title: Analysis of caretaker histories in abuse: comparing initial histories with subsequent confessions.
abstract: OBJECTIVE
  We hypothesize that perpetrators of abuse include elements of truth in their initial history and that an analysis of perpetrator confessions can teach professionals how to identify these initial truths.
  
  
  METHODS
  The information from a consecutive sample of perpetrators' confessions concerning 41 children hospitalized because of injuries caused by child abuse was reviewed. The details about the injuries contained in the confessions were compared with the details provided when these children initially presented for medical care. Information about the perpetrator's gender and relationship to the child, the victim's age and gender, type of injury, family risk factors, the trigger of the abusive event, the circumstances surrounding the event, and the type of trauma were collected.
  
  
  RESULTS
  A total of 45 perpetrators abused 41 children; 76% of perpetrators were male; 56% were the child's father; 34% were the child's mother. The perpetrators initially provided no explanation about how 68% of the children received an injury. In 91% of their initial histories, the perpetrators provided some element of truth about the circumstances or triggering event for the abuse. In 67% of confessions, crying was the circumstance that triggered the abuse. Mothers were more likely to describe the situation that triggered the abuse (85% of mothers versus 58% of fathers, p=ns), while fathers were more likely to describe accurately the circumstances surrounding the abuse (79% of fathers versus 62% of mothers, p=ns).
  
  
  CONCLUSIONS
  Perpetrators of abuse provide initial truths in their presenting history. Child abuse professionals must take a careful history from all caretakers and "listen" for the "elements of truth." These truths are the child's behavior or circumstance that increased stress and triggered the abuse. Employing this method in a careful analysis of confessions can make a significant contribution to the capacity to identify child abuse. In addition, more information about the role of triggers may help to focus child abuse prevention strategies.
authors.affiliation: Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, 2300 Children's Plaza, Box 16, Chicago, IL 60614, USA.
authors.forename: Emalee G
authors.initials: EG
authors.lastname: Flaherty
mesh_terms: D000367:Age Factors; D017028:Caregivers / Q000523:psychology* / Q000706:statistics & numerical data; D015984:Causality; D002648:Child; D002649:Child Abuse / Q000175:diagnosis* / Q000523:psychology / Q000706:statistics & numerical data; D002675:Child, Preschool; D003448:Crying; D005220:Fathers / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D014342:Truth Disclosure; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology*