EXECUTIVE SUMMARY
Teens and young adults ages 12-34 years suffer the highest rates of sexual assault, according to a new clinical report from the American Academy of Pediatrics.
- Since the national organization published its last policy statement on sexual assault in 2008, more information and data have emerged about sexual violence affecting teens, as well as information on the treatment and management of those who have become victims of sexual assault. The new report focuses on the acute assessment and care of adolescent victims who have experienced a recent sexual assault.
- To determine possible assaults, use the HEEADSSS (Home environment, Education and employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression, and Safety from injury and violence) method of interviewing to perform a psychosocial review of systems.
Teens and young adults ages 12-34 years have the highest rates of sexual assault, according to a new clinical report from the American Academy of Pediatrics.1
Since the national organization published its last policy statement on sexual assault in 2008, more information and data have emerged about sexual violence affecting teens, as well as information on the treatment and management of those who have become victims of sexual assault.
The 2017 report focuses on the acute assessment and care of adolescent victims who have experienced a recent sexual assault.
Compared with older adults who have been assaulted, teens are more likely to delay medical care and less likely to press charges, especially if they know the perpetrator.2,3
Data indicate that most victims do know their perpetrators — a younger victim’s perpetrator often is a member of the victim’s extended family, while most older teens know their assailant from a social encounter.4
It is important for providers to ask about sexual assault — just half of high school-age assault survivors ever tell anyone about a sexual assault. Overall, as few as 10% of sexual assaults may be reported to authorities.5
Statistics are even more troubling for teens with developmental disabilities, who have a much higher risk of sexual assault and acquaintance rape. The authors of a study examining data between 2009 and 2011 found that adolescents ages 12-15 years with disabilities experienced rates of violent victimization that were 2.5 times greater than those of teens without disabilities, with numbers climbing for those ages 16-19 years.6
Use Your HEEADSSS
Identifying sexual assault may help reduce the likelihood of it happening again, reduce stigma, and provide the victim with medical, psychological, and supportive care, the report noted.
The American Academy of Pediatrics recommends that providers, as part of health wellness exams, ask teens if they have experienced sexual violence, dating violence, and sexual assaults. To determine possible assaults, use the HEEADSSS (Home environment, Education and employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression, and Safety from injury and violence) method of interviewing to perform a psychosocial review of systems.
By telling teens, “I am asking you these questions to help me find out if there is anything that may be putting your health at risk and to tell me what kind of exam and tests I should conduct,” clinicians set the stage for sensitive questions that lie ahead.
Teens who disclose an assault should be questioned about commercial sexual exploitation as well, the report notes. Clinicians also should consider that “date rape” drugs may have been used in the assault.
Providers also should be familiar with state legal reporting requirements related to sexual assault, as well as understand state laws ensuring the right of teens to obtain medical care at a sexual assault or rape crisis center. In the same vein, clinicians should maintain a database of community resources on when and where to refer adolescents for forensic medical exams and care after an assault.
Screening for sexually transmitted infections, post-exposure prophylaxis, treatment, and follow-up should be provided in accordance with guidance from the CDC.7
Providers should be prepared to offer emergency contraception to female adolescents who disclose sexual assault if reported within 120 hours of the assault.
Documentation of pregnancy status should occur at evaluation and at follow-up, the report advises.
REFERENCES
- Crawford-Jakubiak JE, Alderman EM, Leventhal JM; Committee on Child Abuse and Neglect; Committee On Adolescence. Care of the adolescent after an acute sexual assault. Pediatrics 2017; doi:10.1542/peds.2016-4243.
- Peipert JF, Domagalski LR. Epidemiology of adolescent sexual assault. Obstet Gynecol 1994;84:867-887.
- Heise LL. Reproductive freedom and violence against women: Where are the intersections? J Law Med Ethics 1993;21:206-216.
- Breiding MJ, Smith SG, Basile KC, et al. Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization—national intimate partner and sexual violence survey, United States, 2011. MMWR Surveill Summ 2014;63:1-18.
- Davis TC, Peck GQ, Storment JM. Acquaintance rape and the high school student. J Adolesc Health 1993;14:220-224.
- Harrell E. Crime Against Persons with Disabilities, 2009-2011 — Statistical Tables. Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics; 2012.
- Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2015. Atlanta: U.S. Department of Health and Human Services; 2016.
Teens are more likely to delay medical care and less likely to press charges.
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