Do no more harm: The psychological stress of the medical examination for alleged child sexual abuse

Abstract

Aim: Currently, there is some controversy that the medical examination following allegations of child sexual abuse may further traumatise the child. Access for children to appropriate care may be hindered if decisions about referral are influenced by personal beliefs, rather than by recognition of the potential health and psychological benefits of the assessment. We aimed to study the expectations and emotional responses of children and their parents to the medical examination. Methods:We conducted a prospective quantitative and qualitative study at the Children's Hospital at Westmead. Participants completed questionnaires pre-examination and post-examination, including Children's Anxiety and Pain Scales. Clinicians recorded a Genital Examination Distress Scale and a questionnaire about potentially prognostic variables. Results: Parents found the medical examination significantly less stressful than they had anticipated. They highlighted the importance of being involved in the process, the child's reaction, staff attitudes and the doctor's explanations. Although most parents expected that the medical would be stressful for their child, this did not correlate with the children's reports of feeling scared beforehand. Increased parental and child distress were significantly associated with the child being 12 years or older. The type of abuse was not significantly linked to any of the parent or child self-reports. Conclusion: Our findings indicate that the medical examination is not as stressful as expected and support the recommendation that timely medical assessment by appropriately trained professionals should be offered for all children following allegations of sexual abuse.

The Relationship between Knowledge and Child and Caregiver Distress during the Medical Examination for Child Sexual Abuse

“…Furthermore, understanding of the examination purpose and procedure) was associated with caregiver anxiety. Unlike previous research (e.g., Marks et al, 2009), we found that greater understanding of the exam procedure was significantly related with increased report of caregiver anxiety prior to the examination. One possible explanation could be that caregivers who are aware of the exam procedure (child needing to undress, examination of genitals) may experience increased anxiety at the thought of their child undergoing examination.…”

“…These results indicate that further research is needed in order to examine factors associated with different racial/ethnic groups that may contribute to anxiety during the examination. Furthermore, parental education level is one factor that has been shown in the literature to be associated with distress during the CSAME (Marks et al, 2009) that could also influence understanding of the examination purpose and procedures and should be taken into consideration in intervention development.…”

“…For example, Waibel-Duncan and Sanger (1999) in their study of 30 girls being examined for CSA found that overall parents and their children were poorly prepared for the examination (similar to results found by Steward et al, 1995) and that increased exam knowledge was inversely correlated with child distress during the medical examination. In another study, Marks, Lamb, and Tzioumi (2009) found in their sample of 275 children being examined for possible child sexual abuse, that caregiver knowledge of exam procedures was inversely associated with caregiver report of distress before the examination; however, this relationship was not observed for the children.…”

“…Taken as a whole, results from the aforementioned studies suggest there is a significant relationship between knowledge of the examination procedures and child and caregiver distress during the forensic medical examination. However, several notable limitations exist in the research, including the use of primarily Caucasian participants (e.g., Hornor et al, 2009) and utilization of single raters of child anxiety (Hornor et al, 2009;Lazebnik et al, 1994), with only a handful of studies including both child and caregiver (e.g., Steward et al, 1995) or child and medical provider ratings of child anxiety (e.g., Gully et al, 2000;Marks et al, 2009). As such, the current study attempted to address the limitations in the existing literature by including a sample of Caucasian and African-American children attending CSAME and utilizing multiple informants (i.e., child, caregiver, and provider).…”

Non-verbal behavior of children who disclose or do not disclose child abuse in investigative interviews

“…However, this finding is consistent with Sayfan et al (2008)'s finding that children alleging sexual abuse were more "upset" during investigative interviews than children alleging other types of abuse. Perhaps sexual abuse itself is more stressful (Maikovich, Koenen, & Jaffee, 2009;Marks, Lamb, & Tzioumi, 2009;Vyssoki & Schuermann-Emanuely, 2008;Werner & Werner, 2008) or more difficult to discuss in investigative settings than other types of abuse (Alaggia, 2004;Keary & Fitzpatrick, 1994;Lippert, Cross, & Jones, 2009;London et al, 2008).…”