Department of Pediatrics, Division of Child Abuse, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States; The Children's Hospital of San Antonio Center for Miracles, 315 North San Saba, Suite 201, San Antonio, TX, 78207, United States.
Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States.
Child Abuse Negl. 2020 Mar;101:104360. doi: 10.1016/j.chiabu.2020.104360. Epub 2020 Jan 22.
Several studies conducted in clinical and non-clinical settings have described why and when children disclose sexual abuse. Yet, there is incomplete understanding of how adolescents and young children may differ in factors that delay, prompt and deter disclosure that could inform strategies for clinical practice and prevention.
The aim of this study was to identify factors that prevent, prompt, and delay disclosure among pediatric patients presenting for acute and non-acute medical evaluations of sexual abuse or assault, and to examine any differences in disclosure tendencies among female adolescents and pre-adolescents.
A chart review of a consecutive sample of pediatric patients presenting to the emergency department or outpatient clinic identified 601 patients who were diagnosed with sexual abuse and were willing to answer examiner questions about their disclosure.
Data collection included attainment of patient narratives which were utilized to gather information about abuse disclosures. Recursive abstraction was applied to categorize patient statements for further analysis, while Pearson chi square and logistic regression were utilized for quantitative data.
Young age (<11 years) at abuse onset was the strongest predictor of, and fear of consequences to self was the most common reason for, disclosure delay in both adolescent and pre-adolescent females. Severity of abuse, adult perpetrator, and self-blame predicted delays only in pre-adolescent females.
Social and moral development during middle childhood likely has a strong influence on disclosure tendency. Strategies to promote disclosure should consider reducing fear of consequences associated with the adult-child paradigm.
一些在临床和非临床环境中进行的研究描述了儿童为什么和何时会披露性虐待。然而，对于青少年和幼儿在可能导致披露延迟、提示和阻止的因素上的差异，我们还不完全了解，这些因素可以为临床实践和预防提供信息。
本研究旨在确定在因急性和非急性医疗评估而出现的儿科患者中，哪些因素会导致性虐待或性侵犯的披露延迟、提示和阻止，并检查女青少年和幼儿在披露倾向方面的差异。
对连续的儿科患者样本进行图表回顾，确定了 601 名被诊断为性虐待并愿意回答检查者关于其披露问题的患者。
数据收集包括获取患者叙述，这些叙述用于收集有关虐待披露的信息。递归抽象被应用于对患者陈述进行分类，以便进一步分析，而皮尔逊卡方和逻辑回归用于定量数据分析。
在青少年和幼儿女性中，虐待开始时年龄较小（<11 岁）是披露延迟的最强预测因素，而对自我后果的恐惧是最常见的延迟原因。在幼儿女性中，虐待的严重程度、成年施害者和自责预测了延迟。
在儿童中期，社会和道德发展可能对披露倾向有很大影响。促进披露的策略应考虑减少与成人-儿童范式相关的后果恐惧。
