Date of Award

10-20-2006

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

John Leventhal

Abstract

This study aimed to investigate the context within which children initially disclose their sexual abuse. The study sought to identify triggers that prompted the initial disclosure event, and to investigate the relationship between the choice of initial confidante and the childs age and likelihood of disclosing during formal interview. Data were obtained in a prospective fashion from 60 alleged child sexual abuse victims referred to the Yale Child Sexual Abuse Clinic (CSAC). Inclusion criteria required that a child must have disclosed to a confidante prior to referral to the Clinic; 57 of 60 children met this criterion and are included. Victim and perpetrator demographics, details of the initial disclosure event, and any identified triggers were obtained in a systematic fashion as part of the standard clinical evaluation by CSAC social workers. Analysis was conducted to investigate the relationship between childs age and choice of confidante, and childs choice of confidante and likelihood of disclosing in a formal interview. Of 57 children, 23% were abused by immediate family members and 39% by extended family members; 49% of cases involved penetrative abuse; and 51% of perpetrators were aged 18 or younger. The three most common triggers for disclosure included: questioning by an adult (26.3%), witnessed abuse (12.3%), and safety of being away from perpetrator (10.5%). The three most common initial confidantes included parent-figures (42%), DCF workers or police (15%), and child peers (12%). The majority of children (81%) disclosed during a formal interview with a Clinic social worker. There was a statistically significant relationship between victims age and choice of confidante: 60% of children aged 2-7 initially disclosed to a parent figure, in comparison to only 28% of children aged 8-15 (p=0.034). Additionally, 21% of older children first disclosed to a child peer or sibling, while no younger children did so. We found no relationship between a childs initial choice of confidante and likelihood of disclosing during formal interview (p=0.06). No relationship existed between a childs age and likelihood of disclosing during formal interview (p=0.43); older children, however, were more likely to provide detailed disclosures during formal interview than younger children (p=0.054). In support of our first hypothesis, our data showed a statistically significant relationship between victims age and choice of confidante. Of equal interest, the results did not support our hypothesis that there would exist a relationship between a childs initial choice of confidante and likelihood of disclosing during the formal interview, nor our hypothesis that educational programs or discussions would result in spontaneous disclosures. Of central importance to the understanding of childrens disclosures, our sample most frequently disclosed to a parent-figure while at home and often while engaging in one-on-one activities with the trusted adult confidante to whom they disclosed.

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This is an Open Access Thesis.

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