Anal findings in sexual abuse of children (a descriptive study)

The aim of this study was to assess anal physical findings in children whose abuse was admitted by the perpetrator. Fifty children were studied in whom medical assessment took place remote in time from anal abuse which was admitted by the perpetrator. Medical assessment included examination to detect the presence of anal physical signs. Most frequent signs were anal scars and tags (either single or multiple) present, respectively, in 84 and 32% of cases. In some cases scars extended to the perianal region. Other signs included reflex anal dilatation (RAD) and venous congestion (VC) found, separately or associated with other signs, in over 33% of the cases. In 6% of the cases there were no abnormal anal findings. The results confirm earlier reports that physical signs, including scars, tags, RAD, funneled anus and extensive venous congestion, are often present in abused children, singly or in combination, and that anal examination should be undertaken even months after a known or suspected sexual assault. In the legal setting these physical signs are seen in association with anal abuse and support the child's statement. They do not per se provide proof of abuse.     

Who made the disclosure? Recorded discussions between children and caretakers suspecting child abuse

Within investigations of suspected child abuse, the child's account is often at the core of the judicial process. When analysing the child's account, it is therefore important to consider how parents may have discussed the suspected abuse prior to the official investigation. However, no studies up to the present time have investigated discussions in real cases where parents suspect that their children have been abused. We analysed a sample (N = 19) of recorded conversations between parents and their children, delivered to the police as evidence for alleged physical or sexual abuse. Analyses of the questions used and the information provided in the discussions showed that the parent's strategies when questioning their children were extremely leading and that in the majority of the cases, all new information was provided by the parents. In spite of this, the parents deemed the recorded conversations as records of the children's accounts. While the sample was small and likely to be unrepresentative of child abuse suspicions in general, the findings have important practical implications. The results indicate that when planning an interview in a case where the alleged abuse relies on what a child allegedly has told a parent, particular caution should be taken when referring to these conversations.     

Medical examination of sexually abused children: medico-legal value

The Department of Forensic Medicine (forensic pathology and clinical forensic medicine), Aarhus, Jutland, Denmark, performs examinations of children suspected to have been sexually abused when reported to and requested by the police in Jutland, Denmark. Jutland covers an area of 210,000 km2 with about 300,000 inhabitants in Aarhus. A colposcope initially equipped with an Olympus camera, but now with a video camera attached has been used since 1994. Since 1994 the department has performed more than 100 examinations of children suspected of having been sexually abused. A preliminary study was taken to evaluate all cases from 1995 including the legal outcome. RESULTS: The material included 34 cases with three boys, mean age 11 years, and 31 girls, mean age 8 years, at the time of the examination. The sexual abuse events were fondling including penetration of the vagina, vaginal (14), anal (7), and oral (5) intercourse as well as cunnilingus and nontouching abuses. The medical examination was most often performed more than a week after the abuse. The examination revealed normal findings in 23 cases, nonspecific findings including erytherma in 13 cases, and in only one child was a traumatic lesion with rupture of the hymen seen. The perpetrators were above 25 years of ane and were family members or someone known to the child. Nine perpetrators were convicted at court, of whom three admitted having abused the child. CONCLUSION: A medical examination in cases of sexual child abuse seldom provides a legal proof of sexual abuse. The most important is the story told by the child. Therefore, the examination is a supplement which may support or remain neutral to the story told by the child.     

Clinical forensic examination findings and legal outcome in cases of suspected sexual child abuse

The clinical forensic examinations conducted at the Institute of Legal Medicine of the Hanover Medical School between 1999 and 2008 in cases of suspected sexual abuse of children were evaluated retrospectively and analysed with regard to their legal outcome. In total, the study included 223 children (172 girls, 51 boys) with a median age of 8.6 years. In 34 children (15.2%), forensically relevant diagnostic findings due to anogenital injury and/or detection of semen were recorded. Perpetrators were convicted more often when they were not a member of the victim's family. In cases with victims aged seven years or older, conviction was more common. The study shows that medical findings can best be preserved by an immediate clinical forensic examination. Suspected sexual child abuse can often not be proved by medical examination results, but in some cases diagnostic findings are not mandatory for conviction.     

The role of clinical forensic medicine in cases of sexual child abuse

The work of specialists in forensic medicine in those cases of child abuse that result in the killing of a child is defined and well known. It is less well defined in cases of (suspected) sexual abuse. The cases presented show the difficulties that arise if medical doctors and prosecutors are uncertain about the procedures that have to be followed or do not appreciate the value of objective findings. It is concluded that knowledge about necessary examinations by physicians, police officers and prosecutors has to be promoted in order to improve handling and (legal) outcome of these cases.     

Approaches to the improvement of forensic medical expertise in the cases of sexual crimes and doubtful gender status

The authors analyzed the results of the forensic medical expertise of the cases of sexual assaults and covert sexual abuse. Special attention is given to the peculiarities of forensic-medical expertise in the cases of veneral diseases and HIV-infection, injuries to sexual organs in women and men. The specific approaches to the examination of corpses in the cases of atypical sexual behavior or a murder supposedly committed for sexual motives are considered.     

Post-mortem radiological examination in infants:: Evidence of child abuse?

We examined the value of post-mortem radiological examination of infants who were brought in for medico–legal autopsy. Twenty children between the age of 1 month and 15 months died under the picture of SIDS. No radiological or other signs of previous child abuse were seen in our autopsy material. A fatal case of child abuse with several metaphyseal fractures is reported. Some fractures were not visible on gross examination, but could be demonstrated by radiography and histology. In our material no association between SIDS and child abuse was found. In suspected cases of child abuse, particularly rib fractures and metaphyseal fractures should be sought. We recommend that post-mortem radiography is performed in such cases. If fractures are demonstrated, they should be verified by histologic examination.     

Alleged Biological Father Incest: A Forensic Approach

Paternal incest is one of the most serious forms of intrafamilial sexual abuse with clinical, social, and legal relevance. A retrospective study was performed, based on forensic reports and judicial decisions of alleged cases of biological paternal incest of victims under 18 years old (n = 215) from 2003 to 2008. Results highlight that in a relevant number of cases: victims were female; the abuse begun at an early age with reiteration; the alleged perpetrator presented a history of sexual crimes against children; sexual practices were physically poorly intrusive, which associated with a forensic medical evaluation performed more than 72 h after the abuse, explain partially the absence of physical injuries or other evidence—these last aspects are different from extrafamilial cases. In conclusion, observations about paternal incest are likely to exacerbate the psychosocial consequences of the abuse and may explain the difficulty and delay in detect and disclose these cases. Few cases were legally prosecuted and convicted.     

Adolescent girls investigated for sexual abuse: history,physical findings and legal outcome

Objective: The aim of the study was to summarize the history of assault and record the results of medicolegal examination in adolescent girls under investigation for alleged sexual abuse, and to monitor the outcome of the legal process. The investigation period was 1990–94. Method: A consecutive series of 94 0-para girls, aged 9–22, median age 15.0 years, were examined in the head-to-toe manner including anogenital examination. Girls were referred from investigating police and social authorities. Only non-acute examinations were performed. Findings considered consistent with abusive vaginal penetration were hymenal distortion including deep clefts, hymenal and vestibular scarring, and introital diameter permitting vaginal inspection with a 17 mm speculum in the absence of consensual intercourse. Perianal scarring was recorded. STD sampling was made on indication. Findings were documented on body sketches. Medicolegal conclusions were grouped into three categories according to history and physical findings. Information on the outcome of legal procedures was collected from referring authorities. Results: For 82% (77/94) of the girls, referring agencies provided examining physicians with a detailed and consistent history of abuse, presented results comprise these 77 girls. Intrafamiliar abuse was alleged by 81% (62/77), onset prior to menarche by 53% (41/77), and repeated abuse by 74% (57/77) of the girls. Abusive genital penetration was reported by 77% (59/77) and anal penetration by 19% (14/77). Sequelae after admitted self-inflicted injury were found in 15% (12/77). Deep hymenal celfts and/or vestibular scars were found in 59% (35/59) of the girls reporting penetrative abuse, compared with 6% (1/16) when non-penetrative abuse was alleged, P<0.001. Girls with experience of voluntary intercourse could all be examined with a 25 mm speculum. Of the 17 girls without experience of consensual intercourse but alleging abusive penetration, 47% (17/36) could easily be examined with a 17 mm speculum, compared to none of 13 reporting non-penetrative abuse, P<0.001. Non-specific anal abnormalities occurred in 10 (13%) girls; more often when anal abuse was reported, P<0.001. No specific STDs were found. The medicolegal conclusion supported a history of abusive genital penetration in 41 (69%) cases; findings were non-specific in 11 cases and a normal anogenital status was found in 25 cases. The alleged abuse of 34 of the 77 (44%) girls was tried in court. One suspect was acquitted, 32 men were convicted of the abuse of 33 girls. Eleven perpetrators admitted abuse, and their histories were in concordance with the abuse alleged by the victims, as well as with the physical findings. Conclusion: A medicolegal diagnosis of alleged non-acute cases of sexual abuse relies on a detailed history. Adolescent girls alleging abuse may exhibit signs of admittedly self-inflicted extragenital injury. Our findings confirm that non-penetrative sexual acts leave no lasting genital signs, but that repeated abusive genital penetration significantly more often than non-penetrative abuse leaves deep posterior hymenal clefts and/or vestibular scarring, and a hymenal opening allowing examination with 17–25 mm specula also in girls without experience of voluntary intercourse. In cases with a confessing perpetrator, no discordance was found between the history of the victim, medicolegal conclusion and the history of the perpetrator.     

Clinical forensic examination findings and legal outcome in cases of suspected physical child abuse

Clinical forensic examinations performed at the Institute of Legal Medicine of the Hanover Medical School between 1999 and 2008 in cases of suspected physical abuse of children were analyzed retrospectively with special emphasis on the legal consequences. Altogether, 192 children (85 girls, 107 boys) with a median age of 4.4 years were examined. In 47 cases (24.5 %), the clinical forensic examination findings were interpreted as accidental injuries, birth traumas or unspecific findings. 29 victims (20.0 %) had suffered a shaken baby syndrome. Only part of the presented cases ended with conviction, which was more likely if the victims were aged between 7 and 11 years. Prison terms of 2 years and more were imposed only if the child suffered potentially or acute life-threatening injuries or if additional anogenital lesions were diagnosed indicating sexual child abuse.     

Legal responses to child sexual abuse cases in the Children’s Court of Victoria: study findings on a case-management approach

Child sexual abuse cases present Children’s Courts with distinctive challenges. The highly conflictual nature of child sexual abuse cases means they do not lend themselves to the usual adversarial court processes that characterise the conduct of Magistrate Court matters in Australia. With this in mind, the Children’s Court in Victoria established for 12 months in 2013 a pilot specialised judicial list (known as the ‘D’ List) which offered an intensive Magistrate-led case management approach to child sexual abuse cases in the Family (child protection) Division of the Court. The operation of the List was evaluated to assess the suitability and effectiveness of this approach, and to investigate the challenges associated with managing and deciding this class of cases. The findings confirmed that the List provided better management of cases and reduced delay. Given this, the Court is continuing the judicially proactive intensive case management approach and dedicated list for child sexual abuse matters and extending it to regional courts; believing it to be a more effective approach to managing and deciding this complex class of cases.     

Distinct age-related differences among victims in cases of suspected child abuse

Evidence describing age-related differences among children with suspected physical and sexual child abuse is lacking. We describe findings in severe cases of suspected abuse. Cases with 756 children <15 years old were included during 2001–2013 at the Department of Forensic Medicine, Aarhus University, using forensic evaluation documents, medical records, and court proceedings. Eight percent of children <4 years old died from child abuse, 36% through violence resulting in death, and 64% by manslaughter, whereas 1% > 4 years old died, solely by manslaughter. External injuries were mainly located to head and torso in children <4 years old, changing to the upper and lower extremities in older children. Child sexual abuse was suspected in 52% of cases with living children <4 years old, 83% of children 4–7 years of age, 88% of children 8–11 years of age, and 93% of children >12 years old. Anogenital findings were mainly caused by other medical conditions in children <4 years old, hymenal clefts in the superior half of the hymenal rim were almost exclusively found in children between 8 and 11 years of age, whereas both superficial and complete hymenal clefts in the inferior half of the hymenal rim were found in children >12 years old. The present study describes age-related differences in victims of suspected child abuse. Fatal versus nonfatal child physical abuse and the significance of hymenal findings in child sexual abuse could be studied further.     

Taking the stand: defendant statements in court cases of alleged sexual abuse against infants,toddlers and preschoolers

Investigating and adjudicating allegations of child sexual abuse are challenging tasks. In the present study, we examined defendant statements concerning charges of sexual abuse against young children in Swedish district court cases (87 defendants, 140 child complainants, tried between January 2010 to December 2015). A main objective was to test predictive factors for admissions of guilt using inferential statistical analyses. Furthermore, using qualitative thematical analysis, we sought to identify common patterns in the defendants’ explanations to the allegation. Approximately one-third of the defendants (31%) pleaded guilty during trial. Admissions of guilt were more likely if the defendant was young, if the child was young at the onset of abuse, if the child and perpetrator had an extrafamilial relationship, and if the defendant possessed child pornography. A conflict with the person who made the report (e.g. a custody dispute), a testimony from the child, a direct eyewitness, or an informal disclosure recipient were significantly more common in cases of denials. In the qualitative analysis, a range of alternative explanations behind the abuse allegations were identified. Legal professionals and investigators may benefit from considering these alternative hypotheses during their investigative and judicial work.     

WHERE IS THE JUSTICE? PARENTAL EXPERIENCES OF THE CANADIAN JUSTICE SYSTEM IN CASES OF CHILD SEXUAL ABUSE*

Research concerning child victims of sexual abuse in the judicial system cites largely negative experiences and outcomes. However, few investigations focus on parental experiences of the justice system. Using a grounded theory method this Canadian study explored parental experiences of legal and judicial processes for child sexual abuse victims. Nineteen in‐depth interviews with parents encountering the justice system, as well as interviews with professionals working in those systems were analyzed. Results show a wide range of experiences, with parents reporting predominantly negative outcomes that potentially impede healing for children, indicating earlier judicial reforms have not been realized. Recommendations call for structural changes in the judicial system and more provision of parent‐focused supports.     

Staphylococcal scalded skin syndrome mimicking child abuse by burning

Child abuse by burning comprises 6–20% of all child abuse cases, but misdiagnosis may arise in cases of some medical conditions. We present two cases of suspected inflicted burns, later diagnosed as staphylococcal scalded skin syndrome (SSSS).     

Mandatory Child Abuse Reporting Laws: Issues and Implications for Policy

Child maltreatment has been deemed a national emergency, with more than 2.5 million cases of abuse and neglect reported each year. Social policies designed to address child maltreatment include state statutes requiring professionals to report suspected child maltreatment to authorities. Mandatory reporting laws, while of potential benefit in the identification of abused and neglected children, can often result in higher or lower rates of reporting of abuse. The present paper reviews the functions of mandatory reporting statutes in professional contexts. Factors related to both low and high rates of reporting are discussed. In addition, suggestions for social policy are reviewed.     

Delayed Prosecutions of Historic Child Sexual Abuse: Analyses of 2064 Canadian Criminal Complaints

Recently, in many English-speaking countries, legal principles that had the effect of barring delayed criminal prosecutions have been abrogated. In these jurisdictions, criminal prosecutions of child sexual abuse that is alleged to have occurred in the distant past (historic child sexual abuse or HCSA) are a growing legal challenge. These cases raise myriad issues relevant to research and the development of public policy that would benefit from a considered exchange of ideas that is informed by a clear understanding of the phenomenon. Based on 2064 judicial decisions of Canadian criminal complaints of HCSA we describe the trial, the complainant, the accused, and the offence. In the context of these legal cases, we raise some of the germane issues as well as suggestions for future research and discussion that we believe are particularly current and pressing.     

裁判规范还是行为规范——对滥用职权罪的功能性考察

刑法规范具有行为规范和裁判规范的功能。滥用职权罪应以行为规范功能为先,以“重大损失”作为构成要件限制了其行为规范功能;司法上的扩张解释虽然有助于实现该功能,却又危及罪刑法定原则。滥用职权罪之行为规范立足于规范的实质根据和价值取向,构造为义务规范,旨在保障职权的安全行使。立法和司法工作应当遵循行为规范功能,强化义务意识,预防优先。     

Accidental autoerotic death by volatile substance abuse or nonsexually motivated accidents?

In contrast to typical autoerotic fatalities, when death is due to asphyxia mostly by mechanical compression of the neck, atypical autoerotic accidental deaths (AADs) involve sexual self-stimulation by other means such as electrocution or inhalation of chemical agents. Especially in lethal cases of volatile substance abuse (VSA), a differentiation between suicide or sexually or nonsexually motivated accident is often complicated in practical casework. Considering the small number of AADs involving chemical substance abuse reported in the literature, the number of unreported cases seems to be very high. We report about 5 lethal cases of VSA; analysis was performed using headspace solid-phase microextraction (HS-SPME) and gas chromatography-mass spectrometry (GC/MS). When headspace sampling is not performed at autopsy, the analysis of volatile substances can be very complicated. In 2 cases, an AAD was diagnosed considering findings at the scene, reconstruction of the event, and discussion of the circumstances of the death. These findings demonstrate the importance of VSA in atypical autoerotic asphyxia. Therefore, in cases of suspected lethal inhalational intoxications, as a matter of principle, headspace asservation should be performed at autopsy and an autoerotic motivational background should be taken into consideration for differential diagnosis.