Dissociative and sexual behaviors were assessed in a sample of 350 children ages 7-18. Four groups were evaluated: a nonpsychiatric comparison sample, a psychiatric sample with no history of sexual abuse, a psychiatric sample with clear evidence of sexual abuse, and another group for whom sexual abuse was likely but not substantiated. All children completed the Trauma Symptom Checklist-Children (TSC-C), and varying numbers completed the Rorschach and MMPI. Parents completed the Child Behavior Checklist (CBC), Child Sexual Behavior Inventory (CSBI), and Child Dissociation Checklist (CDC). Mean differences on the Dissociation and Sexual Concerns subscales of the TSC-C existed between the nonpsychiatric and psychiatric groups. The Dissociation subscale was significantly correlated with MMPI Scale 8 and CDC. Sexual Concerns were significantly related to sexual content on the Rorschach, CBC sex problems, and the CSBI. Duration and nature of abuse significantly contributed over and above age and gender in predicting total score on the Dissociation subscale.

The prevention or minimization of future pain is often cited as a reason for removal of the bullet from patients who have incurred a spinal cord injury secondary to a gunshot wound. In an attempt to examine this assumption, multimodal pain ratings were recorded for 14 patients with spinal cord injury due to a gunshot wound in whom the bullet was still present, 14 neurologically matched patients with spinal cord injury due to a gunshot wound in whom the bullet was removed, and 28 control patients with spinal cord injury unrelated to a gunshot wound who were neurologically matched to the first two groups. The results suggest that persons who sustain a spinal cord injury secondary to gunshot wounds report more pain than those injured in other ways. In addition, there was no indication that surgical removal of the bullet was helpful in reducing subsequent pain either early in the rehabilitation process or at 1 year postinjury. The location of the bullet and the type of pain that subsequently developed were not correlated with the initial decision to surgically remove the bullet. Implications for further study and clinical practice are discussed.

Objective. To develop an observation method for assessing pain behaviors in children with juvenile rheumatoid arthritis (JRA).Methods. Thirty children with JRA performed a standardized sequence of activities for video recording, and correlations between the pain behaviors observed on the videotapes and established measures of pain, depression, and functional disability were determined.Results. Pain behaviors were reliably observed (kappa coefficients 0.53-0.79). Total pain behaviors were significantly correlated with subjective reports of pain (r = 0.50) and disability levels (r = 0.64). These behaviors were not significantly associated with children's depression ratings (r = 23). Conclusion.The results indicate that the behavioral observation method provides a reliable and valid measure of pain associated with JRA. Measurement of pain behaviors may be especially useful in treatment outcome studies because these behaviors are relatively independent of depression.Most studies of pain in children have used self-report measures such as visual analog scales (VAS) and category scales (1-5). Unfortunately, limitations in children's cognitive development can make it difficult for them to understand the concept of pain (6-8) and to respond accurately and reliably to self-

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