Sexual Abuse, Another Hidden Pediatric Problem: The 1977 C. Anderson Aldrich Lecture

Abstract

Each week we find among our pediatric-adolescent patients, among youngsters at the Kennedy Child Development Center, and among the children seen at our child psychiatric service, increasing numbers of sexually abused children whose presenting chief complaint is nonspecific. The nonspecific symptoms I have described may be the only clues we physicians have that we may be dealing with sexual abuse. One requires sensitive attention to the patient, good listening, taking time, and always going beyond the presenting "chief complaint." The runaway who is simply asked "Why did you run away?" will say, "I had afight with my folks." The next question is "What was your fight about?" The answer, "I was out late." Most professionals stop right there, but that's where we should all start. We simply have to know more. One needs to lead up to the relationships with the child's mother and father, and then one finally has to ask some direct questions, in as kind a way as possible, in order to give the child permission to relate his/her loneliness, shame, and fears. Sexual abuse should always be viewed from a developmental point of view, and it is the point of each child's development which determines the ultimate impact that sexual abuse has. Early and decisive intervention, rescue, and supportive therapy work well, even if the family is not reunited. The child deserves a chance at therapy just as much as if there were any other insult to development. Pediatricians routinely try to find children who have hearing and speech problems. Should we not be equally open and ready, intellectually and emotionally, for the condition of incest, which is the last taboo? Thank you for allowing me to share with you this hour honoring the late Dr. Aldrich. I hope that I have done him honor.