The diagnosis of child sexual abuse
H. Dubowitz, M. Black and D. Harrington
Division of General Pediatrics, University of Maryland School of Medicine, Baltimore 21201.
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.
