Abstract
BACKGROUND: Child Guidance Centers (CGCs) play a central role in child protection in Japan, yet evidence on abused children referred to psychiatric services remains limited. METHODS: We retrospectively reviewed 84 children referred by CGCs (2019–2023) to a child and adolescent psychiatry department. Demographics, types of abuse, neurodevelopmental disorders (NDs), prior psychiatric care, hospitalization, and experiences of sexual violence by non-caregivers were extracted from medical records and CGC referral forms. Fisher’s exact test, Pearson’s chi-square test, and the Wilcoxon rank-sum test were used, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS: Psychological abuse was most prevalent (80%), followed by physical (70%), neglect (35%), and sexual abuse (33%). Girls had higher odds of sexual abuse (OR 6.16, 95% CI 1.32–28.8) and were more frequently hospitalized. Children with NDs were less likely to have sexual abuse recorded (OR 0.29, 95% CI 0.10–0.83). Hospitalization was associated with experiencing a greater number of abuse types and with sexual abuse (OR 4.23, 95% CI 1.49–12.00), particularly when perpetrated by non-caregivers (OR 4.53, 95% CI 1.51–13.60). CONCLUSIONS: Among CGC-referred children receiving psychiatric care, notable patterns included gender differences in abuse profiles, a high cumulative burden of maltreatment, and a lower recorded prevalence of sexual abuse among those with NDs. These findings highlight the need for careful clinical assessment and coordinated, ND-sensitive approaches that reduce under-recognition. Although derived from a CGC-based referral system, the results may inform efforts to integrate child protection and child and adolescent mental health services internationally. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s44192-025-00360-w.