**5. References**

134 Sexual Abuse – Breaking the Silence

structures as incorporated into pediatric hospitals. Their experience showed better results not only for the assessment of speech in a clinical approach, but also in relation to the advice given to children and their families. The organization of monitoring is also facilitated by this approach [27]. In accordance with the recommendation of Edinburgh, we incorporated a

Tishelman confirms the value of an integrative model and justice for the pediatric care of

Evaluate opportunities for protection, therefore need to protect children by

Make recommendations to the social and legal services concerning the needs of the

All this confirms the value of an integrated pediatric and forensic approach. This attitude is reinforced by the importance of physical and psychological consequences observed in adults who have suffered sexual assault in their childhood. Early care of the child within a pediatric approach should help to avoid such troubling developments 30. Tishelman also speaks of a particular population of children whose judicial evaluation has not confirmed the sexual assault. Those children who leave without a judicial conclusion after a grueling

role for pediatric nurses with a long experience in childcare.

affected children by setting 6 goals in these structures 29:

Assess risk factors of abuse to prevent recurrence

Assess the overall health and psychological trauma of child victims

Provide the child and its family psychological and social care

investigation should also receive monitoring and care 29.

Evaluate specific forensic aspects

hospitalization

child and family


**9** 

*USA* 

**Childhood Sexual Abuse and** 

Kathleen Monahan1 and Carol Forgash2 *Stony Brook University, Stony Brook, N. Y.,* 

*Private Practice, Smithtown, N.Y.,* 

**Adult Physical and Dental Health Outcomes** 

This chapter addresses the negative health outcomes for adult childhood sexual abuse (CSA) survivors. It is now well established that CSA survivors have a myriad of long- term physical health related disorders and disease processes (Boscarino, 2004; Irish, Kobayashi, & Delahanty, 2010; Monahan & Forgash, 2000) mental health difficulties, (Briere & Scott, 2006; Briere & Weathers, 2005; Brown, 2009) and dental health issues (Teram; Leeners, Stiller, Block, Görres, Imthurn, Rath, 2007). Many of these individuals will exhibit health risk behaviors as well (Felitti, Anda, Nordenberg et al, 1998; Owens & Chard, 2001; Chartier, Walker, Naimark, 2008; Liebshutz et al., 2000; Meade, Kershaw, Hansen, Sikkema, 2009). Additionally, oral and dental health has been recognized as a strong predictor of physical health problems. Recently, the

The trauma field has long recognized the association between childhood trauma, PTSD symptomatology and health issues (Schnurr, 1996). One of the most recognized studies to date is the Adverse Childhood Experiences (ACE) study which gathered information from 17, 337 adults 50 years and older (Felitti, Anda, Nordenberg et al, 1998). Information on current health status and childhood adverse experiences such as vitriolic divorce, abuse and neglect, a parent dying, and witnessing one's mother being beaten, were collected. The study found that 30.1% of the respondents reported being physically abused, 19.9% reported sexual abuse, and 11% reported being emotionally abused (Felitti, Anda, Nordenberg, et al, 1998). Moreover, the study found that childhood stressors are strongly related to the development and prevalence of risks factors for disease and health and social well-being

The ACE study reveals a powerful relationship between our emotional experiences as children and our physical and mental health as adults, as well as the major cause of adult mortality in the United States. It documents the conversion of traumatic

throughout the life span (Felitti, Anda, Nordenberg et al, 1998). The authors state,

emotional experiences in childhood into organic disease later in life (p. 245).

In addition, the more adverse experiences one reported, the more likely one was to develop severe, life-threatening health outcomes such as heart disease, skeletal fractures, stroke, diabetes, and cancer (Filetti, Anda, Nordenberg et al, 1998; van der Kolk, 2005). The ACE study points out that childhood abuse has life-long impact on the health and well being of the victim. Filetti (2001) questions, "How does one perform reverse alchemy, going from a normal newborn with almost unlimited potential to a diseased, depressed adult? How does one turn gold into lead?" (p. 1).

dental health of CSA survivors has been an area of investigation.

**1. Introduction** 

