| 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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American Academy of Experts in Traumatic Stress,
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