4/22 Childhood Sexual Abuse

Question 1

Define Child sexual abuse

Answer 1

A child is engaged in sexual activities that he or she cannot comprehend

• for which he or she is developmentally unprepared and cannot give consent
• and/or that violates the law or social taboos of society

Question 2

Compare the prevalence of childhood sexual abuse with that of obesity and asthma. which one is highest? lowest?

Answer 2

Sexual abuse: Prevalence 20%

(1% annually; each year 1% of children experience some form of sexual abuse)

Obesity: Prevalence 17%

Asthma: Prevalence 13%

Question 3

Most child sexual abuse: reported or not?

Answer 3

Nope.

Question 4

Child sexual abuse: generally, who are the perpetrators?

(are the perps known to child / are they family members / are they unknown to child?)

Generally perps are men or women?

Answer 4

60% are known to the child but not related

30% are family members

(only 10% are strangers)

Men are generally the perps for SA of both boys and girls.

Question 5

If the ‘victim’ is an adolescent and agrees to the activity, can it still be sexual abuse?

Answer 5

Depending on state law, yes

Depending on ages of perpetrator and victim, it can be sexual abuse even if an adolescent is willing

aka statutory rape

(this was a starred bullet point)

Question 6

What is the ACE study? what does it investigate?

Answer 6

Series of studies investigating the lifelong impact/social costs of ACE (Adverse Childhood Experience) like household drug abuse, sexual abuse, household mental health issues.

Question 7

What social findings are co-morbid with child sexual abuse? (objective = list 3)

Answer 7

If child had an ACE, chances of having more than one ACE were much higher. Co-morbid social findings:

-Physical abuse

-Battered mother

-Substance abuse in childhood home

Question 8

Define “toxic stress”

Answer 8

Term by CDC and neuro-dev experts describing the notion that vulnerable children are vulnerable to many different types of situations.

Toxic stress in childhood changes the anatomy of the developing brain and also the endocrinological response to future stress.

That is actually super-interesting.

Question 9

What are some of the health conditions that victims of childhood sexual abuse (and other ACEs) are at incr risk for?

Answer 9

Ischemic heart disease

Cancer (any type)

Stroke

Chronic lung disease

Diabetes

Question 10

At what point are physicians required to report abuse or neglect?

Answer 10

In all 50 states, required to report at point of reasonable suspicion.

Do not have to be certain about the diagnosis!

Question 11

What other providers are on the Multidisciplinary team to help clinicians?

Answer 11

-Local expert providers (you can now board-certify in child abuse pediatrics)

-Child Protective Services

• (^those two were starred on ppt)*
• Law Enforcement aka the po-po

Trauma trained mental health clinicians

Trained forensic interviewers (minimizes the # interviews per kid)

Victim Advocates

Prosecution (?ok whatevs)

Question 12

What is your first priority when in a situation of possible abuse?

Answer 12

Safety.

Obtain info from caretaker without child in room (this seems backwards but it is what they wrote)

Make sure child and other family members are safe on discharge from your facility.

She says to call DCFS before they leave your office and have them arrive to your office if needed.

Question 13

Be able to identify these anatomical landmarks on prepubertal female genitalia:

1) vaginal orifice, 2) urethra, 3) clitoris, 4) labia majora, 5) labia minora, 6) hymen, 7) posterior fourchette

Answer 13

1) vaginal orifice, 2) urethra, 3) clitoris, 4) labia majora, 5) labia minora, 6) hymen, 7) posterior fourchette

Question 14

What is the most common physical exam finding in kids who have been SA victims?

Answer 14

Most will have totally normal exam findings. (even with vag or anal penetration)

Reason: tissues involved are mucus membranes; well vascularized and heal quickly. Also are very stretchy and resist damage.

(only 5% overall had exam findings)

Question 15

What are some of the common presenting behaviors of SA victims? (red flags - that we would not expect children who had not been abused to do)

Answer 15

These behaviors = present in < 1.5% of non-SA children. May indicate that a child has been a victim (esp if they are unable to verbalize):

–Put their mouth on genitals

–Ask to engage in sex acts

–Imitate intercourse

–Insert objects into the vagina or anus

–Touch animal genitals

Question 16

SA victims: do they tend to be sexually inhibited or reactive following abuse?

Answer 16

Abused children may be sexually inhibited but more often sexually reactive

Question 17

What are some non-specific presenting symptoms that may indicate SA?

Answer 17

• Recurrent UTI
• Non-specific genital complaints
• Somatic complaints: abdominal pain, headaches
• Sleep disturbance
• Anxiety / fears
• New learning issue
• Peer problems or aggression

(Obviously these could be a lot of things but keep abuse on the differential)

Question 18

When and where is a child likely to disclose the event?

Answer 18

• Up to ¾ of victims who told did so after > one year
• Most of children’s initial disclosures were “accidental” and not to parents
• 96% of children in therapy disclosed over several sessions; some also recanted over time
• Children who disclosed were:

–More often female

–Less often had a close relationship with the abuser

–Older