of tumor site or histopathology, and those that are i(12p) negative have other manifestations of 12p amplification. GCTs occasionally arise extragonadally, and such cases can be especially difficult to distinguish from poorly differentiated somatic carcinomas, a situation that poses a diagnostic and treatment dilemma We developed a technique for two-color fluorescence in situ hybridization chromosome painting on nuclei released from paraffin-embedded sections. In four tumors for which GCT was a differential diagnosis, we examined the 12p and 12q chromosome arm distributions by this technique. By use of 12p and 12q painting probes developed by microdissection, 12p and 12q were distinguished and their relative distributions evaluated. In each of the four cases, 12p regions seemed to be rearranged and over-represented relative to 12q regions. In three of the cases, an apparent i(12p) could be identified. These results support a diagnosis of GCT or GCT origin in these four cases. In tumors for which specific cytogenetic abnormalities are known, chromosome painting by fluorescence in situ hybridization using paraffin-embedded tissue is a useful technique to aid in the diagnosis of tumors that are difficult to differentiate. The patients can then be placed on treatment regimens appropriate for their specific tumor type.     

The scientist-practitioner model: Gandhi was right again.

Examines the adoption of and the ideas behind the scientist-practitioner model from the Boulder Conference. The author discusses the implementation of scientist-practitioner training programs and graduate student reaction to it. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child abuse.

Knowledge of child abuse is limited, with little agreement, among professionals concerning definition, incidence, and causes. Approaches to treatment have met with limited success, and proposed prevention strategies prove impractical due to such factors as the invasion of family privacy and negative effects of labeling deviant or potentially deviant behavior. Prevention efforts are reviewed, and it is suggested that the best preventive strategy is the development of a coherent policy in support of all children and their families. Child abuse is embedded in families, institutions, and society as a whole: Efforts to eliminate it must be directed at all 3 components. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child abuse: assessment and intervention

The National Statistics on Child Abuse and Neglect are staggering and rising despite a national objective to decrease domestic violence, of which child abuse is a part. More than 3 million children are abused each year. That figure represents 25 out of every 1,000 children being physically, sexually, or emotionally abused or neglected by their caretakers. It is important to note that 50% of abused children have an abused mother (American Medical Association, 1992). There are immediate as well as long-term sequelae of abuse including emotional and developmental problems, permanent injury, death, and perpetuation of abuse to the next generation. Since fractures are often part of the constellation of injuries seen in the abused child, orthopaedic nurses may encounter these children in a range of settings. Recognizing the signs of abuse is an important step for intervention on behalf of the child.     

Child abuse: a community problem

Physicians who treat musculoskeletal and neurologic disorders often treat patients who have paresthesias or weakness of a single extremity. Although the diagnosis is often straightforward, cases that are atypical in nature may pose a diagnostic dilemma. This report describes the case of a middle-aged man with symptoms indicative of, though not classic for, a cervical radiculopathy. An extensive investigation was unremarkable and only the eventual rapid progression of symptoms led to the diagnosis of a glioblastoma multiforme. Although this is a deadly form of brain cancer, early recognition provides the best chance for a prolonged and greater quality of life.     

Implementing the scientist-practitioner model: The school psychologist as data-based problem solver.

Describes a data-based problem-solver model (DBPS) for training in school psychology and recommends it as a superordinate model that can facilitate implementation of scientist-practitioner training in all school psychology programs. The fundamental principles and primary components of the DBPS are illustrated by describing its use in a doctoral school psychology training program. The DBPS model incorporates 2 dimensions that are concurrent throughout training: (1) education, yielding generalizable knowledge and skills, and (2) training, focusing on more specific knowledge and skills, with extensive supervised experience in a data-based approach to problems related to schooling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child sexual abuse, early family risk, and childhood parentification: Pathways to current psychosocial adjustment.

In this study, the authors examined the role of parentification (children assuming adult-like roles in the family) as it relates to family risk (parental psychopathology, parental illness, and domestic violence), child sexual abuse (CSA), and psychosocial adjustment in 499 college women. Structural equation modeling was used to test a model of direct, indirect, and mediational pathways through which CSA, family risk, and parentification contributed to later psychosocial maladjustment. Results indicate that CSA and family risk independently and directly predicted higher levels of maladjustment, but only family risk positively predicted parentification in childhood. Parentification was unexpectedly related to less maladjustment. Parentification failed to mediate the relation between early family risk and maladjustment. Findings suggest that family risk factors may contribute to parentification and that parentification is not always related to poorer psychosocial outcomes. Future research should examine the impact of parentification on other aspects of functioning and should assess how individual, familial, and cultural variables (e.g., age, gender, duration, perceived fairness, ethnicity, and family support) moderate the impact of parentification on long-term adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Incidence of sexual abuse

BACKGROUND: Much attention is paid lately at all levels to sexual child abuse. Its incidence in the population is, however, not known. The objective of the present investigation was to assess the incidence of sexual abuse in a defined group of young people. METHODS AND RESULTS: The authors examined, using an anonymously completed semistructured questionnaire, 311 5th year medical students from Charles University, mean age cca 23 years. They found that 66% of the women and 20% of the men some time during their life were subjected to involuntary sexual interaction. Only one third of the delicts, however, had occurred before the age of 12, the majority after the age of 15 years. The offender was most frequently an unknown man who exhibited before the victim or fingered her. Brutal of serious interactions (rape or attempted rape) were recorded only in 6%. The authors did not record a single case of incest. The majority of examined subjects experienced this event as unpleasant, however, usually did not tell it to anybody. Police organs were informed only in four cases. CONCLUSIONS: The presented negative experience can contribute to the development of some psychiatric disorders and psychosomatic diseases, although in the examined group a higher rate of psychic and sexual complaints was not recorded in probands with a negative sexual experience.     

Childhood sexual abuse, adolescent sexual behaviors and sexual revictimization

OBJECTIVE: The aims of this study were to examine the extent to which exposure to childhood sexual abuse (CSA) was associated with increased rates of sexual risk taking behaviors and sexual revictimization during adolescence. METHOD: A birth cohort of 520 New Zealand born young women was studied at regular intervals from birth to the age of 18. At age 18 retrospective reports of CSA were obtained from sample members. Over the course of the 18 year study information was gathered on: (a) childhood, family, and related circumstances; and (b) the young women's history of sexual experiences from 14 to 18 years. RESULTS: Young women reporting CSA, and particularly severe CSA involving intercourse, had significantly higher rates of early onset consensual sexual activity, teenage pregnancy, multiple sexual partners, unprotected intercourse, sexually transmitted disease, and sexual assault after the age of 16. Logistic regression analyses suggested that the associations between CSA and sexual outcomes in adolescence arose by two routes. First, exposure to CSA was associated with a series of childhood and family factors including social disadvantage, family instability, impaired parent child relationships, and parental adjustment difficulties that were also associated with increased sexual vulnerability in adolescence. Second, there appeared to be a causal chain relationship between CSA and sexual experiences in which CSA was associated with early onset sexual activity which, in turn, led to heightened risks of other adverse outcomes in adolescence. CONCLUSIONS: The findings of this study suggest that those exposed to CSA have greater sexual vulnerability during adolescence. This appears to arise because: (a) the childhood and family factors that are associated with CSA are also associated with increased sexual risks during adolescence; and (b) exposure to CSA may encourage early onset sexual activity which places those exposed to CSA at greater sexual risk over the period of adolescence.