Verbal disclosure of abuse in a specialized interview was studied in a sample of 28 children, ages 3 to menarche, who presented with purely physical complaints later diagnosed as a sexually transmitted disease, in the absence of any known prior disclosure or suspicion of sexual abuse. Only 43% gave any verbal confirmation of sexual contact. Fifty-seven percent were “false negatives.” Disclosure was strongly associated with the attitude taken by the child's caretaker toward the possibility of abuse. Children whose caretakers accepted the possibility that their child might have been sexually abused disclosed at a rate almost 3.5 times as great as those whose caretakers denied any possibility of abuse (63% vs. 17%). The results suggest that caretaker attitude and support is a critical variable in the child's disclosure process and a valuable target for intervention and prevention efforts. In addition, it was found that, aside from their STD, many of these abused children presented as free from any specifically suspicious abuse symptoms, suggesting that reliance on single interviews and identification of “red flags” cannot be expected to identify many hidden victims.
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