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Injuries Indicative of Abuse
prone knee-chest
position).
This table was developed from multiple sources, including published classification scales authored by
David Muram, MD and Joyce Adams, MD. Penis and scrotum classification and “other” by Charles
Johnson, MD.
Adapted from:
Muram D. Classification of genital findings in prepubertal girls who are victims of sexual abuse. Adolesc
Pediatr Gynecol 1988; 1:151.
Adams JA. Evolution of a classification scale: Medical evaluation of suspected child sexual abuse. Child
Maltreatment 2001;6:31-36.
Johnson CF. Is it normal or not? SCAN 2001;13:4-5.
Psychosocial Indicators of Sexual Abuse
Sexualized Behaviors
Nonspecific Behaviors
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The following factors may influence the intensity and type of reaction a child has to the experience of
sexual abuse (although some important issues related to any one child’s experience may not be included
in this list):
Identity of perpetrator
Child’s age
Child’s developmental status, including whether or not the child has any
developmental disabilities
History of prior, or concurrent maltreatment, trauma or stress
Relationship with alleged perpetrator
Duration (time span) of the abuse
Circumstances/context of the abuse (i.e. has the child been afraid,
embarrassed, etc?)
Type and intensity of abuse or neglect
Family, social and community support
Child’s coping strategies, and generality personal characteristics (i.e.
temperament)
A child’s reactions may involve behaviors that can be observed by other people, or may simply involve
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