Page 211 - ประมวลสรุปความรู้เกี่ยวกับพิธีสารอิสตันบูลและพิธีสารมินนิโซตา

ISTANBUL PROTOCOL ANNEXES

rather than behaviourally depends on the child’s III. Medical evaluation
age, developmental level and other factors, such
as family dynamics, personality characteristics, Medical examinations should be carried out in a child
cultural norms and psychosocial context, it is friendly setting by trained clinicians with experience in
sometimes useful to include other sources of assessing and documenting physical injury (including
information in the assessment in order to assess those resulting from sexual assault) in infants, children
and record potential impact including: and young persons. Consent for examinations should be
obtained from the children’s caregivers and, in situations
(a) Children’s behaviour during assessments: the in which they are able to give consent themselves, from
evaluator can comment on the level of activity, the children or young persons. Ideally, clinicians should have
nature of the interactions and relationships with access to additional diagnostic facilities, for example
others, affect and state of regulation, general mood and X-rays and other imagining, haematological testing
involvement in play; and further specialist advice as needed. In interpreting
their findings, clinicians usually need to seek additional
(b) External reports: wherever possible, it is information from children, young persons and their
recommended to gather information from parents, caregivers over and above that available from non-
teachers and others about children’s developmental medical interviews. Clinicians should be able to document
history, special needs, psychiatric and medical history, their findings using the agreed international format.
social and school functioning, and behavioural
adjustment, before and after the alleged traumatic Children who have endured torture or ill-treatment
events and changes in patterns of behaviours; must have access to trained, competent paediatric
18
examiners, wherever possible, who can provide
(c) Diagnostic scale and measures: in order to assess medical assessments and recommendations for care.
symptoms, additional instruments, such as scales and In children, part of the evaluation must include
checklists, can be considered. It is desirable as long as safeguarding for the prevention of further torture
the validity and reliability of these instruments have and ill-treatment, recommendations for recovery
been established for the particular population that is and reintegration, and reduction of exposure to
being evaluated, or for similar populations. If these experiencing or witnessing violence. Access to
do not exist, data from dissimilar cultural populations appropriate and confidential medical and psychological
may be consulted but need to be used with care. follow-up care is an entitlement for children.
20

D. Special consideration for assessment of sexual A child who has, or is thought to have, suffered
assault in children sexual torture should wherever possible be
examined by a paediatrician with specialist
Investigators should be sensitive to the fact that children expertise in examining victims of sexual abuse.
and young persons might not comprehend the concept of
sexual assault or be able to identify it. In such cases there
may often be a fear of bringing shame or stigmatization IV. Psychological impact of trauma
on themselves or their families, which may also affect
their ability to disclose their experiences. It is important, Childhood traumas have been associated with a wide
if at all possible, that in such circumstances the child be range of social, health and mental health problems.
19
seen by an expert in child abuse. The evaluator should Cumulative adverse childhood experiences increase
be aware that an examination may be reminiscent of the risk of social, behavioural, health and mental
21
the original assault and should therefore be carried out health problems in a strong and graded manner.
sensitively with appropriate explanations to the child Research has demonstrated that trauma may
22
and the child’s accompanying guardian or caregiver. significantly compromise cognitive development

18 Kathryn Kuehnle and Steven N. Sparta, “Assessing child sexual abuse allegations in a legal context”, in Forensic Mental Health Assessment of Children and Adolescents,
Steven N. Sparta and Gerald P. Koocher, eds. (New York, Oxford University Press, 2006), pp. 129–148.
19 Royal College of Paediatrics and Child Health, The Physical Signs of Child Sexual Abuse: An Evidence-Based Review and Guidance for Best Practice (Lavenham, United
Kingdom, Lavenham Press, 2015). See also Astrid Heger, S. Jean Means and David Muram, eds., Evaluation of the Sexually Abused Child: A Medical Textbook and
Photographic Atlas, 2nd ed. (New York, Oxford University Press, 2000), pp. 229.
20 Convention on the Rights of the Child, art. 39.
21 Nadine J. Burke and others, “The impact of adverse childhood experiences on an urban paediatric population”, Child Abuse & Neglect, vol. 35, No. 6 (2011), pp. 408–413.
22 Michelle Bosquet Enlow and others, “Interpersonal trauma exposure and cognitive development in children to age 8 years: a longitudinal study”, Journal of Epidemiology
and Community Health, vol. 66, No. 11 (2012), pp. 1005–1010.

176