The Sexually Abused Child and His Family: Assessment and Treatment

, by Jean-Yves Hayez and

Emmanuelle de Becker.

This is a book on the sexually abused child and his family, still a topical subject. The problems professional

carers are faced with are numerous and complex, clinical practice and research on this variety of maltreatment

being at a relatively early stage. Both franco-phone professionals and the involved public eagerly expect to

learn more from clinicians with experience in the care of abused children, from their families, and from those

who perpetuate sexual abuse.

This book was written by two Belgian child psychiatrists who present their clinical experience, their

approach, goals, and results. The authors point out how difficult and complex the work is. They call for a

sensitive approach and respect for the involved individuals.

There are two parts to this book. One deals with evaluation, definition of sexual abuse, the psychic structure

of abusers, with family coping, and consequences of abuse for the child. In this part, the emphasis is on data

collection. The second part deals with the authors' approach. Different programs are described, either

individual or group discussions with those involved. Legal authorities do not intervene systematically unless

the family is uncooperative at the outset or during the course of treatment. This book deals with unanswered

questions on sexual abuse, as seen by the authors as part of their teaching. There is a risk, however, that the

answers could be used as a collection of recipes to be applied, systematically, to all cases. In fact, each case

is different and consideration of individual needs and responses is essential.

References to psychoanalytical theories are minimal, which is regretted. Analytic thinking helps in an

understanding of sexual abuse, its impact on children according to age and development stage, the natural

evolution of conflicts and emotions associated, and giving a direction of intensive intervention.

In summary, we are grateful towards our Belgian colleagues for this important contribution to the ongoing

international effort of clinical development and research.

D

R

. M

ARIE

D

ROUET

AFIREM

Ho pital des Enfants Malades

149, rue de Se vres

75730 Paris Cedex 15

France

PII S0145-2134(99)00143-X

Diagnostic Imaging of Child Abuse

(2nd ed.), edited by Paul K. Kleinman, 1998.

The first edition of Diagnostic Imaging of Child Abuse (1987) has been the most authoritative work on the

subject of physical abuse in childhood. This second edition has been updated and considerably expanded and

is now the major text in this specialist field.

The first section considers skeletal trauma in detail and there are excellent radiographic images, many

correlated with high definition post mortem radiographs and with histological specimens. This section looks

at specific injuries and their mechanisms of causation and one chapter is devoted to dating fractures. There are

extensive references to published works and this major compilation will be invaluable to any clinician required

to attend court for cases of child abuse. This section has also considerably expanded the differential diagnosis

of disorders which may simulate abuse. There are specific chapters concerning the diagnosis of osteogenesis

imperfecta and accidental and obstetric trauma. The highly controversial and vexatious diagnosis of "tem-

porary brittle bone disease," sometimes offered in a court of law by the defense, is also discussed.

The second section recognizes an increased awareness of the range and extent of visceral injuries sustained

as a result of abuse and cross sectional imaging modalities, such as computer tomography (CT) and magnetic

resonance imaging (MRI) play an important part in their diagnosis. This section also evaluates head trauma

and describes the increasing importance of new imaging techniques, especially for the investigation of

intracranial injury using cranial ultrasound and MRI.

This section ends with an important chapter on miscellaneous forms of abuse and neglect. The practicing

pediatrician should be aware of the association between chronic disabilities such as cerebral palsy, Down's

syndrome, and osteogenesis imperfecta and physical abuse. Unusual manifestations of physical injury are

illustrated and there are discussions on Munchausen's Syndrome by Proxy and sexual abuse.

The third section deals with child abuse and the law both from a radiologist's view point and that of a child

abuse attorney. Although this is directly related to jurisprudence in the United States, the procedures,

Book Reviews

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