The Diagnosis of Child Sexual Abuse

Abstract

Objective. To examine how the history, psychological evaluation, medical examination, and child�s response to the examination contributed to a diagnosis of child sexual abuse by an interdisciplinary team. Design. Patient series. Setting. Subspecialty clinic for evaluating prepubertal children alleged to have been sexually abused. Participants. One hundred thirty-two children alleged to have been sexually abused and their parents or guardian, evaluated consecutively in a subspecialty clinic between September 1989 and June 1990. Measurements/Main Results. A social worker interviewed the parents, a psychologist interviewed the child, and a pediatrician obtained a medical history and examined the child. Parents completed a Child Behavior Check list and the child�s response to the physical examination was noted. Both a disclosure by the child and abnormal physical findings were significantly and independently associated with the team�s diagnosis of sexual abuse, whereas the presence of sexualized behavior, somatic problems, and the child�s response to the examination did not make an additional contribution to the diagnosis. Conclusions. The findings support the need for a skilled psychological interview and a medical examination of a child alleged to have been sexually abused to make the diagnosis of sexual abuse. An interdisciplinary team appears to be a valuable approach for evaluating these children and their families. Copyright 1992, American Medical Association. All rights reserved.