Custody Newsletter #5

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WELCOME

Welcome to the Custody Newsletter. Our tone is informal; we WANT contributions based on your clinical experiences, as well as more formal presentations.

Second, we solicit input from members of all professions. This is why it is not mandatory that any specific References format be followed e.g., the bibliographic notation system of the American Psychological Association, the American Psychiatric Association, etc.

In general, we favor brief articles, contributions ranging from one-half of a typewritten page to about eight typewritten pages.

Here, in Issue 5, John A. Call, Ph.D., J.D., demonstrates once again (he did an earlier CN piece on joint vs. Sole custody), his remarkable ability to take a complex subject and boil it down to size, without missing any relevant aspect of the involved matter.

False allegations of sexual abuse are said to be rampant in our field. (I’m not certain that the frequency of these allegations is high solely because of disputed custody issues. There are many other forces afoot in current culture which have contributed to this state of affairs.) Whatever be the nature of the constellation of thrusts which has led to this phenomenon, t is certainly true that custody evaluators must be highly attuned not only to all hard data pertinent to the investigation of sexual abuse, but to the subtle nuances as well which surround the launching of a sex abuse investigation.

SEXUAL ABUSE IN PRESCHOOL CHILDREN

INTRODUCTION

Child sexual abuse is rightfully perceived as a particularly heinous crime in our society. This is even more true when the victim is a preschooler. The National Center on Child Abuse and Neglect defines child sexual abuse as contact or interactions between a child and an adult wherein the child is being used for the sexual stimulation of the adult or another person. Furthermore, sexual abuse may be committed by a person is significantly older than the victim or when the abuser is in a position of power or control over the victim.\1]

According to Kaplan and Pelcovitz:

Girls are more frequently reported as sexually abused than boys. The commonest age range is 11 to 14 years. The victim of incest is usually the first daughter, who has been described as coquettish and appealing.

Short-term effects of incest include regression to earlier behaviors, such as thumb-sucking, eating disorders sleep disorders, enuresis, tics, or excessive fears. Sexual abuse victims have been described as demonstrating lack of inhibition of sexual impulses and as seeking affection through sexual contact. This often results in sexual abuse to the child when she is in a foster home. Incest has been associated with the child becoming a runaway, a child prostitute, or a subject of pornographic materials. Sexual abuse victims have been described as depressed, self-mutilative, and as developing sexual dysfunctions such as promiscuity, frigidity, or failure to marry.

Inadequate relationships with their mothers with residual anger toward the mother in adulthood have been described. One of the immediate sequelae of a report of sexual abuse is that he child may feel guilty about the public disclosure. The child often views herself as having betrayed the family, and in fact she may be rejected by both parents.

The majority of perpetrators are males, usually fathers, living in the victim’s household. Three types of incestuous fathers have been described: (1) fathers who are indiscriminately promiscuous, with incest included in this behavioral repertoire; (2) pedophiliac fathers; and (3) fathers who turn to their daughters as sexual partners because of marital discord and a reluctance to go outside the family for a sexual partner. [2]

Because of the increase in the reporting of child sexual abuse, validation of sexual abuse allegations has become a major focus of interest. "Lack of coordination and collaboration among professionals has led to confusion as to the credibility of reports of child sexual abuse." [3] This validation problem can significantly impact the trial phase of a sexual abuse case. This most recently was observed in the McMartin Preschool Molestation Trial in Los Angeles wherein it was reported that the jurors believed that the children had been abused but felt that the assessment procedures utilized were inadequate to definitively pinpoint the abuser.

Likewise, innocent defendants may be convicted of sexual abuse when none occurred. For example, on page 8 of the January 28, 1990 Sunday Oklahoman the following headline was noted- "GIRL RECANTS RAPE TALE; MAN FREED 11-Year-Old Based Story On TV Show." The news story went on to explain that--

\a]n 11-year-old girl who recanted testimony that she was raped by her mother’s boyfriend had fabricated her story after watching a television police drama, lawyers said.

Her testimony, given when she was 9, helped convict Ivie Cornell Norris, who spent 513 days in Pinellas County jail and could have faced life behind bars. The girl recanted Friday and Norris is a free man.

Her mother told the judge that the girl admitted a couple of months ago she had fabricated the story with the idea of getting Norris out of the way because the couple fought "and she just wanted him away from me."

Mary C. Orendorf, a juror at Norris’ trial, recalled Friday how the girl’s credibility was the central issue during four hours of deliberations at the trial in 1988. There was no physical evidence, she said, only the girl’s word.

"We really went over it and over it to see, ‘Is she making this up? Is she telling the truth?’" Orendorf said.

On the stand, the girl appeared calm, even a little timid, she recalled. "It just didn’t seem like she was lying."

The objectives of the present article are threefold, to briefly discuss:
(1) the continuum between normal hugging and kissing and inappropriate sexual touching and fondling; (2) the current differences of opinion regarding how a sexual abuse assessment evaluation may be accomplished; and (3) guidelines and techniques for assessing false allegations. Primarily, the above questions will be investigated with respect to preschool children as the potential victim. These are often the most difficult cases. There is usually no physical evidence and the child, because of his or her lack of intellectual development, is a poor historian.

APPROPRIATE VS. INAPPROPRIATE VS. CRIMINAL TOUCHING

\In] a recent study by Rosenfeld and colleagues of childrearing practices in upper-middle-class families \it was] determined that 45% of 8-to 10-year-old boys had touched their mother’s breasts or genitals, and that 30% of the girls up to age 10 had touched their fathers’ genitals. This behavior has often been regarded as evidence of sexual abuse, [but is it?] The clinician must make a thorough survey of "normal" or sexually ambiguous caretaking routines...during sexual abuse evaluations as they might be misinterpreted as evidence of molestation. [4]

There is a continuum of touching. On one end of the spectrum, for example, is a father kissing his daughter good night, on the other is a father performing fellatio on his daughter. In the middle of this continuum reside what Schetky and Green term the ‘gray area’ wherein sexual abuse cannot be easily proven or disproven. Theses authors subdivide this ‘gray area’ into three parts: (1) sexual overstimulation with no intent to molest; (2) ‘gentle’ molestation where there is intent to molest; and (3) what the authors ambiguously term, ‘another category’.

(The following paragraphs are quotations from Ref. No. 5)

Some children are exposed to chronic sexual overstimulation by one or both parents. The overstimulation may take place during routine childcare practices, such as bathing or toileting, when a parent might rub or clean the child’s genital area too vigorously. It may also occur in "liberated" families in which the parents and children walk around in the nude. On other occasions, a child may be sexually stimulated bny prolonged and sensual hugging and kissing, or by sleeping in the same bed with a parent. In some sexually permissive families, the parents will allow the children to touch and examine their genitals in response to questioning abnout sexual anatomy. There parents are usully unaware of the potential pathological impact of these practices on their children, and fail to appreciate the importance of privacy and delineating physical boundaries for the child’s sel-awareness and body integrity.

These children receive conscious and unconscious gratification of voyeristic, exhibitionbnistic, and incestual fantasies during these stimulating encounters, which may give rise to shame, guilt, fear of punishment or castration and may engender intrapsychic conflict. They might also exhibit seductive and sexually precocious behavior through premature eroticization and identification with the "seductive" parent. There is potential for a "snowballing" effect as the sexualized child elicits further seductive behavior from the parent. The parents usually receive unconscious sexual and incestous gratification from these iteractions, which may or may not serve as a compensation for an unsatisfactory marital relationship. These behaviors are usually egosyntonic for the parents as long as their relationship remains intact.

When a separation or divorce ensues, however, the seductive parent-child contact assumes a more threating perspective. Typically, the seductive parent-child dyad, usually the father and daughter, become more enmeshed as a result of the aniety generated by separation, and the mother becomes threatened by feelings of jealousy and exclusion. In this setting, the mother can easily overreact to the sexualized father-daughter relationship and make an allegation of sexual abuse. At times, she responds to cues of increased distress by the daughter, as the latter experiences an intensification of oedipal guilt and separation anxiety following overnight and vacation visits with the over sexualized father in the mother’s absence. Hysterical and paranoid mothers are more likely to misperceive this sexualized relationship as intentional sexual misuse of the child. In this highly sexualized climate, a vaginal or rectal irritation will often trigger a report of sexual abuse by a pediatrician or mental health professional, eve in the absence of hard physical findings.

Cases of sexual overstimulation in children may be differentiated from actual sexual abuse in that (a) the father-daughter relationship is usually positive and (b) aside from signs of sexual overstimulation, there are no other symptoms of child sexual abuse, i.e., post-traumatic stress responses, depression, regressive behavior, and social withdrawal.

[In "gentle" molestation], the father or paternal caretaker might intentionally fondle the genitals of a preschool child in the context of routine child care, i.e., dressing and bathing. The fondling may be accomplished in a gentle, soothing manner, without force or threats. The child, under these circumstances, may respond with erotic pleasure, being totally unaware of the deviant nature of the act. If there is no attempt at more invasive sexual practices, such as vaginal penetration, anal intercourse, or fellatio, the child may remain asymptomatic. This type of molestation is often not disclosed until the child becomes older and begins to understand the nature of this behavior, or if the pressure for secrecy becomes an onerous burden. Then symptoms of anxiety, regressive behavior, and somatic symptoms might ensue. In a certain percentage of these cases, the gentle fondling will gradually escalate into a more forceful type of genital contact, leading to more prominent symptoms and disclosure.

Family assessment of this type of molestation might reveal: (a) a positive but seductive interaction between the father and child; (b) confirmation of the abuse by the child brought verbalization or reenactment in play and fantasy; and © prominent paternal psychopathology and/or evidence of sexual deviancy. "Gentle" molestation will not yield positive physical or laboratory findings.

Another category of allegations is one in which there is a kernel of truth, but in the course of multiple interrogations and parental pressures the allegation becomes embellished. Thus one may be dealing simultaneously with true and false allegations. This may occur when the child views repeated questions as demands for more information, when she is eager to please the examiner, when leading questions are used, or when she is exposed to allegations made by other victims. [5]

ASSESSMENT OF POSSIBLE SEXUAL ABUSE IN THE PRESCHOOL AGE CHILD

Assessment of possible abuse in a preschool age child is a complex undertaking. According to L.E.A. Walker the two goals of assessment are "to provide a sufficient amount of information from which to determine the child’s current emotional status so as to design a treatment plan if necessary...and second, to assess who did what to the child in order to provide future protection of the child." [6] Not all mental health professionals agree with respect to the ‘correct’ procedure or technique.

Assessment of sexual abuse typically is divided into four parts: (1) medical evaluation and diagnosis of the child; (2) psychological evaluation of the parents; (3)evaluation of the family dynamics and home life; and (4) developmental and psychological evaluation of the child. S. Conerly writes that ideally the psychologist should interview all members of the family, the babysitter, the preschool teacher, and any others who might have knowledge regarding the child and the family.\7] Thus prior to interviewing the child the evaluator should uncover.

1. A personal history, including psycho-sexual development.
2. A family history.
3. History of the child’s development.
4. A list of persons having access to the child.
5. A list of what the child calls each member of the family group, including pets.
6. A list of what the child calls the genitals and elimination functions.
7. Basic idea of the child’s daily routine.
8. Observations of usual and unusual behavior.

The parents should also be asked about their marital history, custody, visitation, and what limits they set on their own sexual behavior in the presence of the child. [8]

Schetky suggest that--

[O]bserving the young child with respective parents, particularly if there is the possibility that allegations in the context of a custody dispute may be false, can be vert helpful. Custodial parents may protest vehemently, claiming it will traumatize the child and that the child has no relationship with the other parent or is terrified of him. Sometimes these concerns may be legitimate, whereas at other times they point to a parent trying to suppress certain information. The clinician will need to weigh the risks versus the benefits of observing the child with the alleged perpetrator when he is a family member.[9]

In general the interview of the child is divided into the following phases: (1) establishing rapport and giving permission to talk; (2) obtaining the history of abuse; (4) probing for details and validating information; and (5) closure.

Conclusive physical evidence of sexual child abuse in preschool children is usually available only in a minority of cases. Thus the clinician must base his or her "judgement about the credibility of an accusation on statement, emotions, and behaviors of the child and the child’s family."[10] Here resides the crux of the forensic psychologist’s dilemma. As Haugaard and Reppucci note "[t]here appear to be two basic processes that a clinician can follow during an interview--assessing whether the alleged sexual abuse occurred or getting the child to confirm the clinician’s belief that abuse occurred."[11]

Those clinicians interested in assessing whether abuse occurred attempt to use all means possible to prevent contamination of the interview data via inappropriate suggestion or undue influence. In general these professionals are much more nondirective in their interview style. Those clinicians interested in confirming that abuse happened are able to justify using more intrusive methods which at times can become extreme. Examples of methods which can be used in an intrusive manner are leading questions and anatomically ‘correct’ dolls. Both of these methods have their proponents and detractors.

For example, some experts argue that the evaluator should know nothing about the alleged abuse prior to interviewing the child. They argue that such information will predispose the clinician to ask certain types of questions which will ‘suggest’ certain types of responses from the child.[12] On the other hand, other experts argue that leading questions are necessary with young children.[13]

[Likewise], while using anatomically correct dolls with alleged victims, Shamroy (1987) suggests that the clinician present the dolls to the child and say, "Let’s pretend that this is you.’ If the child does not name the adult dolls, the \clinician] can say, ‘Let’s pretend that this is mommy’ (or daddy, or whoever), and suggest a situation, such s bedtime...Any information about where the sexual abuse took place or the suspected offender can be induced in the ‘let’s pretend’ situation" (p.165). White, Santilli, and Quinn (1987), however, suggest that the child not be given any directions about what to name the dolls or which situation to put them in. They argue that doing so may suggest incorrect information to the child, inappropriately direct the interview in one direction, and reduce the chance that some other type of abuse that the child has experienced will be revealed.[14]

In conclusion, with the current differences of opinion regarding what is the methodologically appropriate procedure to be used in a child sexual abuse evaluation perhaps the best advice for both the mental health and legal community is to videotape all interviews. "[V]ideotaping of all sessions may provide the only material for assessing the clinician’s method of investigation and may be the only way for the clinician to show that...questioning was appropriate and was done correctly (or for others to show the opposite)."[15]

CREDIBILITY, VALIDITY, AND FALSE ALLEGATIONS

False allegations of sexual child abuse do occur. Musty writes that a false accusation of sexual abuse by a preschool age child may occur when (1) an adult has persuaded a child that the sexual event actually occurred when it had not; (2) when a child has misinterpreted caregiving behaviors; (3) when a child’s thought processes are confused by primary process materials; and/or (4) when a child is involved in the projective identifications of a dominant caregiver.[16] Musty also states that in most cases the child usually believes that his or her story is correct. Likewise, Walker agrees that it is possible to ‘brainwash’ a child to give false reports of sexual abuse and that such occurrences are often extremely difficult to detect. [17] Green and Schetky indicate that although false disclosures are relatively rare they can occur in the following situations.

1. The child is "brainwashed" by a vindictive parent, usually the mother, who fabricates the incest in order to punish the spouse by excluding him from further contact with the child.
2. The child is influenced by a delusional mother who projects her own unconscious sexual fantasies onto the spouse.
3. The child’s allegations of sexual abuse are based upon sexual fantasies rather than reality.
4. The child falsely accuses the father of incest for revenge or retaliation.
5. False allegations of sexual abuse may be initiated by third parties, i.e., hypervigilant parents of preschool children who have been over sensitized by sensational media coverage of sexual abuse scandals at nursery schools and day care centers.
6. False allegations may be spread by contagion through exposure to the testimony of other children, in preschool and day care settings.
7. Medical problems may give rise to increased sexual concerns or account for physical finding, i.e., nonspecific vulvovaginitis, anal fissures caused by constipation, and misinterpretation of medical data.[18]

What factors enhance or detect from a child’s credibility in allegations of sexual abuse? Schetky provides the following list.[19]

CHILD	ENHANCE CREDIBILITY	DECREASE CREDIBILITY
Language	Uses own vocabulary.Vocabulary changes but not the facts.Tells from child’s viewpoint.	Adult terms.Rote phrases.Lack of detail.
Affect	Consonant with allegations.	Inappropriate to allegations.
Behavior	Seductive, precocious, regressed, guarded, somatic complaints.	No behavioral changes.
Interpersonal	Child initially reticent to discuss abuse with mother or others. Child will rarely confront father with the allegation, even with mother present. Child usually fearful in father’s presence, congruent with affect and ideation unless molestation was gentle and nonthreatening. Mothers often depressed; no other specific psychopathology. Child usually demonstrates signs and symptoms of child sexual abuse.	Child discusses the abuse when prompted by mother; child checks with mother. Child will often confront father with allegation in mother’s presence, while seeking mother’s approval. Discrepancy between the child’s angry accusations and the apparent comfort in father’s presence. Prominent paranoid and hysterical psychopathology in mothers. Child might be sexually preoccupied, but does not exhibit signs and symptoms of child sexual abuse.
Cognitive Development	Differentiates fact from fantasy.	Impaired reality testing.
Memory	Good recall of details including sensorimotor. Absence of denial. Idiosyncratic detail.	Vague/evasive. Prior abuse may confuse picture.
Motives	Absence of secondary gain.	Possible secondary gain. Manipulative, need to please parent.
Play/drawings	Sexual themes.May reenact trauma.Exaggerates or avoids sexual features.	Sexual themes absent.
History	Progressive sexual activity over time.Delayed disclosure.Child threatened to keep secret.Psychological coercion.Sex rings, rituals, pornography.	Other medical history explain heightened sexual concerns.
Physical	Gonorrhea under age of 14 other than newborn.Strong indicators: hymenal disruption, anal scars or relation, gonorrhea of rectum or vagina, other V.D.s	Normal P.E. in spite of history of penetration.

Haugaard and Reppucci provide the following list.[20]

ENHANCE CREDIBILITY	DECREASE CREDIBILITY
1. The child has a difficult time disclosing or talking about the abuse.	1. The disclosure is made easily and is not accompanied by noticeable affect.
2. The child makes several half-hearted retractions and subsequent reconfirmations of the abuse.	2. The child uses adult sexual language and is unable to provide specific descriptions of the sexual activity.
3. The disclosure is accompanied by depressed or anxious affect.	3. It appears that it is easy for the child to confront the accused parent.
4. The child has difficulty confronting alleged abuser.	4. There is a discrepancy between the child’s accusations and his or her comfort with the accused parent.
5. The child is anxious or seductive in the alleged abuser’s presence.	5. It appears that the child is being prompted by the accusing parent.
6. The child describes the sexual activity in age-appropriate language anc can give a detailed description of the specific activities that took place.	6. Very intense incestuous sexual activity is described as beginning almost at once.
7. If attempted or completed intercourse is alleged, the intensity of the sexual activity grew gradually over time.	7. The parents are involved in a custody dispute or there are other signs of high levels of marital discord.
8. The accusing parent is ambivalent about involving the child in the investigation.	8. The accusing parent is eager for the child to testify at all costs and insists on being present when the child is interviewed.
9. The accusing parent indicates remorse for not recognizing previous signs of the abuse and for not sufficiently protecting the child.	9. The accusing parent gives only vague responses when asked about the development of his or her suspicion that abuse was occurring.
	10 An older accusing child appears to be seeking revenge against a parent.

Sgroi states that the following factors enhance a child’s credibility: (1) the sexual abuse involves multiple incidents over time; (2) the sexual abuse involves a progression of sexual activity, from less intimate to more intimate types of behaviors; (3) there was a direct or implied requirement of secrecy between the abuser and the victim; (4) there was obvious use of pressure or coercion; and (5) the child provides explicit details of sexual behavior that is not age appropriate. [21]

CONCLUSION

Sexual abuse assessment is not an exact science. First the touching of a child can be appropriate, inappropriate, with intent to molest, or without intent to molests. In other words, touching lies along a continuum which at some point can become confusing as to the criminal wrongdoing of the alleged abuser. Likewise, a review of the literature indicates that there are differences of opinion regarding methods, procedure, and the role of the evaluator. Furthermore, most thoughtful authors acknowledge that there can be occasions of false denials and false disclosures as well as situations where the data is inconclusive. Therefore, there is perhaps one final conclusion for both the mental health and legal community to remember. It is the judge or jury that is charged with determining the quilt or innocence of an accused perpetrator; the clinician only provides information. It is up to the former and not the latter to decide the ultimate issue of the father’s intentions.

END NOTES

1. R. ROTH & P. KENDRICH, CHILD SEXUAL ABUSE DHHS PUB NO. (OHDS) 81-30166, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, 1981.
2. S. Kaplan & D. Pelcovitz, Child Abuse and Neglect and Sexual Abuse, 5 Psychiatric Clinics of North America 328-329, 1982.
3. L. Risin & J.R. Regis, Validation of Child Sexual Abuse: The Psychologist’s Role, 45 JOURNAL OF CLINICAL PSYCHOLOGY 176 (1989).
4. D. SCHETKY & A. GREEN, CHILD SEXUAL ABUSE; A HANDBOOK FOR HEALTH CARE AND LEGAL PROFESSIONALS 117 (1988).
5. Id. At 117-121.
6. L.E.A. WALKER, HANDBOOK ON SEXUAL ABUSE OF CHILDREN 175, 1988. SCHETKY & GREEN, supra not 4 at 63-71 write that the objectives of a clinical evaluation for child sexual abuse are: (1) understanding the child and allegations in the context of family dynamics and the child’s development; (2) validating sexual abuse; (3) evaluating the need for treatment; (4) diagnosis; (5) assessing competency to testify; (6) preparing the child emotionally for the physical exam; and (7) developing and implementing disposition plans.
7. K. MACFARLANE et.al., SEXUAL ABUSE OF YOUNG CHILDREN EVALUATION AND TREATMENT 30, 1986.
8. Id.
9. SCHETKY & GREEN supra note 4 at 64.
10. HAUGAARD & REPPUCCI, THE SEXUAL ABUSE OF CHILDREN A COMPREHENSIVE GUIDE TO CURRENT KNOWLEDGE AND INTERVENTION STRATEGIES 156 (1988).
11. ID. AT 163.
12. ID. AT 166.
13. MACFARLANE et.al. Supra note 7 at 87.
14. HAUGAARD & REPPUCCI supra note 10 at 166.
15. Id. At 162. See also, S. Golding, T. Grisso, & D. Shapiro, Working Draft Specialty Guidelines For Forensic Psychologists, Revised 8/20/89, Section 6.civ. Which states, in part: When forensic psychologists conduct an examination or engage in the treatment of a party to a legal proceeding, they incur a special responsibility to provide the "best documentation" possible under the circumstances.
(1) Usually, video or audio tapes will provide the best documentation of interviews. Because forensic psychologists have advance knowledge in these circumstances that the evidentiary basis of their opinions, testimony or other evidence will be subject to adversarial examination, they may not intentionally fail to collect and document the "best evidence."
16. T. Musty, Preschool Children’s Erroneous Allegations of Sexual Molestation, 148 AMERICAN JOURNAL OF PSYCHIATRY 489-492, 1988.
17. L.E.A. WALKER supra note 6 at 191.
18. SCHETKY & GREEN supra note 4 at 108-109.
19. Id. At 65, 116.
20. HAUGAARD & REPPUCCI supra note 10 at 175-176.
21. SGROI, HANDBOOK OF CLINICAL INTERVENTION IN CHILD SEXUAL ABUSE 71-72 (1982).

AUTHOR: John A. Call, Ph.D., J.D.
5100 North Brookline, Suite 700
Oklahoma City, OK 73112
(405) 949-9235

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