Patricia Taner Leff, MD
JAMA. 1988;260(22):3336. doi:10.1001/jama.1988.03410220120039.
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The subway lurched as my eyes swung past headlines routinely dotting the urban landscape: "Teen Arrested in School Rape." A jolt. I read and reread the name—a child's name. Ricky. Ricky indeed would be 15 years old this year. Could that chubby, troubled 9-year-old boy I had known and treated so many years ago be today's "teen monster," a molester of little girls?

Memories of Ricky. Ricky's world of rage and of sadness. "Mommy," the maternal grandmother (a diabetic woman in her 60s who required extensive medical attention), was his caretaker. She gasped for breath and struggled to regain her composure. "Dr Leff, he was 30 pounds and 5 years old when I got him. With the help of the Lord.... Look at him now.... My daughter drank too much.... My daughter...." She sighed and fixed her eyes on the fat, morose boy grimly drawing in the corner. "Ricky, stand


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