Sir.—The article by Dubowitz et al,1 published in the June 1992 issue of AJDC, on child sexual abuse is a thorough description of the multidisciplinary approach to child sexual abuse evaluation. Unfortunately, it fails to help clarify the important distinction between the legal definitions of child sexual abuse and the medical opinion of the same.
Behaviors that involve adults and children and result in any sexual stimulation run a spectrum from very brief, perhaps unnoted and perhaps unintended, sexual stimulation to premeditated, coercive exploitation. State laws designate which sexual behaviors are unacceptable or abusive. Assessment of whether behaviors violate these standards is the province of governmental investigative and judicial systems. As such, medical professionals are charged with providing accurate information to judges and juries, who are the legal definers of abuse. To use the verbiage "diagnosis of child sexual abuse" serves to blur the boundary of responsibility for
BRAYDEN RM. The Diagnosis of Child Sexual Abuse. Am J Dis Child. 1993;147(2):130. doi:10.1001/archpedi.1993.02160260020008