Dilemma In Child Dilemma In Child AbuseAbuse

Abdulwahab M A TelmesaniAbdulwahab M A Telmesani

Associate Prof. Of pediatricsAssociate Prof. Of pediatrics

Umm Al-Qura UniversityUmm Al-Qura University

Disclosure of Child Sex Disclosure of Child Sex AbuseAbuse

Aspects of Aspects of disclosuredisclosure

The victim disclose the incidenceThe victim disclose the incidence M.D report a clear and proven caseM.D report a clear and proven case M.D reporting a suspected caseM.D reporting a suspected case Influence of the child age on Influence of the child age on

reportingreporting

To report or not to report?To report or not to report?

The ChildThe Child

How about if I am wrong and it is not How about if I am wrong and it is not abuse case?abuse case?

What harm and psychological trauma I What harm and psychological trauma I am going to inflect on the child and his am going to inflect on the child and his family?family?

Am I going to affect the boy/girl future?Am I going to affect the boy/girl future?

The M.DThe M.D

Who is going to support me?Who is going to support me?

Would it fire back at me?Would it fire back at me?

Am I at risk of being physically Am I at risk of being physically harmed?harmed?

The Culture/SocietyThe Culture/Society

Rigid.Rigid. Too many redlines.Too many redlines. Follow a wide safety margin.Follow a wide safety margin. Stigmatizing.Stigmatizing. No clear abuse legislations.No clear abuse legislations.

Boy XBoy X

HxHx

12 y boy.12 y boy. Problem of defecation.Problem of defecation. Passing whitish mucous material and Passing whitish mucous material and

sometimes blood.sometimes blood. Weight loss.Weight loss. Academic deterioration.Academic deterioration.

HxHxcont.cont.

Chaotic family background.Chaotic family background. Father is cruel as per the boy.Father is cruel as per the boy. The boy shakes when speaking The boy shakes when speaking

about his father.about his father. Father appeared as nice and Father appeared as nice and

concerned re his son. concerned re his son.

HxHxcont.cont.

Parents got separated during the Parents got separated during the time of clinic visits.time of clinic visits.

P/EP/E

Wt and Ht below 5 %ile Wt and Ht below 5 %ile Patulous anusPatulous anus Unusually large anal fissureUnusually large anal fissure Rectal prolapsedRectal prolapsed

DxDx

Picture consistent with sexual abuse.Picture consistent with sexual abuse.( suggested by 3 other physicians)( suggested by 3 other physicians)

Other pathology was R/OOther pathology was R/O

The existing legal framework for The existing legal framework for confidentiality protections is also a confidentiality protections is also a complex patchwork of state and complex patchwork of state and federal law. Additional complexity is federal law. Additional complexity is associated with the lack of clarity associated with the lack of clarity regarding how various regarding how various confidentiality requirements apply to confidentiality requirements apply to minors minors

The protection of confidentiality is a The protection of confidentiality is a significant concern for adolescents significant concern for adolescents who are seeking care and for health who are seeking care and for health care professionals who are providing care professionals who are providing it. it.

Thus, prompt disclosure buffered the Thus, prompt disclosure buffered the influence of more severe abuse. Disclosure influence of more severe abuse. Disclosure also had a main effect on the likelihood of also had a main effect on the likelihood of further victimization. further victimization.

Participants who told an adult promptly after Participants who told an adult promptly after the abuse were less likely to the abuse were less likely to reportreport additional additional unwanted sexual experiences. unwanted sexual experiences.

Kogan SMKogan SM Journal of Child Journal of Child

Sexual AbuseSexual Abuse

Disclosure of childhood sexual abuse: Disclosure of childhood sexual abuse: Links to emotion expression and adult Links to emotion expression and adult

attachmentattachment

“ “Earlier disclosures were associated with Earlier disclosures were associated with extra- familial perpetrators, childhood extra- familial perpetrators, childhood emotional expressiveness, and disclosures emotional expressiveness, and disclosures to immediate family” to immediate family”

Distel, Nancy Distel, Nancy EE

DISSERTATION DISSERTATION

Disclosure of childhood sexual abuse: Disclosure of childhood sexual abuse: Links to emotion expression and adult Links to emotion expression and adult

attachmentattachment ““Later disclosures were associated with Later disclosures were associated with

incest, withdrawal and distraction emotion incest, withdrawal and distraction emotion coping strategies, coping strategies, disclosuredisclosure to persons to persons outside the immediate family, and self-outside the immediate family, and self-reported dismissing-avoidant attachment reported dismissing-avoidant attachment behaviors” behaviors”

Distel, Nancy EDistel, Nancy E DISSERTATION DISSERTATION

Social reactions to child sexual Social reactions to child sexual

abuse disclosures: a critical reviewabuse disclosures: a critical review

Most studies assessing social reactions Most studies assessing social reactions in detail have concerned adult in detail have concerned adult survivors retrospectively reporting on survivors retrospectively reporting on their their disclosuresdisclosures of child sexual abuse. of child sexual abuse.

Ullman SE Ullman SE Journal of Child Journal of Child

Sexual AbuseSexual Abuse

Social reactions to child sexual Social reactions to child sexual

abuse disclosures: a critical reviewabuse disclosures: a critical review

Clear evidence shows that negative Clear evidence shows that negative social reactions are harmful to survivors' social reactions are harmful to survivors' well-being well-being

Ullman SE Ullman SE

Journal of Child Journal of Child

Sexual AbuseSexual Abuse

Disclosure of childhood sexual abuse: Disclosure of childhood sexual abuse: Links to emotion expression and adult Links to emotion expression and adult

attachmentattachment Distel, Distel,

Nancy ENancy E

DISSERTATIONDISSERTATION

Disclosure of childhood sexual abuse: Disclosure of childhood sexual abuse: Links to emotion expression and adult Links to emotion expression and adult

attachmentattachment “ “exploratory analysis of the victim's self-exploratory analysis of the victim's self-

reported emotional responses to the reported emotional responses to the abuse revealed high levels of abuse revealed high levels of experienced fear, sadness, and shame, as experienced fear, sadness, and shame, as well as elevations in surprise, guilt, and well as elevations in surprise, guilt, and angeranger””

Distel, Nancy EDistel, Nancy E

DISSERTATION DISSERTATION

Boy XBoy X F/UF/U

Father and mother counseledFather and mother counseled Father sent to psychiatristFather sent to psychiatrist Mother sent to psychologistMother sent to psychologist Family reunitedFamily reunited The boy is better physically and The boy is better physically and

psychologicallypsychologically