CHILD: False Indicators of Child Abuse

Child, Child abuse, evaluation, false symptoms, trial, victim

Child Abuse “Syndromes”

Even sexualized behavior cannot be used as proof of abuse. What children normally do sexually is more involved than most people believe (Best, 1983; Gundersen et al., 1981; Langfeldt, 1981; Leung and Robson, 1993; Martinson, 1981; Okami, 1992). Friedrich et al. (1991) asked mothers of 880 nonabused two- to twelve-year-old children to complete questionnaires concerning sexual behavior. Although behaviors imitative of adult sexual behaviors were rare, the children exhibited a wide variety of sexual behaviors at relatively high frequencies. Mannarino et al. (1991) report no differences in sexual behavior between abused girls and a clinical control group, although both scored higher than did the normal controls. Gordon et al. (1990) found no differences in sexual knowledge between their samples of sexually abused and nonabused children. Haugaard and Tilly (1988) found that approximately 28% of male and female undergraduates reported having engaged in sexual play with another child when they were children. Lamb and Coakley (1993) report that 85% of their sample of female undergraduates described a childhood sexual game experience. A third of these experiences, which the respondents rated as “normal,” involved genital fondling with or without clothing and some reported oral-genital contact and attempts at sexual intercourse.

In addition, since many sexually abused children do not suffer significant trauma (Browne and Finkelhor, 1986; Finkelhor, 1990; Gomes-Schwartz et al., 1990; Kendall-Tackett et al., 1993; Wakefield and Underwager, 1988a), an abused child may fail to exhibit any behavioral signs. It is a mistake to use the absence of behavioral signs as support for an allegation being false.

Using behavioral indicators to assess sexual abuse may result in a mistake in either direction. Besharov (1990) observes that behavioral indicators, by themselves, are not a sufficient basis for a report. Levine and Battistoni (1991) state that none of these indicators, in any combination, are valid without a direct statement by the child about sexual involvement or sexual knowledge. A statement representing the consensus of a group of international, interdisciplinary experts in child sexual abuse (Lamb, 1994b) concluded:

“No specific behavioral syndromes characterize victims of sexual abuse. Sexual abuse involves a wide range of possible behaviors which appear to have widely varying effects on its victims. The absence of any sexualized behavior does not confirm that sexual abuse did not take place any more than the presence of sexualized behavior conclusively demonstrates that sexual abuse occurred; rather, both pieces of information affect the level of suspicion concerning the child’s possible experiences and should to serve to promote careful and nonsuggestive investigation.” (p. 154)

There are few scientific data supporting the claim of a sexual abuse syndrome or a child sexual abuse accommodation syndrome (CSAAS) (Summit, 1983). These syndromes are speculative and meet neither Frye nor Daubert. The revisers of DSM-III refused to include them in DSM-III-R because there is no evidence to support them (Corwin, 1988).

Myers (1993) notes that both diseases and syndromes share the medically and forensically important feature of diagnostic value. Both point with varying degrees of certainty to particular causes. However, whereas with many diseases the relationship between symptoms and etiology is clear, with syndromes, this relationship is often unclear or unknown. The certainty with which a syndrome points to a particular cause varies with the syndrome. Two syndromes often offered in expert testimony in cases of alleged child abuse are the battered child syndrome and CSAAS. The battered child syndrome has high certainty since a child with the symptoms is very likely to have suffered nonaccidental injury. Therefore, this syndrome has high probative value and, in fact, has been approved by every appellate court to consider it. This can be contrasted with the child sexual abuse accommodation syndrome (CSAAS) which does not point with any certainty to sexual abuse. The fact that a child shows behaviors of the CSAAS does not help determine whether the child was sexually abused.

The CSAAS is a nondiagnostic syndrome. It does not meet the test of falsifiability when used to support abuse since there is nothing that can count against it. Therefore Daubert would lead to the judicial decision that use of the CSAAS is inadmissible. By contrast, in the battered child syndrome there is research evidence accumulating to demonstrate that nonaccidental injuries can be successfully discriminated from accidental injuries by the nature of the injuries.

The child sexual abuse accommodation syndrome.
Summit, Roland C.; Child Abuse & Neglect, Vol 7(2), 1983. pp. 177-193.
Abstract:
Classifies the most typical reactions of children to sexual abuse into a child abuse accommodation syndrome. The syndrome is composed of 2 categories that define basic childhood vulnerability and 3 categories that are sequentially contingent on sexual assault: (1) secrecy; (2) helplessness; (3) entrapment and accommodation; (4) delayed, unconvincing disclosure; and (5) retraction. The accommodation syndrome is proposed as a simple and logical model for use by clinicians to improve understanding and acceptance of the child’s position in the complex and controversial dynamics of sexual victimization. Application of the syndrome tends to challenge entrenched myths and prejudice, providing credibility and advocacy for the child within the home and the courts and throughout the treatment process. The child’s coping strategies as analogs for subsequent behavioral and psychological problems, including implications for specific modalities of treatment, are discussed.

Commentary: Abuse of the Child Abuse Accommodation Syndrome
Elias, Harry M.; Journal of Child Sexual Abuse, Vol 1(4), 1992. pp. 169-171.
Abstract:
Comments on R.C. Summit’s (see record 1994-02082-001) article on the Child Sexual Abuse Accommodation Syndrome(CSAAS). The original lesson to be learned from the CSAAS is that society, and many professionals who come into contact with sexually abused children, frequently have preconceived ideas about how a traumatized person will react. Such misconceptions can cause people not to listen, not to understand, and not to learn.

Commentary: Summit’s ‘abuse of the CSAAS.’
MacFarlane, Kee; Journal of Child Sexual Abuse, Vol 1(4), 1992. pp. 165-167.
Abstract:
Comments on R. C. Summit’s (see record 1994-02082-001) article on the abuse of the Child Sexual Abuse Accommodation Syndrome (CSAAS). It is argued that the fact that the CSAAS has been blamed in absentia for the reversal of cases in which it was never mentioned, speaks not only to the determination of those who have invoked it to suit their own purposes, but to the universality of its message.

Abuse of the Child Sexual Abuse Accommodation Syndrome.
Summit, Roland C.
Journal of Child Sexual Abuse, Vol 1(4), 1992. pp. 153-163.
Abstract:
Discusses the origins of the concept of the Child Sexual Abuse Accommodation Syndrome ([CSAAS] R. C. Summit; see record 1984-15274-001) and the subsequent distortions that court misuse has imposed. The CSAAS is a clinical observation that has become both elevated as gospel and denounced as dangerous pseudoscience. It is hoped that such a contextual review can serve as a guide toward a more accurate understanding among clinicians, judges, and advocate attorneys.

The rehabilitation of the Child Sexual Abuse Accommodation Syndrome in trial courts in Kentucky.
Stewart, William F.; Young, Rose
Journal of Child Sexual Abuse, Vol 1(4), 1992. pp. 133-141.
Abstract:
Attempts to reconcile the position of Kentucky law in regard to the Child Sexual Abuse Accommodation Syndrome(CSAAS) with that of R. C. Summit’s (1992) views. Summit described this syndrome in an attempt to explain the seemingly paradoxical behavior of child victims in disclosing sexual abuse. The following conditions should be met for the CSAAS to be admissible in the prosecution of child sexual abuse: (1) The symptoms of CSAAS should be present through interviewing the child, (2) testimonial use of the CSAAS must be in general terms to avoid the hearsay objection, and (3) prosecutors should avoid specific questions about the victim. An outline of Kentucky’s legal history concerning this issue is provided.

The rehabilitation of the Child Sexual Abuse Accommodation Syndrome in trial courts in Kentucky: Commentary.
Summit, Roland C.; Journal of Child Sexual Abuse, Vol 1(4), 1992. pp. 147-151.
Abstract:
Comments on W. F. Stewart and R. Young’s (see record 1994-02079-001) article on the rehabilitation of the Child Sexual Abuse Accommodation Syndrome (CSAAS) in trial courts in Kentucky. Rehabilitation of the CSAAS is not enough, especially if the CSAAS continues to be held as the repository for all the symptoms of child sexual abuse. The courts must initiate policies that will admit legitimate, percipient clinical information. If judges are allowed to share in court the pitfalls of abuse and the hearsay travails of those who work with abuse, they can direct their unquestioned authority in the field of law to compel the rehabilitation of the justice system for the protection of children.

How do children tell? The disclosure process in child sexual abuse.
Bradley, April R.; Wood, James M.
Child Abuse & Neglect, Vol 20(9), Sep 1996. pp. 881-891.
Abstract:
Examined children’s disclosures of sexual abuse in 234 sexual abuse cases validated by Protective Services in Texas. Denial of abuse occurred in 6% of cases, and recantation in 4% of cases in which a child had already disclosed abuse. Four of the 8 victims who recanted appeared to do so in response to pressure from a caretaker. 72% had disclosed abuse to someone else prior to contact with Protective Services or the police. 96% made a partial or full disclosure of abuse during at least 1 interview with Protective Services or police. The child sexual abuse accommodation syndrome described by R. C. Summit (1983) seems to be infrequent among the types of cases seen by child protection agencies. Findings do not support the view that disclosure is a quasi-developmental process that follows sequential stages.

Expert witnesses in child abuse cases: What can and should be said in court.
Ceci, Stephen J. (Ed); Hembrooke, Helene (Ed); pp. 159-184. Washington, DC, US: American Psychological Association, 1998. viii, 299 pp. (from the chapter)
Contributes to the ongoing efforts of mental health and legal practitioners to meet forensic and ethical demands for valid sexual abuse assessment by providing an overview and critique of instruments and techniques currently applied to the validation of child sexual abuse. Topics discussed include defining child sexual abuse; theoretical models applied to the validation of child sexual abuse; the Child Sexual Abuse Syndrome and the Child Sexual Abuse AccommodationSyndrome; traumatic sexualization; and interviewing children about sexual abuse.

Disclosure of Child Sexual Abuse: What Does the Research Tell Us About the Ways That Children Tell? London, Kamala; Bruck, Maggie; Ceci, Stephen J.
Psychology, Public Policy, and Law, Vol 11(1), Mar 2005. pp. 194-226.
Abstract:
The empirical basis for the child sexual abuse accommodation syndrome (CSAAS), a theoretical model that posits that sexually abused children frequently display secrecy, tentative disclosures, and retractions of abuse statements was reviewed. Two data sources were evaluated: retrospective studies of adults’ reports of having been abused as children and concurrent or chart-review studies of children undergoing evaluation or treatment for sexual abuse. The evidence indicates that the majority of abused children do not reveal abuse during childhood. However, the evidence fails to support the notion that denials, tentative disclosures, and recantations characterize the disclosure patterns of children with validated histories of sexual abuse. These results are discussed in terms of their implications governing the admissibility of expert testimony on CSAAS.

TOPIC: Symptoms of Abuse in Children

Beyond Sexual Abuse: The Impact of Other Maltreatment Experiences On Sexualized BehaviorsMelissa T. Merrick, Alan J. Litrownik, Mark D. Everson, and Christine E. Cox
CHILD MALTREATMENT, Vol. 13, No. 2, May 2008 122-132
Abstract:
This study sought to broaden research findings linking maltreatment to sexualized behaviors by investigating whether maltreatment experiences other than sexual abuse predict such behaviors. The sample included 690 children without reported sexual abuse histories who are participants in the LONGSCAN Consortium, a prospective multisite investigation of childhood maltreatment. Child Protective Service reports before age 8 years and caregiver reports on the Child Sexual Behavior Inventory-II at age 8 years were used to examine the relationship between maltreatment timing and type, and sexualized behaviors. Logistic regression analyses suggested that early (< 4) and late (4-8) reports of physical abuse were associated with more sexualized behaviors (odds ratios = 1.9-2.6). The pattern differed by gender, with physical abuse predicting sexual intrusiveness and displaying private parts in boys, and boundary problems in girls. Findings suggest that maltreatment other than sexual abuse, and the developmental periods in which it occurs, may be linked to the development of sexualized behaviors.