Sexual Abuse—

What Do You Ask A Child When You Suspect The Worst?

By Jan Howard

There were 88,000 substantiated cases of sexual abuse of children, a rate of 1.3 per 1,000 children, in 1999 in the United States.

Sexual abuse is the involvement of dependent, developmentally immature children and adolescents in sexual acts that they do not fully comprehend, to which they are unable to give informed consent, or that violate the social and legal taboos of society.

Dr John M. Leventhal, professor of pediatrics at Yale University School of Medicine, spoke about “What to ask when sexual abuse is suspected” during the third annual Child Abuse Conference held recently at Danbury Hospital, sponsored by the Department of Pediatrics.

 “Twenty to 25 percent of women were sexually abused before age 16; of men, five to ten percent,” he said.

From 1990 to 1992 the rate of child sexual abuse went up, he said, but declined between 1992 and 1998. He questioned whether this decline was because of more abusers being locked up, doing a better job of stopping recurring abuse, or changes in how cases are classified.

To determine sexual abuse, an interviewer must put pieces of a puzzle together. He or she must look at the child’s behavior and statements, look at family and social history, and interview the child.

“Stay away from leading questions,” he said.

By interviewing the child, a doctor or other person can determine if there has been sexual abuse, understand the child’s experience for evaluation and treatment, and to help the child begin to process the experience, through counseling.

An interviewer must understand the child, and think about what the child is thinking about and difficulties that might occur, he said. As an example, he talked about a 6-year-old girl, with signs of physical abuse, who was hypothermic and had numerous bruises and scars. When questioned, the child said her brother had buried her in snow, but there was no snow. Then she said her mother hit her with the strap of her purse. It was important to determine how she was injured.

In efforts to determine how the abuse occurred, there is pressure on the child’s ability to remember and report.

 Child sexual abuse usually involves secrecy, helplessness, entrapment and accommodation, delayed, conflicted and unconventional disclosure, and retraction, he said.

The interviewer must determine what is the truth, he said. A child may want to be helpful but be embarrassed to talk about the experience or not want to say anything in order to preserve his or her place in the family. There may be pressures on the child either to remain silent or disclose because of threats by the perpetrator or because he or she wants to please or protect a parent.

Researchers have studied the ability of children to remember and report accurately on an experience. There were staged events to test children’s recall in regard to the events over a certain time period.

The studies found there was no waning of memory. The children did not seem to forget, but as they got older they told more details and different parts of the story each time.

“There was a lot of inconsistency. They were remembering in a different way,” Dr Leventhal said. “They were remembering different parts of what happened.”

He suggested strategies to enhance children’s recall, enhance their initial narrative, and reduce the need for leading questions.

Children can be trained to be more informative. Dr Leventhal said children in an open-ended condition provided more details and words when asked about sexual abuse. They were first asked questions about their families, then questions about the abuse.

“They were telling you what they wanted to say,” he said.

Dr Leventhal said interviewers should know the extent of the child’s language skills and development level. They should know the names used for body parts, names of people in the family, and the child’s ability to understand the difference between truth and lies.

To get the details, ask what happened, where and when, and how often. Ask what part of the perpetrator touched the child and what part of the child’s body was touched. Ask if the child was being photographed or if he or she watched a video.

It is absolutely all right for non-experts to interview a child, Dr Leventhal said. Ask the child to talk about exactly what happened, and then ask what happened next.

“The key is to stop at the right time,” he said. Write a detailed note about what the child said.

During a physical examination of the child, ask the child to show on his or her own body what happened, he said. “This can be very helpful,” he said.

Avoid multiple interviews and multiple interviewers, he said. Ask clear questions. Do not interrupt the child or assume to know the meaning of what the child is saying.

“Do not react to awful news,” Dr Leventhal said. “Talking to children about personal things, you risk hearing things that are terrible that happened to children.”