More Training in Detecting Child Sexual Abuse Needed, Expert Says

Physicians at one of Southern California’s best-known medical schools asked Astrid Heger, a pediatrician who specializes in child sexual abuse, to meet with them one morning last year to review four cases of suspected abuse.

That the doctors would even entertain the notion that molestation could explain radical changes in the children’s behavior illustrates a major change in how physicians think these days, Heger said.

Change of Attitude

Until recent years, when widely publicized studies showed that 40% of women and 30% of men surveyed said that as children they had been fondled, or worse, few physicians let the idea of sexual abuse enter their minds, according to Suzanne Sgroi, a Connecticut physician who also specializes in child sexual abuse.

For those, like Heger, who have been trying to get doctors to consider sexual abuse as one explanation for behavior problems, the doctors’ inquiry into the four cases was something of a victory.

But, for Heger, it was not entirely a positive experience.

“They were convinced there was sexual abuse in all four cases,” Heger said, “but there was no support for that diagnosis in any of the cases.”

Abuse Not Involved

The physicians, she said, did not have enough clinical training to diagnose accurately either the children’s sometimes bizarre behavior or the scars some of them had. In fact, as it turned out, child abuse was not involved in any of the four cases.

Thus, Heger’s detailed clinical advice that morning saved four families from the trauma of misdiagnosis in matters with severe emotional and legal consequences.

“What we need are sensitive, conservative examinations of children by competent, well-trained physicians,” said Heger, 43, director of the sexual abuse program in the pediatrics department at the USC School of Medicine.

But there are more pediatricians and emergency room physicians than Heger and the rest of the small corps of child sexual abuse experts can ever reach directly.

“The thing that scares me most is we have a little bit of knowledge out there without ongoing training,” she said.

Now, though, the Los Angeles area United Way has moved into the delicate area with a series of videotapes to train physicians, psychologists and social workers, judges, prosecutors, detectives and beat cops about child sexual abuse. The project was managed by Brad Sales, United Way’s director of media relations, and produced by Emily Chappell, United Way vice president for public information.

The first tape, a training film for doctors with model interviews and lectures on interpreting scars illustrated with color photographs, is already being marketed to physicians, pediatric groups and medical schools nationwide, at $195 a copy. Work on the other tapes is nearing completion.

Creation of the tapes stems from an innovative United Way committee formed to focus a modest portion of the annual federated fund-raising drive’s proceeds on systemic responses to new and emerging social problems that are outside United Way’s existing network of human services agencies.

Called the Discretionary Fund Distribution Committee, it allocates to special one-time projects 10% of the increased money raised each year by United Way Inc., a coalition of 349 member agencies, 14 major health charities and the American Red Cross.

‘Needed Money’

The committee granted $143,000 to United Way to make the tapes, by far the largest of 13 grants totaling $873,721 from the 1983-84 fund-raising campaign.

Sales said the tapes grew out of an emergency request to United Way by Children’s Institute International here, which found itself deluged with media attention after the McMartin Preschool molestation case broke in fall, 1983. Many of the McMartin children had been interviewed by institute therapists.

“They needed money for media relations and funding to hire another therapist,” Sales said, “but it quickly became apparent there was a much bigger problem with professionals needing expert advice. After we helped Children’s Institute with public relations they were deluged with pleas for technical assistance locally and from places such as Jordan, Minn., and Hawaii.

“That’s how we came up with the concept of capturing the best technical assistance available on videotape,” he added.

United Way Inc. contracted for sets and for mock interviews with Heger and child actors.

The tape for physicians opens with a baby in a stroller. Sophisticated video graphics quickly relate estimates that one of three children will be sexually abused by age 18, that 50% of such abuse never gets reported to the authorities and that 80% of physically abusive mothers surveyed say they were sexually abused as children.

And then, in white letters on a black background, comes Dr. Sgroi’s observation:

“The recognition of sexual molestation in a child is entirely dependent on the individual’s inherent willingness to entertain the possibility that the condition may exist.”

The tape makes repeated use of a powerful image, an artist’s rendering of a human head in profile inside a cage.

‘Emerging Flood’

“The emerging flood of child sexual abuse cases can be compared historically to our situation 20 years ago when we were standing on the frontier of child physical abuse,” Heger said.

“We need to abort the sexual abuse in childhood as early as possible and get the kids into therapy so they can work it out and not grow up needing to be violent,” Heger said. “Only a small, small percentage of children get into the system, but if we could get more in then we could break the cycle.

“What other medical problem impacts one-third of all children and is rarely diagnosed?” she asked.