Assessing Children's Credibility in Courtroom Investigations of Alleged Child Sexual Abuse: Suggestibility, Plausibility, and Consistency.

As children's testimonies of child sexual abuse (CSA) often lack concrete evidence to corroborate a child's claims, attorneys devote a substantial amount of time to establishing a child as credible during the course of a trial. Examining 134 CSA victim testimonies for children aged 5-17 (M = 12.48, SD = 3.34; 90% female), we explored how attorneys assess child credibility through specifically targeting children's suggestibility/honesty, plausibility, and consistency. Results revealed that while prosecutors examine plausibility more often to establish credibility, defense attorneys focus their assessments on suggestibility/honesty and potential inconsistency. However, both attorneys asked many more questions about children's consistency than any other area of potential credibility. Furthermore, while prosecutors ask proportionally more credibility-challenging questions of older children, the defense do not. These results suggest that prosecutors may be missing an opportunity to establish children as honest and consistent and elucidate a need to train attorneys on the implications of children's inconsistencies, suggestibility, and plausible abuse dynamics.

Is There Consensus About Children's Memory and Suggestibility?

The modern scientific study of children's eyewitness memory was initially motivated, in important part, by the sensational preschool investigations and prosecutions of the 1980s and 1990s (e.g., the McMartin case, the Kelly Michaels case, the Country Walk case). These cases form the centerpiece of Professor Cheit's scholarly book, The Witch-Hunt Narrative. In recent years, researchers have made great strides in helping the legal system tackle some of the complex issues involved in child sexual abuse investigations. While commenting on Professor Cheit's book, we review areas of consensus regarding child forensic interviewing, areas of disconnect between scientific laboratory studies and needs of the legal system, and the potential effects of bias on the scientific enterprise relevant to Professor Cheit's treatise. Although we find that there is consensus in the field regarding a set of general principles, there is often room for disagreement in evaluating a particular case, and there is still much to be learned about how best to interview children when allegations of sexual abuse arise.

Commentary About Cheit's Witch-Hunt Narrative: The Historical Context.

Ross Cheit's lengthy study is strongest when he describes in detail the findings of his 13 years of research into the original records of the key "witch hunt" cases of the 1980s to set the record straight, when possible, about what really happened. However, because this was partial history that focused primarily on the interplay between academic psychology and the media in a limited number of cases, a commentary about the broader historical and institutional context may lead to a more optimistic conclusion than Cheit seems to reach. Since this latest discovery of child sexual abuse (and its partial suppression with the rapid and predictable construction of the witch-hunt narrative), professionals across a range of disciplines continue to refine statistical science to document the prevalence and impact of child sexual abuse. They continue to enhance our understanding about children's memory and suggestibility. They have steadily refined methods to elicit full and accurate information from alleged child victims, created child advocacy centers with multidisciplinary teams to handle cases skillfully, and have developed evidence-based assessment tools and treatment protocols for substantiated victims. This solid and continuing academic output, coupled with nationwide institutionalization of the childhood trauma and maltreatment fields in organizations such as the National Child Advocacy Center, the American Professional Society on the Abuse of Children, and the National Child Traumatic Stress Network make this rediscovery of child sexual abuse different from the many other discoveries and suppressions that preceded it.

[Recognizing signs of sexual abuse]. / Signalen van seksueel misbruik herkennen.

Sexual abuse is very common. In the Netherlands 42% of women and 13% of men aged over 25 years have experienced unacceptable sexual behaviour. Most victims do not seek professional help nor do they report the abuse to the police, and most of the victims who do seek medical help do not mention the abuse. Doctors often do not recognize the signs of sexual abuse. Most victims of rape have symptoms that may develop into posttraumatic stress disorder (PTSD) if they persist for more than 4 weeks, such as sleep problems or panic attacks. Victims of sexual abuse also more often develop a psychiatric disorder or medically unexplained symptoms (MUS). Doctors should ask about sexual abuse in cases of MUS or unexplained mental problems. The complications of abuse can be treated with eye movement desensitization and reprocessing (EMDR) or cognitive processing therapy (CPT).

The Therapy Beneath the Fun: Medical Clowning During Invasive Examinations on Children.

OBJECTIVE: The qualitative research presented here is part of a larger project on the significance of medical clowning during invasive examinations in children in the Department of Gastroenterology and the Center for the Sexually Abused in a hospital in Israel. It investigated what makes up the essence of medical clowning, what skills and techniques are used by medical clowns, and whether their work contains therapeutic elements. METHODS: A total of 9 children undergoing invasive examinations and 9 of their accompanying parents participated in semistructured interviews, which were analyzed using a thematic analysis methodology assisted by an Atlas-ti software program. RESULTS: The interviews revealed that the medical clowning intervention during invasive examinations was essentially therapeutic, with the clown using theatrical and clowning tools to incorporate therapeutic elements such as empowerment, reversal of role, reframing, and building a therapeutic alliance. In addition, during the invasive examinations, the medical clowning followed the model of brief crisis intervention therapy. CONCLUSION: The study advances the need to incorporate medical clowns as an integral part of medical teams performing invasive procedures and to include clowns in all stages of the hospital visit when children undergo invasive examinations.

Forensic Interviews for Child Sexual Abuse Allegations: An Investigation into the Effects of Animal-Assisted Intervention on Stress Biomarkers.

The use of therapy animals during forensic interviews for child sexual abuse allegations is a recommendation by the Therapy Animals Supporting Kids Program to help ease children's discomfort during the forensic interview process. Based on this recommendation, this study incorporated a certified therapy canine into the forensic interview process for child sexual abuse allegations. This study investigated changes in salivary cortisol, immunoglobulin A, blood pressure, and heart rate as a result of forensic interview phenomenon (e.g., outcry) incorporating animal-assisted intervention versus a control condition in children (N = 42) interviewed for alleged child sexual abuse. The results supported significantly greater heart rate values for the control group (n = 23) who experienced sexual contact and/or indecency than the experience of aggravated sexual assault compared to no difference in HR for the intervention group (n = 19). The results suggest that the presence of the canine in the forensic interview may have acted as a buffer or safeguard for the children when disclosing details of sexual abuse. In the intervention group, children's HR was lower at the start of the forensic interview compared to the control group. Finding an effect of having a certified handler-canine team available during the forensic interview on physiological measures of stress has real-world value for children, child welfare personnel, and clinical therapists. It is suggested that animal-assisted intervention be expanded to children facing other types of trauma and to treatment programs for child survivors of sexual abuse.

Testing and Treatment After Adolescent Sexual Assault in Pediatric Emergency Departments.

OBJECTIVE: To examine rates of recommended of testing and prophylaxis for chlamydia, gonorrhea, and pregnancy in adolescents diagnosed with sexual assault across pediatric emergency departments (EDs) and to determine whether specialized sexual assault pathways and teams are associated with performance of recommended testing and prophylaxis. METHODS: In this retrospective study of 12- to 18-year-old adolescents diagnosed with sexual assault at 38 EDs in the Pediatric Hospital Information System database from 2004 to 2013, information regarding routine practice for sexual assault evaluations and presence and year of initiation of specialized ED sexual assault pathways and teams was collected via survey. We examined across-hospital variation and identified patient- and hospital-level factors associated with testing and prophylaxis using logistic regression models, accounting for clustering by hospital. RESULTS: Among 12,687 included cases, 93% were female, 79% were <16 years old, 34% were non-Hispanic white, 38% were non-Hispanic black, 21% were Hispanic, and 52% had public insurance. Overall, 44% of adolescents received recommended testing (chlamydia, gonorrhea, pregnancy) and 35% received recommended prophylaxis (chlamydia, gonorrhea, emergency contraception). Across EDs, unadjusted rates of testing ranged from 6% to 89%, and prophylaxis ranged from 0% to 57%. Presence of a specialized sexual assault pathway was associated with increased rates of prophylaxis even after adjusting for case-mix and temporal trends (odds ratio 1.46, 95% confidence interval 1.15 to 1.86). CONCLUSIONS: Evaluation and treatment of adolescent sexual assault victims varied widely across pediatric EDs. Adolescents cared for in EDs with specialized sexual assault pathways were more likely to receive recommended prophylaxis.

Dissociation and symptoms of culture-bound syndromes in North America: a preliminary study.

The aim of this study was to determine whether classical culture-bound syndromes occur among psychiatric inpatients with dissociative disorders in North America. The Dissociative Trance Disorder Interview Schedule, the Dissociative Experiences Scale, and the Dissociative Disorders Interview Schedule were administered to 100 predominantly Caucasian, American, English-speaking trauma program inpatients at a hospital in the United States. The participants reported high rates of childhood physical and/or sexual abuse (87%), dissociative disorders (73%), and membership in the dissociative taxon (78%). They also reported a wide range of possession experiences and exorcism rituals, as well as the classical culture-bound syndromes of latah, bebainan, amok, and pibloktoq. Our data are consistent with the view that possession and classical culture-bound syndromes are predominantly dissociative in nature and not really culture-bound from the perspective of Caucasian, English-speaking America.

Introduction: in the aftermath of the so-called memory wars.

The term "memory wars" has been used by some to characterize the intense debate that emerged in the 1990s regarding the veracity of recovered memories of child sexual abuse. Both sides in this debate have been motivated by scientific and ethical concerns. Recent years have witnessed a burgeoning of relevant behavioral and neuroimaging evidence that when taken together, points the way toward reconciliation. All of the contributors to this volume acknowledge that true recoveries characterize a substantive proportion of recovery experiences and that suggestive therapeutic techniques may promote false memories. Disagreements continue to exist on the cognitive and motivational processes that can lead to true recoveries and the extent to which false recovered memories occur.

A theoretical framework for understanding recovered memory experiences.

If recovered memory experiences appear counter-intuitive, this is in part due to misconceptions about trauma and memory, and to a failure to adopt a comprehensive model of memory that distinguishes personal semantic memory, autobiographical event memory, and memory appraisal. Memory performance is generally superior when events, including traumas, are central to identity. Prolonged trauma in childhood, however, can produce severe identity disturbances that may interfere with the encoding and later retrieval of personal semantic and autobiographical event information. High levels of emotion either at encoding or recall can also interfere with the creation of coherent narrative memories. For example, high levels of shock and fear when memories are recovered unexpectedly may lead to the experience of vivid flashbacks. Memory appraisals may also influence the sense that an event has been forgotten for a long time. Recovered memories, although unusual, do not contradict what we know about how memory works.

Cognitive underpinnings of recovered memories of childhood abuse.

Recent research on recovered memories of childhood sexual abuse has shown that there are at least two types of recovered memory experiences: those that are gradually recovered within the context of suggestive therapy and those that are spontaneously recovered, without extensive prompting or explicit attempts to reconstruct the past. These recovered memory experiences have different origins, with people who recover memories through suggestive therapy being more prone to forming false memories, and with people who report spontaneously recovered memories being more prone to forgetting prior instances of remembering. Additionally, the two types of recovered memory experiences are linked to differences in corroborative evidence, implying that memories recovered spontaneously, outside of suggestive therapy, are more likely to correspond to genuine abuse events. This chapter highlights the background of the recovered memory debate, summarizes recent studies with individuals reporting recovered memory experiences and points towards applications in the justice system and in clinical practice.

Motivated forgetting and misremembering: perspectives from betrayal trauma theory.

Individuals are sometimes exposed to information that may endanger their well-being. In such cases, forgetting or misremembering may be adaptive. Childhood abuse perpetrated by a caregiver is an example. Betrayal trauma theory (BTT) proposes that the way in which events are processed and remembered will be related to the degree to which a negative event represents a betrayal by a trusted, needed other. Full awareness of such abuse may only increase the victim's risk by motivating withdrawal or confrontation with the perpetrator, thus risking a relationship vital to the victim's survival. In such situations, minimizing awareness of the betrayal trauma may be adaptive. BTT has implications for the larger memory and trauma field, particularly with regard to forgetting and misremembering events. This chapter reviews conceptual and empirical issues central to the literature on memory for trauma and BTT as well as identifies future research directions derived from BTT.

Children's eyewitness memory for multiple real-life events.

The present research examined the influence of prior knowledge on children's free recall, cued recall, recognition memory, and source memory judgments for a series of similar real-life events. Forty children (5-12 years old) attended 4 thematic birthday parties and were later interviewed about the events that transpired during the parties using the National Institute of Child Health and Human Development protocol. Of the events, half were generic in that they could have occurred at any birthday party, and half were specific to the theme of the party. Older children demonstrated more evidence of using gist-based information to guide their memory performance than did younger children. However, younger children were able to use global gist to inform their source memory judgments, qualifying past word-learning research.

Development and initial validation of the institutional child abuse processes and coping inventory among a sample of Irish adult survivors of institutional abuse.

OBJECTIVE: To develop a psychometric instrument to evaluate psychological processes associated with institutional abuse and coping strategies used to deal with such abuse. METHODS: As part of a comprehensive assessment protocol, an inventory containing theoretically derived multi-item rational scales which assessed institutional abuse-related psychological processes and coping strategies were administered to 247 Irish adult survivors of institutional child abuse. Exploratory and confirmatory factor analyses were used to derive 6-factor scales, the reliability and validity of which were assessed. RESULTS: Factor scales to assess the following constructs were developed (1) traumatization, (2) re-enactment, (3) spiritual disengagement, (4) positive coping, (5) coping by complying, and (6) avoidant coping. There were varying degrees of support for the validity of the scales with most support for the traumatization and re-enactment scales. CONCLUSIONS: The Institutional Child Abuse Processes and Coping Inventory (ICAPCI), particularly its traumatization and re-enactment scales, may be used in future research on adult survivors of institutional child abuse because they are currently the only scales that have been developed with this population to provide reliable and valid assessments of these constructs. PRACTICE IMPLICATIONS: The ICAPCI may be used, cautiously, to assess adult survivors of institutional child abuse.

Children's autobiographical reports about sexual abuse: A narrative review of the research literature.

BACKGROUND: The empirical and theoretical literature on children's autobiographical statements about child sexual abuse and other forms of maltreatment should be of potential importance to all professionals who regularly interview children as part of their professional duties. AIMS: To present an introduction to this field. METHODS: Narrative review. RESULTS: Preschool children appear to be capable of providing reliable testimony on highly salient personal experiences such as sexual abuse, though a substantial proportion of children may choose not to. However, suggestive interviewing practises, particularly when used with younger children, may elicit false allegations. There is little evidence to suggest that experiences from the preverbal period of life can later be meaningfully reconstructed by means of statements or clinical signs. CONCLUSIONS: Use of children as witnesses and informants requires special considerations, knowledge and skills.

Penile-response profiles of sexual aggressors during phallometric testing.

This study analyzes sexual-preference profiles in a sample of 420 sexual aggressors who exhibited a valid profile during their initial phallometric assessment. The sexual stimuli used in the process were audiotapes describing sexual-offending scenarios. Two types of sexual stimuli sets were used: one developed for sexual aggressors against women and a second developed for sexual aggressors against children. Penile responses were recorded during stimulus presentation using a mercury-in-rubber strain gauge. Classification analyses (hierarchical and K-means clustering combination) were conducted separately for three groups of sexual aggressors: (a) sexual aggressors against children (n = 253), (b) sexual aggressors against women (n = 138), and (c) mixed sexual aggressors (n = 29). The sexual aggressors against children exhibited four penile-response profiles, the sexual aggressors against women two penile-response profiles, and the mixed sexual aggressors only one penile-response profile. In addition, analyses carried out on randomly split subsamples established that the generated profiles for sexual aggressors against children and sexual aggressors against women were stable.

Pediatric sexual abuse: emergency department evaluation and management.

Pediatric sexual abuse is an overwhelming problem in the United States. It is estimated that 25% of females and 16% of males in the United States are sexually abused before the age of 18. The emergency department (ED) is frequently the point of entry for care of sexually abused children and adolescents. Personnel from the ED are usually the first "reporters" of sexual abuse, propelling these issues into the medicolegal system. Therefore, it is critical for ED practitioners to have the knowledge and skill set required to provide thorough, comprehensive care for this patient population. The ED holds a powerful position in the multidisciplinary approach to pediatric sexual abuse, involving social workers, child protective services, and law enforcement. This article presents the essential information required to assume a leadership role in the medical management of the sexually abused child/adolescent in the ED, including mandatory reporting, triage, assessment, treatment, and follow-up.

Expert judgment in cases of alleged child sexual abuse: clinicians' sensitivity to suggestive influences, pre-existing beliefs and base rate estimates.

Clinicians' expertise in child sexual abuse (CSA) cases was explored by giving a questionnaire covering clinical experience, self-evaluated expertise, beliefs and attitudes about CSA and a trial material concerning CSA to 320 child mental health professionals. In the material the suggestiveness of the interview with the child was varied and one condition did not contain any interview transcript. Participants were sensitive to the presence of leading questions but not to the presence of other suggestive techniques and not to the possibility that suggestive techniques could have been used when no interview transcripts were included. Experience only affected sensitivity to leading questions. Strong attitudes and beliefs lessened the sensitivity to leading questions and made participants more prone to wanting the case to be prosecuted when other suggestive influences than leading questions were present. Practical implications of the results will be discussed.