Aportes del psicoanálisis a los estudios de abuso sexual infantil: Análisis del discurso de la madre de una niña abusada sexualmente / Contributions of psychoanalysis to studies of child sexual abuse: Mother's speech analysis about her sexually abused daughter

Se presentan los resultados dela tesis doctoral sobre los deseos y defensas (y sus estados) de la madre de una niña abusada sexualmente, con el objetivo de conocer su estructuración subjetiva en este difícil acontecimiento. Se trata de un estudio de caso en el que se usa como método el Algoritmo David Liberman (ADL), en el análisis del discurso de la madre, seleccionadas tres sesiones y una carta manuscrita. El estudio de deseos y defensas puede contribuir a describir y conocer el posicionamiento subjetivo de una madre frente a la situación abusiva de su hija, y como ésta es vivida por ella AU

The results of the doctoral thesis on the wishes and defenses (and their states) of the mother of a sexually abused girl are presented, with the aim of knowing her subjective structuring in this difficult event. This is a case study in which the David Liberman Algorithm (ADL) is used as a method in the analysis of the mother's speech, three sessions and a handwritten letter selected. The study of desires and defenses can contribute to describing and knowing the subjective position of a mother in the face of her daughter's abusive situation, and how it is experienced by her AU

Use of Tanner stages to estimate chronological age in alleged child pornography cases: A systematic review. / Uso de las etapas de Tanner para estimar la edad cronológica en presuntos casos de pornografía infantil: Revisión sistemática.

INTRODUCTION: The last two decades have seen an exponential growth in the distribution and availability of child pornographic material on the Internet and social networks. The medical community is involved in assisting the investigating authorities in relation to estimating the age and sexual maturity of the alleged victims. OBJECTIVE: To determine the efficacy of using Tanner stages as a method for esti mating chronological age in alleged child pornography cases based on published evidence. MATERIAL AND METHOD: Systematic review study in PubMed and Scopus databases following PRISMA guideli nes. Articles describing the outcome of using Tanner stages to estimate chronological age in alleged child pornography cases were identified. For screening, those written in English or Spanish published from January 1, 2000, to April 30, 2020, were considered. The following data were extracted from the articles included: type of study; material and methods used; Tanner items examined; evaluators' characteristics; results; estimated chronological age versus real age; observer-dependent variations (bias); and conclusions. RESULTS: Seven studies were included. Three were literature reviews and four were case studies with expert testimony and observer bias. This method is ineffective when the alleged victim, in both sexes, shows sexual maturation in Tanner stages 3-5. In stages 1-2, it may be useful to state that the victim is under 18 years old, but not to determine their chronological age. CONCLUSION: Scientific evidence discourages the use of Tanner stages to estimate the chronological age of the vic tim from images in alleged child pornography cases. Pediatricians, and other medical professionals, should avoid making a testimony that is not scientifically based.

Child Sexual Assault Nurse Examinations and Prosecutorial Decisions to Accept or Reject Cases of Child Sexual Abuse.

INTRODUCTION: Prosecution of child sexual abuse (CSA) cases provides safety for communities and justice for victims. Prosecutorial decisions are multifactorial and include the presence of a structured coordinated community response to outcries and access to skilled healthcare providers. This study examines the impact forensic nurse sexual assault examinations (SAEs) have on prosecution in a population of children seen at a child advocacy center (CAC). METHODS: The authors examined case data from 553 cases of reported CSA, seen by a forensic nurse in a CAC. RESULTS: Statistical analysis focused on prosecution decisions with and without SAE, with and without physical findings. Logistic regression determined prosecution occurred more often when SAE had been conducted (p = 0.026, OR = 1.732, 95% CI [1.068, 2.808]), regardless of examination findings. LIMITATIONS: The limitations include a single location for data and the multifactorial reasons for prosecution of cases. DISCUSSION: The multifactorial elements contributing to prosecutorial decisions are diverse. The formalized approaches in CACs historically show increased prosecution. Teasing out the impact of an SAE in a CAC may be reflective of positive CAC approaches. Regardless, a statistically significant finding of association uniquely with the SAE, with or without findings, implies more studies are needed to support the role of the forensic nurse in successful prosecutions of CSA cases.

Understanding Risk of Suicide among perpetrators who view child sexual abuse material (CSAM).

Attempts to address the threat of harm posed by perpetrators of child sexual abuse (CSA) have rightly increased in recent years, with well-known efforts such as operation NOTARISE resulting in 750 arrests; however, the cost of such operations is also high. Operation NOTARISE resulted in 24 suicides; the estimated economic and social cost of which has been estimated to be £34.8 million.[1] Perpetrators who view child sexual abuse materials (CSAM) are not only at higher risk of suicide than the general population, individuals diagnosed with a mental health disorder, and perpetrators of other violent and sexual crimes,[2-5] but they also appear to be at higher risk of suicide than perpetrators of CSA who engage directly in sexual acts with a child .[6-8] An in-depth understanding of the experiences of CSAM offenders is missing in the literature, but is required to understand how to mitigate the risk of suicide amongst this high risk group. This qualitative study investigates the experiences of CSAM perpetrators from the perspectives of law enforcement officers (n = 16), CSAM perpetrators themselves (n = 5), and help-line operators who have provided support to CSAM perpetrators through the Lucy Faithfull Foundation "Stop it now!" helpline (n = 6). Analysis was conducted separately for each dataset and in accordance with guidelines set out by Braun and Clark .[9] The focus of this paper is the six over-arching themes that were common across all datasets: (i) offender demographics; (ii) psychological impact of arrest; (iii) coping with the investigation; (iv) cognitive distortion; (v) shame and stigma; and (vi) professional support. Findings are discussed in the context of the challenges faced by law enforcement and healthcare professions when providing support to this high risk group, and eight key recommendations are made to reduce the risk of suicide.

[Epidemioclinical and legal aspects of sexual abuse among minors in Monastir, Tunisia]. / Aspects épidémiocliniques et suites judiciaires des abus sexuels chez les mineurs à Monastir, Tunisie.

INTRODUCTION: Child sexual abuse is a disturbing reality and a major public health problem. Indeed, it is a subject that has long been treated as taboo, with dramatic consequences on physical and mental health as well as on social wellbeing of the victims. The purpose of this study was to highlight the epidemiological and clinical features as well as the legal aspects of child sexual abuse. METHODS: we conducted a retrospective descriptive study at the psychiatric outpatient service of the University Hospital of Monastir over a period of 12 years and 6 months. All children younger than 18 years diagnosed with suspected or confirmed sexual assault were included. RESULTS: a total of 93 children, victims of sexual abuse were enrolled. The average age of patients was 10 years, with a standard deviation of 3.9 years. Sex-ratio M/F was 0.9. The most common sexual contact was touching (47,3% of cases). The majority of abusers were male (93,5%). In more than half of the cases (53,8%) they were relatives of the child and in 28% of cases intra-familial abuse was reported. Initial psychiatric assessment showed mental disorders in 70% of cases. CONCLUSION: sexual abuse is a very broad field of violence which varies widely in nature and intensity. Although, in some types of sexual abuse occasionally there is a lack of physical traces, the emotional and psychological impact is ubiquitous and characterized by numerous clinical manifestations.

Characteristics of Older Adult First-Time Sex Offenders: Insights From the Missouri Registry.

OBJECTIVE: To explore the characteristics of older adult first-time sex offenders (who offended for the first time at the age of 65 years or above). DESIGN: The authors retrieved and analyzed data from the publicly available Missouri sex offender registry database up to December 2018 and the Missouri public case management system website. PARTICIPANTS: Registered older (≥65 years) sex offenders in the state of Missouri, United States. MEASUREMENTS: Sociodemographic characteristics of the offender, offense type(s), offense, and conviction dates; age and sex of the victim(s); and case disposition information (whether the trial was waived or not and what were the sentences imposed). RESULTS: One hundred and ninety-four older adult sex offenders all males were identified, of which 172 were first-time offenders. The majority were white; the median age of offense was 68.6 years old. One hundred and thirty-nine (80.8%) first-time offenders were convicted strictly of non-pornography offenses, with prepubescent girls the predominant victim pool. The most prevalent charge in this subgroup was Child Molestation, First Degree (36.5%). Twenty-eight (16.3%) offenders were convicted strictly of pornography offenses, the most prevalent one being Possession of Child Pornography (96.6%). The recidivism rate among first-time offenders was close to 1%. CONCLUSION: A substantial proportion of older registered sex offenders are first-time sex offenders and most of them have underage victims. Although the offense and recidivism rates seem to be low, future longitudinal studies should focus on the predictors of sexual offending in the older population, in order to design targeted preventive measures, risk assessment, and treatment options.

Os usos do abuso sexual / Los usos del abuso sexual / The uses of sexual abuse

Resumo Este artigo analisa as narrativas de mulheres e homens; mães e pais; cuidadoras e cuidadores de crianças e adolescentes envolvidos em denúncias de abuso sexual, na condição de vítimas, e que foram, por essa razão, inseridas/os no sistema de garantia de direitos, objetivando demonstrar o que pensam, que enunciados utilizam para falar sobre o abuso sexual e os sentidos atribuídos à sua inserção na rede de atendimentos. Para auxiliar a operar teoricamente utilizou-se a noção de biopolítica, enquanto uma forma de governo e uma tecnologia do poder de Foucault, associada às ideias de um governo pela psicologia de Castel e à retórica do trauma de Fassin. A partir da análise, é possível descrever como o abuso se torna a forma de legitimação maior para que se possa acessar a proteção do Estado e como as formas de governar capturam a todos/as e balizam as narrativas em sutis esferas.

Resumen Este artículo analiza las narrativas de mujeres y hombres, madres y padres, cuidadores de niñas, niños y adolescentes involucrados en denuncias de abuso sexual, como víctimas, y que fueron, por eso, insertados en el sistema de garantía de derechos, con el objetivo de demostrar lo que piensan, qué declaraciones utilizan para hablar sobre el abuso sexual y los significados atribuidos a su inserción en la red de asistencia. Para ayudar a operar teóricamente, se utilizó la noción de biopolítica, como una forma de gobierno y una tecnología de poder de Foucault, asociada a las ideas de un gobierno de la psicología de Castel y la retórica del trauma de Fassin. A partir del análisis es posible describir cómo el abuso se convierte en la forma de mayor legitimación para que se pueda acceder a la protección del Estado y cómo las formas de gobernar capturan a todas y todos y marcan las narrativas en esferas sutiles.

Abstract This article analyzes the narratives of men and women; mothers and fathers and caretakers of children and adolescents involved in sexual abuse allegations, as victims, and that, for that reason, they have been inserted in the Rights Guarantee System, aiming to demonstrate what they think, what statements they use to talk about sexual abuse and the meanings attributed to their insertion in the care network. To facilitate the theoretical comprehension, the notion of Biopolitics was used as a type of government and one of Foucault's technologies of power, also linked to the ideas of a government for Castel's psychology and to Fassin's rhetoric of trauma. From the analysis it is possible to describe how the abuse becomes the major way of legitimizing in order to access the government protection, and how the forms of government capture all people and support the narratives in subtle ways.

Analyzing the scientific foundation of Child Sexual Abuse Accommodation Syndrome: A reply to Lyon et al.

The issue before the New Jersey Supreme Court in the Frye hearing New Jersey v. J.L.G. (2018) was whether the scientific community agreed that Summit's (1983) Child Sexual Abuse Accommodation Syndrome rested on a firm scientific foundation. Lyon et al. (this issue) critique our approach to describing child sexual abuse disclosure, which involved extrapolating rates from children who came to the attention of authorities. Lyon et al. claim that our conclusions are marred by sampling biases resulting from what they term the ground truth problem, suspicion bias and substantiation bias. The points Lyon et al. claim we "fell victim to" were the very points we acknowledge are inherent difficulties in estimating the extent to which children will come forward to tell others about sexual maltreatment. Lyon et al. offer an alternative solution to the inherent difficulties in studying a difficult-to-identify population, relying in large part on 21 papers published mostly in the 1960s and 1970s. We argue that the method they propose has more flaws than the one it is intended to replace. Points of agreement and disagreement, along with suggestions for future research, are discussed. Moving forward, we argue that studies are needed that embrace both validity and generalizability in order to foster data-driven theories rather than invoking the intuitive suppositions of Summit's (1983) syndromal evidence.

The Relevance of Certain Case Characteristics in the Successful Prosecution of Child Sexual Abuse Cases in Indonesia.

Successful prosecution in child sexual abuse (CSA) cases is an essential purpose of law enforcement agencies to ensure accountability of perpetrators and children's safety. However, research has shown that legal prosecution of CSA cases is a highly complex endeavor resulting in only a limited percentage of cases being prosecuted and ultimately proven in court. Most attrition occurs at the stage of the police investigation. The current study is the first study of CSA prosecution in an Asian country. We aimed to identify factors, which contribute to Indonesian CSA cases prosecution. We examined police files of CSA cases (N = 179) from three police units in greater Jakarta. We found that only 32% (n = 58) of cases were prosecuted. The following factors increased the odds of prosecution: victim being threatened, the suspect confessed, medical examination report being present, duration of investigations between one to 2 months, and the case being charged under the Child Protection Law. These findings (threat, suspect confession, and the presence of a medical examination report) correspond to previous studies in other jurisdictions.

When sexual offence is an unexpected diagnosis - exploration of medical, legal and social aspects in Nepalese scenario.

In Nepal, following allegations of sexual assault, the survivor is taken by the police to a Government Hospital for medical examination and sample collection. To provide an integrated service to survivors of gender-based violence, a One-Stop Crisis Management Centre (OCMC) is established in many Government Hospitals. However, paediatric survivors of sexual abuse frequently seek initial care at the emergency department, as most present with a medical complaint rather than for sexual abuse. It is therefore important to train emergency physicians with the skills required to identify the features and diagnose a case of sexual assault. We present a case where the diagnosis of sexual assault of a child was an incidental finding and discuss the challenges faced in dealing with such cases in non-OCMC Hospital.

Can Legislation Alone Protect Devadasi Girls from Child Sexual Abuse and Exploitation?

Girls in India continue to be sexually abused/exploited under the veil of traditional practices such as Devadasi dedication despite the existence of legislation meant to protect them from child sexual abuse. This study recounts the experiences of 30 Devadasi girls who were dedicated, initiated into sexual activity, and involved in commercial sexual activity as children. It underscores the need to address this practice as a criminal offense to be prosecuted under the legislation. Efforts must be made to explicitly connect Devadasi dedication and child sexual abuse in the minds of the public, law enforcement agencies and government officials.

Child pornography: Characteristics of its depiction and use.

Child pornography involves the realisation of deviant fantasies with very specific characteristics with regard to its content and use and therefore the legal action needed to deal with it. The internet has facilitated its dissemination and access and complicates the issue but we need to be able to identify and track people who use illegal pornography. This paper is based on a review of the literature and presents some criminological characteristics of child pornography on the internet.

A Public Health Approach to Global Child Sex Trafficking.

Human trafficking and child sex trafficking and sexual exploitation in particular are global public health issues with widespread, lasting impacts on children, families, and communities. Traditionally, human trafficking has been treated as a law enforcement problem with an emphasis on the arrest and prosecution of traffickers. However, use of a public health approach focuses efforts on those impacted by exploitation: trafficked persons, their families, and the population at large. It promotes strategies to build a solid scientific evidence base that allows development, implementation, and evaluation of prevention and intervention efforts, informs policy and program development, and guides international efforts at eradication. This article uses the public health approach to address human trafficking, with a focus on child sex trafficking and exploitation. Recommendations are made for public health professionals to contribute to antitrafficking efforts globally.

Thirty years of the convention on the rights of the child: Developments in child sexual abuse and exploitation.

Since its adoption by the United Nations in November 1989, the Convention on the Rights of the Child (CRC) has become the most universally ratified human rights treaty in history; presently only the United States has not ratified it. The CRC articulates children's human rights and notably includes freedom from sexual abuse and exploitation. Yet thirty years after the Convention was adopted, child sexual abuse and exploitation (CSA/E) remain serious, persistent, and evolving global issues. This overview both describes the current state of research on child sexual abuse and exploitation and evaluates the CRC's legacy in terms of State-level responses to CSA/E. Points of agreement and disagreement over what constitutes CSA/E and how widespread it is are explored. Also presented are the contexts in which CSA/E takes place, and factors associated with children's risk of being sexually abused or exploited. Emerging issues in these areas are the internet and children's use of it, as children may now become subject to abuse or exploitation even when physically alone. The second part of the paper addresses the CRC's influence on States' domestic legislation and States' responses to CSA/E more broadly. Gaps in efforts to monitor and report on the CRC's implementation with respect to its impact on CSA/E are described. The discussion offers guidance for future efforts to research and respond to child sexual abuse and exploitation, and in particular the ongoing need for support to survivors beyond the legal response paradigm.

The Sexual Abuse and Neglect of "Left-behind" Children in Rural China.

The separation of rural families in China has resulted in a large number of "left-behind" children, who are frequently subjected to sexual abuse. Failing and insufficient tutelage owing to the migration of parents into cities and the distinctive rural living environment (e.g. drab and enclosed habitats) are the major causes of the high incidence of sexual abuse against left-behind children. We have applied the concept of "ritualized law" (lihua de fa) to delineate the powerless position of the state legal system vis-á-vis the sexual assaults committed against left-behind children in rural China. Pervasive and ingrained traditional customs and rituals, and the intermediary relationships between familiar people, have restricted the reach of the judicial system in rural areas. Moreover, deeply rooted traditional beliefs and the primacy of interpersonal (and inter-familiar) harmony over legal and formal institutions have weakened the legal system and, in many cases, allowed sexual offenders to avoid prosecution.

El protocolo de actuación en la atención a menores víctimas en los Institutos de Medicina Legal y Ciencias Forenses / Guidelines for professional conduct in the care of child victims in Institutes of Legal Medicine and Forensic Science

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Protective and Supportive Injunctions for Children Exposed to Sexual Abuse: The First Data from Turkey.

Child sexual abuse (CSA) requires multidisciplinary approach by forensic, social, and medical services, thus Child Advocacy Centers (CACs) have been established to evaluate CSA cases in Turkey. At CACs the social needs of children are assessed by social workers. Protective and supportive injunctions (PSIs) are considered at each step of evaluation and are proposed to child courts. This study aimed to evaluate PSIs at a local CAC, which is one of the leading CACs in Turkey. The study group consisted of children and adolescents exposed to CSA admitted to Izmir CAC between April 2014 and April 2015. Socio-demographic characteristics, social investigation reports, psychiatric reports, and proposed PSIs were evaluated. The rate of social investigation necessity was 28.3% (n = 113), and the rate of being proposed for at least one PSI was 24.3% (n = 97). The most common proposed injunctions were maintenance care injunctions (n = 47; 48%) and counseling injunctions (n = 46; 47%). The rate of proposed PSIs was significantly higher in adolescents, incest cases and abuse types including penetration than in the other groups. This is the first study to evaluate PSIs in the child protection system. Our results provide data about the risk groups that need PSIs among the victims of CSA cases.

The Cutting Edge of Forensic Interviewing.

This article contextualizes new knowledge about forensically interviewing and assessing children when there are concerns about child abuse. The article references the impact of the Child Abuse Prevention and Treatment Act and the circumstance in the 1980s where investigators and clinicians had little guidance about how to interview children about alleged sexual abuse. It further speaks to the consequences of lack of interview guidelines and how videotaped interviews in the McMartin Pre-school cases served as the catalyst for the backlash against child interviewers and their interview techniques. Painful as the backlash was, it led to research and evidence-based practice in interviewing children about child sexual and other abuse. Principal among the practice innovations were forensic interview structures to be used when there is alleged child sexual and other abuse and the strong preference for one interview by a skilled interviewer, who is nevertheless a stranger to the child. Although these innovations satisfied many professionals in the child maltreatment field and critics of child interviewers, the new practices did not address a number of abiding issues: 1) how to meet the needs of children who are unable to disclose maltreatment in a single interview, 2) how to determine which children are suggestible in a forensic interview, and 3) how decisions are made about the likelihood of abuse, based upon the child's information during the interview. The articles in this special section address these cutting-edge issues.