Developmental differences in detection and disclosure of sexual abuse

This study examined the role of developmental differences in the detection and disclosure of child sexual abuse.

A random medical record review was conducted of 72 children and adolescents seen over a consecutive 3-year period for suspected sexual abuse in the emergency room of a pediatric hospital. The following data were gathered: (1) demographic information, (2) presenting symptomatology that initiated caregiver decision to seek evaluation, (3) type of disclosure (purposeful or accidental), and (4) precipitants to disclosure.

Preschool age children were significantly more likely than school age children and adolescents to exhibit behavioral or physical symptoms that prompted caregivers' suspicion of sexual abuse. Preschool age children made disclosures accidentally and typically with an immediate precipitating event unrelated to the abuse itself. In contrast, sexual abuse disclosures from school age children were purposeful and not associated with a precipitating event.

Practitioners need to be aware of the developmental differences in the detection of sexual abuse, including the forces that inhibit disclosure in older children.