Interpreting children's labels for sex-related body parts of anatomically explicit dolls.

Sexually abused children are often said to use idiosyncratic terminology when referring to sexual body parts. Anatomic dolls are often used in sexual abuse investigations, especially of younger children, with both their behavioral and verbal responses used to draw conclusions about the likelihood of sexual abuse. However, there is little information available about the responses of nonabused children to these dolls. This study characterizes the terms nonreferred children use to label sexual body parts of anatomic dolls. The study involved 144 children ages 3 through 8 years who were asked for their names for specific body parts including anus, breast, buttock, penis, scrotum, and vagina. Responses for breast, buttock, and penis were more precise than for other body parts. More than half the respondents did not have labels for anus and scrotum. The "age" and "gender" of the dolls had little effect on the children's responses. Older children had more accurate terminology than younger children for sexually related body parts except for penis and anus. For the most part, the gender of the child or the interviewer had little influence on responses.

Interaction of normal children with anatomical dolls.

Anatomical (sexually explicit) rag dolls are frequently used in interviews of children suspected of being sexually abused. Abused children have been noted clinically to be aggressive and sometimes sexually precocious in their doll play, and testimony to that effect is often accepted in the courtroom as pertinent evidence. However, to date, normative data on the play behaviors with the sexually explicit dolls have been unavailable. This pilot study provides empirical information on the play interaction of a relatively large number of normal (nonreferred) children with anatomical dolls. One hundred forty-four children (ages 3 to 8 years) were observed in a playroom containing these special dolls during three conditions: (1) with an adult present, (2) without an adult, and (3) with the dolls undressed. The observations showed that nonreferred children found these dolls no more interesting than other toys. Little aggression and no explicit sexual activity were observed. In contrast to clinical observation of abused children, the doll play of nonreferred children is unlikely to be characterized by aggression or sexual concerns; thus these behaviors when observed in interaction with these dolls should be taken seriously.

Magnetic resonance imaging of intracranial injuries from child abuse.

Magnetic resonance imaging (MRI) and computed tomography (CT) were compared in four children who had evidence of intracranial injury caused by shaking. All children had intracranial bleeding, neurologic impairment, and history or physical examination findings suggestive of child abuse. Three had bilateral retinal hemorrhages, and three had visual impairment. MRI revealed bilateral subdural hematomas in all four children, but CT showed this in only one. Skull fractures in one patient were visualized by CT alone. MRI alone demonstrated posterior fossa bleeding in one patient and intraparenchymal bleeding in another; an additional patient in whom CT showed relatively diffuse atrophy also had defined areas of focal atrophy apparent on MRI. Subarachnoid hemorrhages were equally well detected using CT or MRI. Overall, MRI was superior to CT for detection of intracranial injury caused by shaking, and may help to document milder instances of this form of child abuse.

PKU and temperament. Rating children three through seven years old in PKU families.

Parents of children with PKU completed behavior rating forms for their children three through seven years old. The 25 completed forms represented 79 percent of the families contacted; 16 of the children had PKU and 9 were siblings of children with PKU. Of the 16 children with PKU, 15 were on phenylalanine-restricted diets at the time of the study. The children with PKU were rated as significantly more rhythmic, more intense, and less persistent than the siblings without PKU. When ratings were compared with those obtained from a private pediatrics practice, children with PKU were significantly less persistent and the siblings were significantly less rhythmic and less intense. There was a significant correlation between blood phenylalanine levels and persistence ratings, with children having higher blood levels tending to be rated as less persistent than children having lower blood levels.

Partial recovery from severe child neglect and abuse.

A 3-year-old boy and his 9-month old sister received developmental assessments 2 weeks after removal from a neglectful and abusive family. The children were evaluated for a second time 5 months after removal, after spending the interval together in a foster care setting. They received no specialized services geared toward stimulating their development. Significant impairments in growth, cognition, adaptive skills, and language noted during the initial assessment were not as evident at followup. The developmental profiles, however, were not normal. The largest gains were in adaptive skills. Expressive language skills remained relatively impaired. It appears that significant developmental gains can occur in developmentally impaired children who are removed from an abusive and neglectful home and placed in foster care for several months.