| Historical
Synopsis
In the late 19th century, Sigmund Freud
found that many of the adult patients he treated
reported childhood sexual abuse, which Freud found
to be causally related to these patients' symptoms
of psychological distress. Overwhelming contention
from both scientific and political leaders led Freud
to eventually withdraw his findings in this area,
although he remained equivocal in later writings.
The latter half of the 20th century saw
a return to a focus on childhood sex abuse as the
etiology of later distress and dysfunction. Fueled
by the proliferation of scientific evidence, child
advocates refused to back down when confronted by
skeptics, and staunchly maintained the attitude
that "children don't lie; if it hadn't happened,
they couldn't report it." An attempt to make
up for decades of ignorance and rejection of children's
stories of abuse led to an unfettered and unexamined
acceptance of every child's story of abuse as true.
By the close of the 1980s, the negative repercussions
of this attitude were obvious. Now infamous cases
such as California v. Buckey (the McMartin
Preschool case, 1990) and New Jersey v. Michaels
(1993) highlight the trauma and tragedy that can
and do result from children's stories being uncritically
accepted as valid. The State of Montana saw its
own version with Montana v Harts (1993).
For a relatively brief period of time, the argument
seemed to revolve around whether children would
deliberately lie about a personal experience of
sexual abuse. An abundance of research has now disassembled
the question when it is stated this way. It has
been learned and amply documented that the issue
of TRUTH when applied to children's statements is
multidimensional. The focus on how children's statements
might differ from adults' statements has compelled
a scientific return to an understanding of child
development in moral, cognitive, emotional and social
spheres. Many volumes have recently appeared on
the suggestibility of children, the creation of
false or distorted memories, motivation, and other
aspects of truth-telling, all of which attempt to
explain why some children's reports of sexual abuse
are not true, even though the child may appear to
be sincere. (See Ceci & Bruck, 1995; Doris,
1991; Goodman & Bottoms, 1993;
Perry & Wrightsman, 1991).
Statement of the Problem
While some scientists have focused on the main
question of how to figure out if a child's story
is true, others have focused on the formulation
of investigative techniques that are less likely
to facilitate the false authentication of invalid
reports, and on the internal dynamics involved in
a child's production of an invalid report. Still
others have focused on the social phenomenon characterized
by the public's response to the tremendous rise
in the incidence of reported child sex abuse. Due
at least in part to the vulnerability of children
and the sense of responsibility associated with
the need to protect them from harm, it may be the
case that people involved in that process overreact
to allegations of sexual abuse. This overreaction
has been termed "moral panic" by some
writers (Edwards & Lohman, 1994). The moral
aspect of this phenomenon derives from the sexual
component, which is highly charged in our society,
as well as from the already charged situation which
exists when the protection of children is at issue.
It could be reasonable argued that protection of
children from harm, particularly sexual abuse, is
the moral imperative our society has adopted as
the most important. In the arena of child sexual
abuse allegations there is, therefore, a particular
opportunity for the desire to exhibit "good
intentions" to overshadow the need for objective,
consistent, and ongoing dynamic tension which exists
societally with regards to the question of whether
child sexual abuse occurs and, if so, how prevalent
it is. This debate also goes on in the realms of
law, psychology, and throughout the child protective
services network. To the extent that moral panic
creates a generic prejudice against those merely
accused of child sexual abuse (Vidmar, 1997), it
must be accounted for in any competent investigation
of allegations. When practitioners are called upon
to provide investigative and evaluative procedures
in child sexual abuse cases, they are often at a
loss as to how to proceed. They may be placed in
a double bind, wanting to help, but not knowing
how to proceed in a way that is defensible in court.
Practitioners may be concerned that treating a false
allegation as true can be as traumatizing to non-abused
children (who may become convinced through suggestive
interviewing that they have been abused), as is
treating a true allegation as false (and accusing
truly abused children of lying). The literature
has unfortunately focused on the disagreements among
experts over the various techniques available, rather
than on any core similarities.
As experts independently developed then published
formats, guidelines or techniques for conducting
the best possible investigation into allegations
of child sex abuse, scientific debate over the pros
and cons of each major offering proliferated, until
it began to seem to the novitiate that there was
no agreement at all. Several experts have offered
what they considered to be scientifically acceptable
procedures for determining the validity of child
sex abuse allegations. Paramount are a) Gardner's
(1992) True and False Accusations of Child Sex
Abuse and (1995) Protocols for the Sex-Abuse
Evaluation; b) Greenberg's (1990) Conducting
Unbiased Sexual Abuse Evaluations; c) Boat and
Everson's (1986) Structured Interview for Using
Anatomical Dolls; d) Hindman's (1987) Sixteen
Steps Toward Legally Sound Sexual Abuse Investigations;
and e) Raskin and Esplin's (1991) Statement Validity
Analysis. Michael Lamb's (1994) "Consensus
Statement" is a welcome glimmer of hope on
the horizon, but is based on the agreement of 20
individuals in attendance at a conference in Switzerland
and does not account for the published opinions
of absent experts. This article is offered as a
caveat against using inappropriate techniques when
professionally interacting with a child who is alleging
sex abuse, and as a guide to conducting a valid
examination of such a child that will be both admissible
and defensible in a court of law.
Major Theoretical Approaches
According to Raskin and Esplin (1991), "Statement
Validity Analysis" (SVA) is a set of interview
techniques and analytical procedures for obtaining
and evaluating statements. These procedures compel
the evaluator to explore and consider all of the
available information and many possible explanations
prior to, during, and after the interview. SVA essentially
incorporates three procedures: the first is the
obtaining of a free narrative by the child who alleges
sexual abuse, without using dolls or other props
as communication aids. This interview is not therapy
and should not be performed by the child's therapist
due to dual role conflicts (Committee on Ethical
Guidelines for Forensic Psychologists, 1991; American
Academy of Child and Adolescent Psychiatry, 1988).
Guidelines are offered as to the formation of alternative
hypotheses, when to use cue questions, direct questions
and probe questions. The second procedure is the
application of Criteria Based Content Analysis (CBCA,
Raskin & Esplin, 1991) to the narrative provided
by the child and recorded verbatim. CBCA analyzes
the narrative statement for general characteristics,
specific contents, and motivation-related contents.
The third procedure is the application of the Validity
Checklist (Raskin & Esplin, 1991) to the entire
body of data accumulated through both legal and
psychological means relevant to the case. The Validity
Checklist consists of four categories of information
to be analyzed: a) psychological characteristics
of the child; b) interview characteristics of the
child and the examiner, c) motivational factors
relevant to the child and others involved in the
allegations and; d) investigative questions regarding
the consistency and realism of the entire body of
data. These procedures, taken together, discourage
premature conclusions by forcing a systematic consideration
of all necessary and available information.
Boat and Everson (1986) have developed a comprehensive
set of guidelines on interviewing children who allege
sex abuse, using Anatomically Detailed (AD) dolls.
This involves a structured interview that begins
by assessing cognitive competencies, then uses AD
dolls to help children with immature verbal ability
communicate what may have happened to them. The
American Psychological Association's Council of
Representatives (1994) has recently published a
position paper on the use of AD dolls, in which
the use of AD dolls is endorsed as a communication
and memory aid for children undergoing a sex abuse
investigation, but not as a definitive diagnostic
test that can say with certainty whether a child
has been sexually abused.
Hindman (1987) has published Step By Step: Sixteen
Steps Toward Legally Sound Sexual Abuse Investigations.
The book provides guidelines for interviewing children
who allege child sexual abuse. She recommends use
of another of her books, A Very Touching Book
(1985), which describes the concepts of "good
touch, bad touch and secret touch" to a child
who is then asked to relate whether he or she has
experienced any "touching trouble" and
if so to describe it. Although Hindman states that
AD dolls may be used to augment the interview, she
offers no specific guidelines as to use of the dolls,
and the general guidelines offered differ from the
guidelines of Boat and Everson.
Gardner's (1992, 1995) investigative method is
interview-based. He emphasizes the importance of
evaluating not only the alleged victim, but also
the alleged perpetrator, and the accuser, and reserves
the right to bring all three together in the same
room for conjoint interviewing. In his 1992 book,
he offered 30 "differentiating criteria"
for use in assessing the likelihood of sexual abuse.
In his 1995 book, he offers an additional 21 criteria
derived from direct inquiry and 11 criteria derived
from projective testing. He also lists several criteria
to be considered when evaluating the alleged victim's
parents, the accused male, the accused female, and
the accuser. Gardner explains that there is no scoring
scheme or cut-off point to indicate when sexual
abuse has occurred, but that his criteria form a
continuum of likelihood that a child has or has
not been sexually abused: the greater the number
of indicators met, the greater the likelihood that
a child has been abused.
Greenberg (1990) offers suggestions for conducting
unbiased investigations of alleged child sexual
abuse victims. He focuses on the interview format,
but allows certain toys to be used as stimuli for
verbalizations and behavior. He speaks to the role
and context of the forensic investigator, the importance
of evaluating children's competencies before judging
the content of their speech, the use of counterbalanced
questioning about the alleged victimization and
the alleged perpetrator, questioning about sequelae
of the alleged abuse, and achieving closure at the
end of the interview.
Inter-Theoretical Differences
Wells and Loftus (1991) state that "Statement
Validity Analysis" has inadequate empirical
support and may lack ability to partition individual
and age-related differences in linguistic abilities
from validity-related differences. Gardner (1992)
opposes the use of AD dolls, calling them a source
of "psychological grief" to children.
Others, including Underwager and Wakefield (1990)
posit that AD dolls are sexually suggestive. Contrary
to the other methods, Gardner's method emphasizes
interviewing the alleged perpetrator whenever possible,
and often jointly with the alleged victim, before
rendering an opinion as to whether sexual abuse
of a child has occurred.
Bruck and Ceci (1993/1995) emphasize the myriad
ways in which children's competence and accuracy
of information can be sabotaged by incompetent investigative
procedures and interview techniques, while Lamb,
Sternberg & Esplin (1995) offer ways in which
the conscientious investigator can enhance the quality,
accuracy, and amount of information obtained from
children who allege sex abuse. In addition, Lenore
Terr (1994) emphasizes the accuracy of children's
memory, while Elizabeth Loftus (1994) eloquently
argues the fallibility of children's memory. Memory
itself cannot be judged to be accurate or inaccurate
unless the investigator's interviewing style and
techniques are sound.
Case Synopsis: Montana
v. Harts
In Montana v. Harts (State of Montana v.
Harts, 1993), the State's child protective services
workers had performed the first several evaluations
of two children, ages 3 and 5, who had alleged sexual
abuse by their great-grandparents, ages 78 and 81,
who had no documented history of previous criminal
behavior or of sexually inappropriate behavior.
Child protective services workers and police rewarded
the children with praise when they provided affirmative
responses to their questions. When one child reported
something that the other could not at first remember,
pressure applied until the child could remember
it. No effort was made to verify the physical possibility
or impossibility of the allegations. The children
were sent to a therapist who insisted that the children
elaborate on this abuse by asking them to "draw
a picture of your rectum" and "draw a
picture of how you feel about Pa's genitals."
These drawings were submitted to the county attorney
over the next two years as evidence of abuse. Other
grossly inappropriate "therapeutic techniques"
were also used to extract confirmation from the
children that bizarre and violent sexual abuse had
been perpetrated against them. The 5-year-old boy
was put into treatment sessions with a 9-year-old
boy who was a confirmed sexual abuse victim. The
therapist typically saw the children in her home
for up to 6 hours at a time. The therapist forbade
anyone to talk to the children, including their
grandparents, unless they promised not to express
any doubt as to the children's allegations, or unless
the therapist was present. When the children tried
to say that their reports were "just dreams"
or had never been true, these statements were discounted.
The therapist asked the children to draw something
and when they did not, she produced the drawing,
labeled it as the child's, and sent it to the county
attorney. The therapist collected crime victim's
compensation funds for the children's treatment,
long before an unbiased investigation was performed,
reinforcing the necessity from the therapist's perspective
that the crime be confirmed even if it had not occurred.
Through disorderly and biased procedures, these
children were induced, albeit unintentionally, to
report ever more heinous acts of sexual abuse against
them.
Deposition testimony indicated that upon re-evaluation
the children's statements did not meet credibility
criteria when the procedure, "Statement Validity
Analysis" (Raskin & Esplin, 1991) was applied.
Re-evaluation also indicated that initial evaluation
procedures had been faulty. The county attorney
filed a brief to quash this challenging testimony
at trial, maintaining that SVA and the other procedures
described above were inadmissible as expert testimony
due to major disagreements and lack of consensus
among experts in the field.
A review and analysis of the literature identified
eight core similarities among the major approaches
to such evaluations. Expert testimony was offered
that these eight similarities, used as the foundation
for the investigation of the sex abuse allegations,
do meet evidence admissibility requirements. The
judge allowed the challenged testimony, ruling that
investigative procedures utilizing these eight core
similarities were scientifically acceptable and
admissible as evidence. Prior to trial a Statement
Validity Analysis was performed enabling further
expert testimony to the effect that the children
probably had not been abused, but had been led to
believe that they were, based on suggestive, coercive,
and biased investigative and therapeutic conduct.
The Judge ultimately ruled that the alleged sexual
offenders were "not guilty."
Areas of Consensus
Analysis of these major investigative formats indicates
that, in spite of the many criticisms of each method
of investigation, there is substantial overlap among
them. Eight similarities are either explicitly or
implicitly a part of the major published approaches
to the clinical investigation of alleged child sexual
abuse. Several months after testimony was given
in the Hart case detailing these eight similarities,
Michael Lamb (1994) published an interdisciplinary
consensus statement on the investigation of child
sex abuse allegations that reviews areas of consensus
among 20 experts from Europe, North America and
the Middle East. Conference attendees were able
to agree on seven areas of consensus. Table 1 is
a compilation of items on both the "Hart"
list and the "Lamb" list.
(Insert Table 1 here)
Areas of Agreement Among Experts in Child Sex
Abuse Investigations
1) The investigator must carefully examine his
or her own emotions and possible biases regarding
child sex abuse before undertaking to interview
children who allege sex abuse, so as not to unwittingly
project those biases into the assessment of the
child's allegations.
2) A well-trained and experienced forensic interviewer
and not the child's therapist should conduct the
investigation. This will yield more informative
and accurate accounts by children.
3) The greatest accuracy is obtained by eliciting
a free narrative from the child in response to open-ended
questions. Inaccuracies increase with the level
of suggestiveness and coerciveness of the interview
techniques used.
4) A structured interview technique with which
the interviewer is familiar should be used, not
a freeform or unstructured interview.
5) The interview and child's behavioral responses
should be recorded, preferably by videotape, but
at least by audiotape with detailed notes. Note-taking
alone should be reserved for cases involving special
circumstances.
6) Preschool age children are prone to suggestiveness
and fantasy/reality confusion, and thus require
special skills by the interviewer, including a concession
that such confusion is possible, and knowledge of
developmental differences.
7) Some measure of a child's ability to distinguish
between truth and falsehood must be taken and all
such measures are not equal. For example, asking
a child to "tell the truth" about the
color of your sweater and the child says 'red' and
the sweater is red, does not mean that the child
can reliably distinguish between truth and falsehood
in all applications.
8) Some children's statements will be false and
must be distinguished from true statements by the
application of a structured technique, and not by
"gut feeling" or "hunches" unsupported
by articulable criteria.
9) Behaviors that mimic sexual activity are seen
more frequently in abused children than in non-abused
children.
10) Children's accounts that contain peripheral
details and are logically embedded in a rich context
are more likely to represent a true occurrence.
11) Tools and props such as anatomically detailed
dolls, puppets, or human figure drawings may be
useful when interviewing children under age 5 or
older children who are uncommunicative.
12) Although medical exams commonly do not show
evidence of sexual abuse, they should be performed
and documented in every case as soon as possible
after the allegation, by a highly trained specialist
using multiple techniques and sophisticated equipment.
Training Public Officials
Doris et al. (1995) recently emphasized the importance
of formal training for child protective services
workers. Public officials are not to blame for their
relative ignorance in the area of child sex abuse
investigations. Several have pointed out that psychologists
first hammered them for a decade to take child sex
abuse allegations seriously, and that they are now
criticized for their well-intentioned (albeit misguided)
efforts to advocate for children who cannot advocate
for themselves. The criticism, however, is not against
advocacy for children, but against poor quality
of training and of investigative procedures. Poorly
trained workers and investigators commit errors
based on lack of knowledge of the fundamentals delineated
here, giving rise to legal and personal fiascos
such as the Hart case discussed briefly
herein. Whichever scientific method of investigation
of child sex abuse allegations is chosen as the
method to be taught to child protective services
workers, or others, the fundamental procedures delineated
herein should form the minimal foundation for a
clinical investigation.
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