Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Child Abuse, Sexual/legislation & jurisprudence , Sex Offenses , Pediatrics , Psychiatry , PsychologyABSTRACT
OBJETIVOS: Desenvolver e estimar a validade discriminante de instrumento para determinar a probabilidade de ocorrência do abuso sexual em crianças. MÉTODOS: Estudo de caso-controle com 201 crianças que consultaram em ambulatórios de pediatria e locais de referência para vítimas de violência sexual, entre março e novembro de 2004. Casos eram crianças com suspeita ou revelação de abuso sexual e controles eram crianças sem suspeita de abuso sexual. Aplicamos, aos responsáveis, questionário com 18 itens e cinco opções de respostas segundo a escala Likert, abordando comportamento e sintomas físicos e emocionais apresentados pelas crianças. Excluímos nove crianças sem controle esfincteriano e um item com poucas respostas. Avaliamos a validade de constructo discriminante e a consistência interna dos itens com obtenção de coeficientes de correlação (Pearson, Spearman e Goodman-Kruskal), coeficiente alfa de Cronbach e cálculo da área da curva ROC (receiver operator characteristics). Calculamos a razão de verossimilhança e os valores preditivos positivos para os cinco itens do questionário com os melhores desempenhos. RESULTADOS: Questionário composto pelos cinco itens que melhor discriminaram crianças com e sem abuso sexual em dois contextos. A pontuação resultante da soma das respostas com pesos de 0 a 4 (amplitude de 0 a 20), através do teorema de Bayes (razão de verossimilhança), indica a probabilidade pós-teste de abuso sexual. CONCLUSÕES: O instrumento proposto é de fácil aplicação, auxiliando na identificação de crianças vítimas de abuso sexual. Definiu-se a pontuação que indica a probabilidade de abuso sexual, orientando na conduta de cuidado à criança.
OBJECTIVES: To develop an instrument to determine the probability of child sexual abuse and to estimate the questionnaire's discriminant validity. METHODS: Case-control study of 201 children seen at pediatric clinics and referral centers for the victims of sexual violence, between March and November 2004. Cases comprised children who had either been reported or suspected of being sexually abused and controls comprised children with no such suspicion. We applied a questionnaire to a parent or guardian of each child that consisted of 18 items, each with five Likert scale responses, dealing with the behavior and physical and emotional symptoms exhibited by the children. We excluded nine children for lack of sphincter control. One question was discarded since very few people replied to it. We evaluated the discriminant validity and internal consistency of the items, calculating correlation coefficients (Pearson, Spearman and Goodman-Kruskal), Cronbach's alpha coefficient and area under the ROC curve. We calculated likelihood ratios and positive predictive values for the five items on the questionnaire that performed best. RESULTS: The questionnaire comprises the five items that best discriminate sexually abused children from non-abused children in two contexts. The score resulting from the sum of responses weighted at 0 to 4 points (overall amplitude of 0 to 20) indicates the post-test probability of sexual abuse by means of the application of Bayes theorem (likelihood ratios). CONCLUSIONS: The instrument is easy to apply and helps in the identification of sexual abuse victims. A cutoff point was defined to indicate the probability of sexual abuse, which can be very useful to guide management of children.
Subject(s)
Humans , Child, Preschool , Child , Child Abuse, Sexual/diagnosis , Child Behavior/psychology , Surveys and Questionnaires/standards , Adaptation, Psychological , Case-Control Studies , Mass Screening , Reproducibility of Results , ROC Curve , Statistics, Nonparametric , Sexual Behavior/psychologyABSTRACT
OBJECTIVES: To develop an instrument to determine the probability of child sexual abuse and to estimate the questionnaire's discriminant validity. METHODS: Case-control study of 201 children seen at pediatric clinics and referral centers for the victims of sexual violence, between March and November 2004. Cases comprised children who had either been reported or suspected of being sexually abused and controls comprised children with no such suspicion. We applied a questionnaire to a parent or guardian of each child that consisted of 18 items, each with five Likert scale responses, dealing with the behavior and physical and emotional symptoms exhibited by the children. We excluded nine children for lack of sphincter control. One question was discarded since very few people replied to it. We evaluated the discriminant validity and internal consistency of the items, calculating correlation coefficients (Pearson, Spearman and Goodman-Kruskal), Cronbach's alpha coefficient and area under the ROC curve. We calculated likelihood ratios and positive predictive values for the five items on the questionnaire that performed best. RESULTS: The questionnaire comprises the five items that best discriminate sexually abused children from non-abused children in two contexts. The score resulting from the sum of responses weighted at 0 to 4 points (overall amplitude of 0 to 20) indicates the post-test probability of sexual abuse by means of the application of Bayes theorem (likelihood ratios). CONCLUSIONS: The instrument is easy to apply and helps in the identification of sexual abuse victims. A cutoff point was defined to indicate the probability of sexual abuse, which can be very useful to guide management of children.
Subject(s)
Child Abuse, Sexual/diagnosis , Child Behavior/psychology , Surveys and Questionnaires/standards , Adaptation, Psychological , Case-Control Studies , Child , Child, Preschool , Humans , Mass Screening , ROC Curve , Reproducibility of Results , Sexual Behavior/psychology , Statistics, NonparametricABSTRACT
OBJECTIVE: To review single aspects, which involve sexual abuse in childhood and adolescence, giving subsidies for accurate diagnosis and management, emphasizing the short and long-term consequences. SOURCES OF DATA: National and international literature review of the MEDLINE and LILACS databases, using abuse and sexual violence as keywords (1988 to 2005), in addition to the authors theoretical and practical experiences. SUMMARY OF THE FINDINGS: Sexual abuse has a great impact on child and adolescent physical and mental health, affecting development and causing lifelong damage. Its early detection allows for adequate treatment and follow-up, with minimum consequences. Family involvement must be taken into consideration, and any kind of improper relationship should be evaluated and treated, so that it can be discouraged and eliminated; otherwise, intergenerational abuse will result and probably recur. The identification of domestic violence and of physical and psychological warning signs concerning sexual abuse is part of the general evaluation. CONCLUSIONS: Pediatricians should be able to identify the signs and symptoms sexually abused children and adolescents carry with them. They have to listen carefully to the patients, perform the necessary clinical examination and establish the proper treatment. They should also be able to deal with psychological aspects and have enough knowledge about the laws and about legal and social protection measures, which are always very useful in assisting victims of sexual violence.
Subject(s)
Family , Sex Offenses , Adolescent , Child , Child Abuse, Sexual/legislation & jurisprudence , Child Abuse, Sexual/statistics & numerical data , Child Abuse, Sexual/therapy , Female , Humans , Male , Prognosis , Sex Offenses/legislation & jurisprudence , Sex Offenses/psychology , Sex Offenses/statistics & numerical dataABSTRACT
OBJETIVO: Revisar os aspectos peculiares que envolvem o abuso sexual na infância e na adolescência, oferecendo subsídios para o diagnóstico e conduta corretos, salientando suas conseqüências a curto e longo prazo. FONTES DE DADOS: Revisão da literatura nacional e internacional através do MEDLINE e LILACS, utilizando como palavras-chave "abuso" e "violência sexual" (1988 a 2005), aliada à experiência clínica dos autores. SíNTESE DOS DADOS: O abuso sexual tem um impacto muito grande na saúde física e mental da criança e do adolescente, deixando marcas em seu desenvolvimento, com danos que podem persistir por toda vida. Sua detecção precoce possibilita o tratamento e acompanhamento adequados, com a minimização das seqüelas. O envolvimento familiar deve ser levado em conta. Todas as distorções de relacionamento necessitam ser avaliadas e tratadas, para que se interrompa sua continuidade, que se dará no abuso intergeracional e na possibilidade de revitimização. A identificação da violência doméstica e dos sinais de alerta físicos e psicológicos para o abuso sexual fazem parte da avaliação. CONCLUSÕES: Todo pediatra precisa estar apto a decodificar os sinais e sintomas que a criança e o adolescente vítimas de abuso sexual trazem consigo. Necessita ser proficiente na escuta, no exame clínico e no tratamento. Deve estar capacitado para o manejo psicológico da situação de violência e ter conhecimento da legislação e meios de proteção legais e sociais existentes em sua comunidade, sempre necessários na assistência às vitimas de abuso sexual.
