IPT Book Reviews

Title: A Practical Guide to the Evaluation of Sexual Abuse in the Prepubertal Child
Authors: Angelo Giardino, Martin A. Finkel, Eileen R. Giardino, Toni Seidl, and Stephen Ludwig
Publisher: Sage Publications, Inc., 1992

Sage Publications, Inc.
2455 Teller Road
Thousand Oaks, CA 91320
(805) 499-0721
$49.95 (c)

According to the preface, this 152-page book is intended "to serve as a reference guide for health care professionals called upon to evaluate children suspected of having been sexually abused." Included are "clinical social workers, psychologists/psychiatrists, child protective service workers, and law enforcement personnel" (p. xiii). The inclusion of police, prosecutors, and protective workers in the health care team suggests the bias of this book. Throughout, children are termed the "victim" and the possibility of a suspicion of sexual abuse being a mistake is never considered or mentioned.

In the discussion of a health care professional interviewing a child, the authors state, "children are unlikely to fabricate tales about detailed sexual activity" (p. 16). While there are occasional cautions about asking leading questions or suggesting concepts to a child, the thrust is to believe that children have been abused, regard them as victims, and aim at eliciting information that will aid in prosecuting the perpetrator. Health care professionals are encouraged to suspect abuse, and signs are given that can be a basis for concluding abuse may have happened. No research citations are given for any of the suggested signs.

There is confusion between the investigative goal of seeking an accurate, truthful account and the therapeutic goal of beginning the process of healing. The latter assumes that the child has been abused and that healing from the abuse is therefore necessary. The health care professional doing a medical evaluation may well be the first authority figure to encounter the child, so the authors believe that therapy for the abuse should begin there. The health care professional thus does both — investigates and heals.

The chapters providing guidance on how to conduct a medical examination and what the observations may mean summarize the medical procedures succinctly and clearly. But only literature supporting these interpretations is cited. As an example, the research falsifying the interpretation of inappropriate sexual behaviors to mean prior abuse is not presented. There is a discussion of diseases and physical injuries that may mimic signs of abuse and can be mistaken for effects of abuse. There are a number of useful diagrams and pictures that may assist a non-medically trained professional understand some of the basic facts about human anatomy.

The book does not offer a balanced or comprehensive approach to relevant research data. It does, however, give an idea of what many medical examinations may be like. This provides a basis for determining the weight to be given to a specific medical examination when there is an allegation of sexual abuse.

Reviewed by Ralph Underwager, Institute for Psychological Therapies, Northfield, Minnesota.

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