<< Child Sexual Abuse: An Update


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Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial  should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study, such as the  type of study and the number of patients in the study, will be included in bold type following the reference, where  available. In addition, the most informative referencescited in the paper, as determined by the authors, will be  noted by an asterisk (*) next to the number of the reference.

  1. Kempe CH. Sexual abuse, another hidden pediatric problem: the 1977 C Anderson Aldrich Lecture. Pediatrics 1978;62:382-389. (Address)
  2. Sgroi SM, Blick LC, Porter FS. A conceptual framework for child sexual abuse. In: Sgroi SM, ed. Handbook of Clinical Intervention in Child Sexual Abuse. Lexington, MA: Lexington Books; 1982:9-37. (Textbookchapter)
  3. Burgess AW, Holmstrom LL. Sexual trauma of children and adolescents: pressure, sex, secrecy. Nurs Clin North Am 1975;10:551-563. (Review)
  4. American College of Obstetrics and Gynecology. Sexual assault(ACOG) Technical Bulletin No. 172. Int J Gynaecol Obstet 1993;43:67-72. (Guidelines)
  5. Russell DEH. Rape in Marriage. Bloomington, IN: Indiana UniversityPress; 1990. (Textbook)
  6. Finkelhor D. Sexually Victimized Children. New York, NY: Free Press; 1979. (Textbook)
  7. Putnam FW. Ten-year research update review: child sexual abuse. J Am Acad Child Adolesc Psychiatry 2003;42:269-278. (Review)
  8. * Heger A, Ticson L, Velasquez O, et al. Children referred for possible sexual abuse: medical findings in 2384 children. Child Abuse Negl 2002 Jun;26(6-7):645-659. (Retrospective, 2384 children)
  9. * Paolucci EO, Genuis ML, Violato C. A meta-analysis of the published research on the effects of child sexual abuse. J Psychol 2001;135:17-36. (Meta-anlysis, 37 studies, 25,367 people)
  10. US Department of Health and Human Services. Child Maltreatment 2002: Summary of Key Findings. Report from the National Clearinghouse on Child Abuse and Neglect Information. Washington, DC. 2004. (Epidemiologic data)
  11. Gorey KM, Leslie DR. The prevalence of child sexual abuse: Integrative review adjustment for potential response and measurementbiases. Child Abuse Negl 1997;21:91-398. (Epidemiologic data)
  12. * Finkelhor D. Current information on the scope and nature of child sexual abuse. Future Child 1994;4:31-53. (Review)
  13. * Leventhal JM. Epidemiology of sexual abuse of children: Old problem, new directions. Child Abuse Negl 1998;22:481-491. (Review)
  14. Runyan DK. Prevalence, risk, sensitivity, and specificity: A commentary on the epidemiology of child sexual abuse and the developmentof a research agenda. Child Abuse Negl   1998;22:493-498. (Review)
  15. Finkelhor DH. Child Sexual Abuse: New Theory and Research. New York,NY: Free Press; 1984. (Textbook)
  16. Finkelhor D, Browne A. The traumatic impact of child sexual abuse: A conceptualization. Am J Orthopsychiatry 1985;55:530-541. (Descriptive)
  17. Summit RC. The child sexual abuse accommodation syndrome. Child Abuse Negl 1983;7:177-193. (Descriptive)
  18. Finkel MA. Anogenital trauma in sexually abused children. Pediatrics 1989;84:317-322. (Prospective, 7 children)
  19. McCann J, Voris J, Simon M. Genital injuries resulting from sexual abuse: a longitudinal study. Pediatrics 1992;89(2):307-317. (Prospective,3 children)
  20. Emans SJ, Woods ER, Allred EN, et al. Hymenal findings in adolescent women: impact of tampon use and consensual sexual activity. J Pediatr 1994;125:153-160. (Prospective, 300 children)
  21. Heger AH, McConnell G, Ticson L, et al. Healing patterns in anogential injuries: a longitudinal study of injuries associated with sexual abuse, accidental injuries, or genital surgery in the preadolescent child. Pediatrics 2003;112(4):829-837. (Prospective, 94 children)
  22. * Christian CW, Lavelle JM, De Jong AR, et al. Forensic evidence findings in prepubertal victims of sexual assault. Pediatrics 2000 Jul;106(1 Pt 1):100-4. (Retrospective, 273 children)
  23. Christian CW, Giardino AP. Forensic Evidence Collection. In: Finkel, MA, Giardino AP, eds. Medical Evaluation of Child Sexual Abuse: A Practical Guide. Thousand Oaks, CA: Sage Publications, Inc; 2002:131-158. (Textbook chapter)
  24. Berkowitz CD. Medical consequences of child sexual abuse. Child Abuse Negl 1998 Jun;22(6):541-50; discussion 551-554.
  25. Boos SC. Accidental hymenal injury mimicking sexual trauma. Pediatrics 1999;103(6, Pt. 1):1287-1290. (Case study)
  26. Bays J, Jenny C. Genital and Anal Conditions Confused with Child Sexual Abuse Trauma. Am J Dis Child 1990 Dec;144:1319-1322. (Case series)
  27. Bays J. Conditions mistaken for child physical abuse. In: Reece RM, Ludwig, S, eds. Child Abuse: Medical Diagnosis and Management. Philadelphia, Pa: Lippincott, Williams & Wilkins; 2001:177-206. (Textbook chapter)
  28. Frasier, LD. The anogential exam: Diagnostic Dilemmas, mimics of abuse. In: Finkel M, Giardino A, eds. Medical Evaluation of Child Sexual Abuse: A Practical Guide. 2nd ed. Thousand Oaks, CA. Sage Publications; 2002:23-37. (Textbook chapter)
  29. Nadal, FM, Giardino, AP. Differential Diagnosis: Conditions that Mimic Child Maltreatment. In Giardino ER, Giardino AP, eds. Nursing Approach to the Evaluation of Child Maltreatment. St. Louis, MO: GW Medical Publishing; 2003:215-250. (Textbook chapter)
  30. Emans SJ, Laufer M, Goldstein DP. Pediatric and Adolesent Gynecology.5th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2004. (Textbook)
  31. Jenny C, Kirby P, Fuquay D. (1989). Genital lichen sclerosus mistaken for child sexual abuse. Pediatrics 1989 Apr;83(4):597-599. (Case study)
  32. Gazi MA, Ankem MK, Pantuck AJ, et al. Management of penile toilet seat injury--report of two cases. Can J Urol 2001 Jun;8(3):1293-1294.(Case study)
  33. Rickwood AM, Hemalatha V, Batcup G, et al. Phimosis in boys. Br J Urol 1980;52:147-150. (Case study)
  34. Finkbeiner AE. Balanitis xerotica obliterans: a form of lichen sclerosus. South Med J 2003 Jan;96(1):7-8. (Editorial)
  35. Giardino, AP, Finkel, MA, Giardino ER, et al. A Practical Guide to the Evaluation of Sexual Abuse in the Prepubertal Child. Newbury Park, CA: Sage Publications; 1992. (Textbook)
  36. Finkel, M. (2002a) Physical examination. In: Finkel M, Giardino A, eds. Medical Evaluation of Child Sexual Abuse: A Practical Guide. 2nd ed. Thousand Oaks, CA: Sage Publications; 2002:39-98. (Textbook chapter)
  37. Katner D, Plum HJ. Legal Issues. In: Giardino AP, Giardino ER, eds. Recognition of Child Abuse for the Mandated Reporter. 3rd ed. St. Louis, MI: GW Medical Publishing; 2002:309-350. (Textbook chapter)
  38. Myers, JEB. Legal Issues in Child Abuse and Neglect Practice. 2nd ed. Thousand Oaks, CA: Sage Publications; 1998. (Textbook)
  39. Myers, JEB. The legal system and child protection. In: Myers JEB, Berliner L, Briere J, Hendrix CT, Jenny C, Reid TA, eds. The APSAC Handbook on Child Maltreatment. 2nd ed. Thousand Oaks, CA: Sage Publications; 2002:305-328. (Textbook chapter)
  40. National Clearinghouse on Child Abuse and Neglect Information. Child abuse and neglect state statutes elements: reporting laws. Number 2: Mandatory reports of child abuse and neglect. Washington, DC: USDHHS: 2002. (Guidelines)
  41. Dubowitz H, DePanfilis D. Handbook for Child Protection Practice.Thousand Oaks, CA: Sage Publications; 2000. (Textbook)
  42. Zellman GL, Faller KC. Reporting of child maltreatment. In: Briere J, Berliner L, Buckley JA, et al, eds. The APSAC Handbook on Child Maltreatment. Thousand Oaks, CA: Sage Publications; 1996. (Textbook chapter)
  43. * Flaherty EG, Sege R, Binns HJ, et al. Health care providers' experience reporting child abuse in the primary care setting. Arch Pediatr Adolesc Med 2000 May;154(5):489-493. (Survey, 76 physicians, 8 nurse practitioners, 1 physician's assistant)
  44. Butz AM, Redman BK, Fry ST, et al. Ethical conflict experiences by certified pediatrics nurse practitioners in ambulatory settings. J Pediatr Health Care. 1998;12:183-190. (Survey, 118 nurse practitioners)
  45. Finkel M. The evaluation. In: Finkel M, Giardino A, eds. Medical Evaluation of Child Sexual Abuse: A Practical Guide. 2nd ed. Thousand Oaks, CA: Sage Publications; 2002:23-37. (Textbook chapter)
  46. Saywitz KJ, Snyder L, Nathanson R. Facilitating the communicative competence of the child witness. Applied Developmental Science 1999;3(1):58-68. (Prospective, 180 children)
  47. Saywitz KJ, Goodman GS, Lyon TD. Interviewing children in and out of court: current research and practice implications. In: Myers JEB, Berliner L, Briere J, et al, eds. The APSAC handbook on child maltreatment. 2nd ed. Thousand Oaks, CA: Sage Publications; 2002:349-378. (Textbook chapter)
  48. * American Academy of Pediatrics, Committee on Child Abuse and Neglect. Guidelines for the Evaluation of Sexual Abuse of Children: Subject Review. Pediatrics 1999;103(1):186-191.  Guidelines)
  49. Adams J. Medical evaluation of suspected child sexual abuse. J Pediatr Adolesc Gynecol 2004;17:191-197. (Review)
  50. Walker AG. Handbook for Questioning Children: A Linguistic Perspective. American Bar Association Center on Children and the Law. 1994. (Textbook)
  51. Perry NW, McAuliff BD, Tam P, et al. When lawyers question children: Is justice served? Law and Human Behavior 1995;19:609-629. (Descriptive)
  52. deViller JG, deViller PA. Language Acquisition. Cambridge, MA: Harvard University Press; 1978. (Textbook)
  53. Medin DL, Ross BH. Cognitive Psychology. New York, NY: Harcourt, Brace, Jovanich; 1992. Cited in: Poole DA, Lamb ME. Investigative Interviews of Children. American Psychological Association. 1998. (Textbook)
  54. Walker AG, Warren AR. The language of the child abuse interview: asking questions, understanding the answers. In: Ney T, ed. True and False Allegations of Child Sexual Abuse: Assessment and Case Management. New York, NY: Brunner/Mazel; 1995. (Textbook chapter)
  55. Finkel M, DeJong A. Medical findings in child sexual abuse. In: Reece R, Ludwig S, eds. Child Abuse: Medical Diagnosis and Management. 2nded. Philadelphia, PA: Lippincott, Williams & Wilkins; 2001:207-286. (Textbook chapter)
  56. Jenny C. Medical Issues in Child Sexual Abuse. The APSAC Handbook on Child Maltreatment. Thousand Oaks, CA: Sage Publications; 1996.(Textbook chapter)
  57. Heger AH, Ticson L, Guerra L, et al. Appearance of the genitalia in girls selected for non-abuse: review of hymenal morphology and nonspecific findings. J Pediatr Adolesc Gynecol 2002 Feb;15:27-35. (Retrospective, 147 children)
  58. Adam JA, Harper K, Knudson S, et al. Examination findings in legally confirmed child sexual abuse:iIt's normal to be normal. Pediatrics 1994;94:310-317. (Retrospective, 236 children)
  59. Ludwig S. Child abuse. In: Fleisher G, Ludwig S, eds. Textbook of Pediatric Emergency Medicine. 4th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2000:1669-1704. (Textbook chapter)
  60. Adams JA. Evaluation of a Classification Scale: Medical Evaluation of Suspected Child Abuse. Child Maltreat 2001;6(1):31-36. (Description of classification system)
  61. Kellogg N, Menard SW, Santos A. Genital anatomy in pregnant adolescents: "normal" does not mean "nothing happened." Pediatrics 2004 Jan;113(1):e67-e69. (Retrospective, 26 adolescents)
  62. * Berenson A, Chacko MR, Wieman CM, et al. A case control study of anatomic changes resulting from sexual abuse. Am J Obstet Gynecol 2000;182:820-834. (Case control study, 392 children)
  63. Kirschner RH, Stein RJ. The mistaken diagnosis of child abuse: a form of medical abuse? Am J Dis Child 1985;139:873-875. (Review)
  64. Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines. 2002 May;51(RR06);1-80. (Guidelines)
  65. Botash AS. Examination for sexual abuse in prepubertal children: an update. Pediatr Ann 1997 May;26(5):312-320. Erratum in: Pediatr Ann 1997 July;26(7):437. (Review)
  66. Santucci KA, Nelson DG, McQuillen KK, et al. Wood's lamp utility in the identification of semen. Pediatrics 1999 Dec;104(6):1342-1344. (Prospective, 41 physicians)
  67. Lahoti SL., Mcclain N, Girardet R, et al. Evaluating the child for sexual abuse. Am Fam Physician 2001;63(5):883-892. (Review)
  68. Levitt C. Further technical considerations regarding conducting and documenting the child sexual abuse medical examination. Child Abuse Negl 1998 Jun;22(6):567-568; discussion 569-571. (Review)
  69. American Professional Society on the Abuse of Children. Glossary of terms and the interpretations of findings for child sexual abuse evidentiary examinations. APSAC: Chicago, IL; 1998:1-28. (Guidelines)
  70. Muram D. Medical evaluation of child victims of sexual abuse. Curr Opin Obstet Gynecol 1989;1(2):250-258. (Review)
  71. Ricci,L. Photodocumentation of the abused child. In: Reece R, Ludwig S, eds. Child Abuse: Medical Diagnosis and Management. 2nd ed. Philadelphia,PA: Lippincott Williams & Wilkins; 2001:385-404. (Textbook chapter)
  72. Ricci,L. Documentation of physical evidence in child sexual abuse. In: Finkel M, Giardino A, eds. Medical Evaluation of Child Sexual Abuse: A Practical Guide. 2nd ed. Thousand Oaks, CA: Sage Publications; 2002:99-110. (Textbook chapter)
  73. Ricci LR, Smistek BS. Photodocumentation in the Investigation of Child Abuse. Office of Juvenile Justice and Delinquency Prevention. Portable Guides to Investigating Child Abuse. 1997. (Monograph)
  74. Palusci VJ, Cyrus TA. Reaction to videocolposcopy in the assessment of child sexual abuse. Child Abuse Negl 2001;25(11):1535-46. (Prospective, 227 children)
  75. Finkel MA, Ricci LR. Documentation and preservation of visual evidence in child abuse. Child Maltreat 1997;2:322-330. (Descriptive)
  76. Finkel MA. Technical conduct of the child sexual abuse medical examination. Child Abuse Negl 1998;22;555-566. (Review)
  77. Ingram DL, Everett VD, Lyna PR, et al. Epidemiology of adult sexually transmitted disease agents in children being evaluated for sexual abuse. Pediatr Infect Dis J 1992 Nov;11(11):945-950. (Review)
  78. Ingram DL, Everett VD, Flick LA, et al. Vaginal gonococcal cultures in sexual abuse evaluations: evaluation of selective criteria for preteenaged girls. Pediatrics 1997 Jun;99(6):E8. (Prospective, 2898 children)
  79. Shapiro RA, Schubert CJ, Myers PA Vaginal discharge as an indicator of gonorrhea and Chlamydia infection in girls under 12 years old. Pediatr Emerg Care 1993 Dec;9(6):341-345. (Retrospective, 622 children)
  80. Hammerschlag MR. Appropriate use of nonculture tests for the detection of sexually transmitted diseases in children and adolescents. Semin Pediatr Infect Dis 2003 Jan;14(1):54-59. (Review)
  81. * Palusci VJ, Reeves MJ. Testing for genital gonorrhea infections in prepubertal girls with suspected sexual abuse. Pediatr Infect Dis J 2003 Jul;22(7):618-623. (Decision analysis)
  82. Siegel RM, Schubert CJ, Myers PA, Shapiro RA.The prevalence of sexually transmitted diseases in children and adolescents evaluated for sexual abuse in Cincinnati: rationale for limited STD testing in prepubertal girls. Pediatrics 1995 Dec;96(6):1090-1094. (Prospective, 855 patients)
  83. HIV Post-Exposure Prophylaxis for Children Beyond the Perinatal Period. New York State Department of Health AIDS Institute, Office of the Medical Director. Available at: http://hivguidelines.org. Accessed January 27, 2005. (Guidelines)
  84. US Department of Health and Human Services. A report on the maltreatment of children with disabilities. (No. 105-89-16300). Washington, DC: Westat. 1995. (Epidemiologic data)
  85. Gil DG. Violence against Children: Physical Child Abuse in the United States. Cambridge, MA: Harvard University Press; 1970. (Textbook)
  86. Garbarino J, Brookhouse P, eds. Special Children, Special Risks: The Maltreatment of Children with Disabilities. New York, NY: Aldine; 1987. (Textbook)
  87. Elvik SL, Berkowitz C. Sexual abuse in the developmentally disabled: dilemmas of diagnosis. Child Abuse Negl 1990;14:497-502. (Case series)
  88. Balderian N. Sexual abuse of people with developmental disabilities. Sexuality and Disabilities 1991;9:323-335. (Review)
  89. Sullivan PM, Brookhouser PE, Scanlon JM, et al. Patterns of physical and sexual abuse of communicatively handicapped children. Ann Otol Rhinol Laryngol 1991;100:188-194. (Retrospective, 482 children)
  90. Sullivan PM, Knutson JF. The association between child maltreatment and disabilities in a hospital-based epidemiological study. Child Abuse Negl 1998;22:271-288. (Descriptive)
  91. Valentine DP. Double jeopardy: child maltreatment and mental retardation. Child Adolesc Soc Work J 1990;7:487-499. (Descriptive)
  92. Zirpoli TJ. Characteristics of persons with mental retardation who have been abused by caregivers. J Special Educ 1987;21:31-41. (Descriptive)
  93. Hudson KM, Giardino AP. Child abuse and neglect. In: Kurtz LA, Dowrick PW, Levy SE, Batshaw ML, eds. Handbook of Developmental Disabilities. Gaithersburg, MD: Aspen; 1995:542-554. (Textbook chapter)
  94. Elliott CH, Jay SM, Woody P. An observation scale for measuring children's distress during medical procedures. J Pediatr Psychol 1987 Dec;12(4);543-551. (Description of scale)
  95. Britton H. Emotional impact of the medical examination for child sexual abuse. Child Abuse Negl 1998;22:573-579. (Descriptive)
  96. Gulley KJ, Britton H, Hansen K, et al. A new measure for distress during child sexual abuse examination: the genital examination distress scale. Child Abuse Negl 1999:23(1):61-70. (Prospective, 300 children)
  97. Lynch L. Faust J. Reduction of distress in children undergoing sexual abuse medical examination. J Pediatr 1998;133:296-299. (Descriptive)
  98. Steward MS, Schmitz M, Steward DS, et al. Children's anticipation and response to  olposcopic examination. Child Abuse Negl 1995;19:997-1005. (Prospective, 43 mothers and daughters)
  99. Lazebnik R, Zimet GD, Ebert J, et al. How children perceive the medical evaluation for suspected sexual abuse. Child Abuse Negl 1994;18(9):739-745. (Retrospective, 99 children)
  100. Dubowitz H. Child abuse programs and pediatric residency training. Pediatrics 1988;82:477-480. (Survey, 72% of US pediatric residency programs)
  101. De San Lazaro C. Making paediatric assessment in suspected sexual abuse a therapeutic experience. Arch Dis Child 1995 Aug;73(2):174- 176. (Description of assessment techniques)
  102. Lawson L, Preparing sexually abused girls for genital evaluation. Issues Compr Pediatr Nurs 1990;13:155-164. (Descriptive)
  103. Kendall-Tackett KA, Williams LM, Finkelhor D. Impact of sexual abuse on children: a review and synthesis of recent empirical studies. Psychol Bull 1993 Jan;113(1):164-180. (Review)
  104. Kendall-Tackett K. Treating the Lifetime Health Effects of Childhood Victimization. Kingston, NJ: Civic Research Institute; 2003. (Textbook)
  105. Berliner L, Elliot D. Sexual Abuse of Children. In: Briere J, Berliner L, Buckley JA, Jenny C, Reid T, eds. The APSAC Handbook on Child Maltreatment. Thousand Oaks, CA: Sage Publications; 1996:51-71. (Textbook chapter)
  106. Briere J. Treating adult survivors of severe childhood abuse and neglect: Further development of an integrative model. In: Myers, JEB, Berliner L, Briere J, et al. (eds) The APSAC Handbook on Child Maltreatment. 2nd ed. Thousand Oaks, CA: Sage Publications; 2002:175-204.(Textbook chapter)
  107. Briere J, Elliott DM. Prevalence and psychological sequelae of selfreportedchildhood physical and sexual abuse in a general population sample of men and women. Child Abuse Negl 2003 Oct;27(10):1205-1222. (National, geographically stratified random sample survey, 1442 subjects)
  108. Kawsar M, Anfield A, Walter E, et al. Prevalence of sexually transmitted infections and mental health needs of female child and adolescentsurvivors of rape and sexual assault attending a specialist clinic. SexTransm Infect 2004 Apr;80(2):138-141. (Retrospective, 98 children)
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  110. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. In: Franey K, Geffner R, Falconer R, eds. The Cost ofMaltreatment: Who Pays? We All Do. San Diego, CA: Family Violence and Sexual Assault Institute; 2001:53-69. (Textbook chapter)
  111. Myers JEB, Stern P. Expert Testimony. In: Myers JEB, Berliner L, Briere J, Hendrix CT, Jenny C, Reid TA, eds. The APSAC Handbook on Child Maltreatment. 2nd ed. Thousand Oaks, CA: Sage Publications;2002:379-402. (Textbook chapter)
  112. Child Maltreatment 2002. Department of Health and Human Services, Administration for Children and Families. Washington, DC. Web site available at: http://www.acf.hhs.gov/programs/cb/publications/ cm02/cm02.pdf. Accessed January 26 ,2005. (Epidemiologicdata)
  113. Goldner J, Dolgin C, Manske S. In: Briere J, Berliner L, Buckley JA,Jenny C, Reid T, eds. The APSAC Handbook on Child Maltreatment. Thousand Oaks, CA: Sage Publications; 1996. (Textbook chapter)
  114. American College of Emergency Physicians. Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient. Dallas, TX: American College of Emergency Physicians; June 1999. Noziglia CM, Levitt C. (Policy statement)
  115. American Academy of Pediatrics. Sexually transmitted diseases in children and adolescents. In: Pickering LK, ed. Redbook 2003, Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003:157-167. (Guidelines)

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Maria D McColgan; Angelo P Giardino

Publication Date

January 1, 2005

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