Multi-informant assessment of anxiety regarding ano-genital examinations for suspected child sexual abuse (CSA)

Objective: Given the commonly held belief that physical examinations for child sexual abuse (CSA) are very distressing, our primary objective was to evaluate anxiety during these assessments using the Multidimensional Anxiety Score for Children (MASC-10). A second objective was to compare self-reported anxiety to parental report using the MASC-10 and to medical provider's rating of emotional distress using the Genital Examination Distress Scale (GEDS). Methods: Child/parent dyads completed the MASC-10 prior to the evaluation and were retested at the completion of the medical exam. GEDS assessment occurred during the medical exam. Results: One hundred seventy-five subject dyads were enrolled and were predominantly female (77%), Caucasian (66%), accompanied by mother (90%), and receiving Medicaid (57%). A significant subgroup of children reported clinically significant levels of anxiety at the pre-examination assessment (17.1%) and post-examination assessment (15.4%). However, most subjects reported low anxiety at both pre- and post-examination assessments. Both child and parent report demonstrated less anxiety, on average, post-examination compared to pre-examination scores. Reduced anxiety was measured with a mean pre-T-score = 55.8 versus mean post-T-score = 53.1 (p < .001). Correlation coefficients for pre-T-scores and post-T-scores of child/parent dyad were 0.3257 (p < .0001) and 0.3403 (p < .0001). A small correlation was noted between child reported anxiety and medical provider observation using the GEDS for pre-exam (0.1904, p = .01), and post-exam (0.2090, p = .02). Conclusions: Our research indicates that the majority of children are not severely anxious during medical evaluations for CSA. In addition, the MASC-10 shows promise as an instrument to assess anxiety from the ano-genital examination in CSA because it could be quickly completed by most patients and their parents, indicated a wide range of anxiety levels, and demonstrated some sensitivity to change. While parent report may identify some child anxiety, parent and provider report should not be substitutes for the self-report of children's anxiety during this medical evaluation. Practice implications: A practical, quick, validated measure of anxiety can be used in the setting of CSA evaluations to identify anxiety in this population. (C) 2010 Elsevier Ltd. All rights reserved.