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

ABSTRACT: 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.

SUBMITTER: Vrolijk-Bosschaart TF

PROVIDER: S-EPMC5607905 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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

Vrolijk-Bosschaart Thekla F TF Brilleslijper-Kater Sonja N SN Widdershoven Guy A GA Teeuw Arianne Rian H ARH Verlinden Eva E Voskes Yolande Y van Duin Esther M EM Verhoeff Arnoud P AP Benninga Marc A MA Lindauer Ramón J L RJL

European journal of pediatrics 20170826 10

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 co ...[more]

PMID: 28844100

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Project description:Background: Child sexual abuse (CSA) is a worldwide problem affecting children of all ages and socioeconomic backgrounds. A knowledge gap exists regarding the psychological outcomes for children, boys in particular, who are abused during their early lives. Objective: To provide a descriptive psychological profile of children who experienced sexual abuse as infants or toddlers from a male daycare worker and babysitter, and to assess the psychopathological impact on their parents. Method: Parents of children involved in the Amsterdam Sexual Abuse Case (41 parents; 44 children, age range 3-11 years, 30 boys, 14 girls) completed measures on post-traumatic stress disorder (PTSD), dissociation, sexual and non-sexual behaviour problems, and attachment insecurity in their children, as well as on parental psychological well-being, 3 years after disclosure. Sexual abuse characteristics were obtained from police records. Results: We found that 3% of confirmed child victims had PTSD, 30% sexual behaviour problems, 24% internalizing problems, 27% attachment insecurity, and 18% any psychiatric disorder (including PTSD); 39% were asymptomatic. In parents, we found feelings of guilt, shame, and anger about the abuse of their child; 19% showed PTSD symptoms and 3% showed avoidant and 8% anxious attachment problems in their intimate relationship. Parental symptomatology was related to child symptomatology, except for child sexual behaviour problems. One-quarter of confirmed child victims and 45% of parents had received psychological treatment. Conclusions: Three years after disclosure, extrafamilial CSA in very young children was associated with sexual and non-sexual behaviour problems and attachment insecurity, but rarely with PTSD or dissociation. For parents it was associated with PTSD symptoms and emotional reactions. Assessments and interventions should focus on the wide spectrum of problems that follow CSA, as well as on parental psychopathology and the parent-child relationship. Future follow-up assessments in our longitudinal study should provide insights into longer-term outcomes.

Project description:BackgroundThe life and health of street children is becoming a global concern. Street children are vulnerable to a variety of problems including physical, psychological and sexual exploitations as well as social isolation. Therefore, it was the purpose of this study to point out the experience of sexual and physical exploitation and its determinant factors among street children in Addis Ababa, the capital city of Ethiopia.MethodologyA phenomenological qualitative method was conducted from March to June 2016 in Addis Ababa, Ethiopia. Data were collected from street children by focus group discussion (FGD) and in-depth interview. Open code was used to analyze data. The transcribed note was translated. Following this coding was done. Based on a coding book, major themes and main categories were developed and analyzed.ResultThe study has explored the life experience of street children in the city. Deaths of parents/unhealthy relationship of extended families forced them be on a street. Thus, flee to street to search for work was the main reason for joining to a street. Street children are vulnerable to sexual and physical exploitations on a daily basis. For street children, street is the world characterized by misery deprivation, physical, verbal and sexual abuse and become daily victims of violence. There is no safe place for the children of on-street. Most street children are involved in all types of sex; heterosexual, bisexual, homosexual and group sex are common among themselves and out siders. They are involved highly in transactional sex for survival. Drug use, stress and depression are common experiences. Thus, they were socially isolated. The main challenges of living on a street are lack of basic needs, social isolation, lack of safety and security and being out of school are the common problems these vulnerable groups are facing.ConclusionsStreet children are at high risk of sexual and physical exploitation. Interventions targeting integration and reunion with families, reduction of physical and sexual exploitation, access to education, mental health promotion and reduction of drug use behavior should be taken in to considerations.

Project description:Children with disabilities (CWDs) are at a higher risk of being maltreated than are typical children. The evidence base on the abuse of children with disabilities living in low- and middle-income countries is extremely limited but the problem is particularly acute in East Africa. We don't know the types of evidence that exist on this topic. This problem is compounded by the fact that key indicators of disability, such as reliable prevalence rates, are not available currently. This paper addresses this serious problem by mapping the existing evidence-base to document the coverage, patterns, and gaps in existing research on the abuse of children with disabilities in East Africa. An evidence map, following systematic review guidelines, was conducted and included a systematic search, transparent and structured data extraction, and critical appraisal. Health and social science databases (Medline, EMBASE, PsychInfo, Taylor&Francis, Web of Science, and SAGE) were systematically searched for relevant studies. A substantive grey literature search was also conducted. All empirical research on the abuse of CWDs in East Africa was eligible for inclusion: Data on abuse was systematically extracted and the research evidence, following critical appraisal, mapped according to the type of abuse and disability condition, highlighting gaps and patterns in the evidence-base. 6005 studies were identified and screened, of which 177 received a full-text assessment. Of these, 41 studies matched the inclusion criteria. By mapping the available data and reports and systematically assessing their trustworthiness and relevance, we highlight significant gaps in the available evidence base. Clear patterns emerge that show a major data gap and lack of research on sexual abuse of children with disabilities and an identifiable lack of methodological quality in many relevant studies. These make the development of a concerted and targeted research effort to tackle the abuse of children with disabilities in East Africa extremely difficult. This needs to be addressed urgently if the abuse of children with disabilities is to be prioritised by the global health community.

Dataset Information

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

Conclusion

Publications

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

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