CHALLENGING CASE: BEHAVIORAL CHANGES Erica: A Question of Sexual Abuse*

CASE Erica, 20 months old, is brought to the office of her pediatrician by her mother who is concerned about the possibility of sexual abuse. She describes her daughter’s behavior as unusual during the past 2 weeks. At first, she thought Erica was experiencing abdominal pain when she pointed to her abdomen. Gradually, it became apparent that she was pointing to her vagina with the utterance “ooh.” Erica’s mother noted that she seemed more withdrawn and less animated when left alone. However, she remained interactive and responsive with her mother, and there were no separation problems when leaving her at child care each day. About 1 week later, while alone with her mother, Erica said, “Daddy . . . play” several times. When her mother inquired what she and her daddy played, Erica took her mother’s hand, went to her parents’ bedroom and pointed to their bed. At the same time she pointed to her vagina and said, “Daddy . . . play.” Her mother, who appeared surprised and alarmed, thought Erica was imagining something. When her mother asked Erica about “Daddy . . . play” the following day, Erica repeated the bedroom scene. This event, coupled with Erica’s atypical quiet periods of play, gave her mother reason to believe that she may have been sexually abused. Erica’s mother asked her pediatrician three questions: “Could my daughter make up such a story?” “If it is true, what do I do now to prevent it from happening again?” and “Will it harm my child for her life?”