Reliability and credibility of young children's reports. From research to policy and practice

Comparison Between Male and Female Survivors of Sexual Abuse and Assault in Relation to Age at Admission to Therapy, Age of Onset, and Age at Last Sexual Assault: Retrospective Observational Study

BACKGROUND

Sexual abuse and sexual assault are complex phenomena that involve many factors (or correlates) and have many health and financial implications for individuals, families, and society. Every correlate needs to be studied in detail, individually and in relation to other correlates. Only with a thorough understanding of these correlates can more efficient and targeted prevention and intervention programs be designed.

OBJECTIVE

The purpose of this study was to examine the differences between male and female survivors of sexual abuse and sexual assault regarding the correlates of the survivors' age of onset of assault, age at the last assault, and age at which they entered therapy.

METHODS

Therapists at eight sexual assault centers in the province of Alberta, Canada, completed a questionnaire on each of their clients over a period of 7 years. A total of 3302 participants, of whom 2901 (87.86%) were female and 401 (12.1%) were male survivors of sexual abuse and assault, were included in this study. Mostly descriptive analyses were carried out on the 4 variables of concern in this study.

RESULTS

Regarding the number of survivors who sought therapy, female survivors outnumbered male survivors by a ratio of 7:1, with different ratios for different age groups. As children age, their risk of being sexually assaulted for the first time decreases. Male children are more likely to be sexually abused at a younger age, whereas female children are more vulnerable to being assaulted at all ages, particularly in adolescence. The mean age of onset of sexual abuse was found to be 6.71 (SD 2.86) years, and the odds of experiencing the first sexual assault during childhood, as opposed to adolescence, were 4:1 for females and 9:1 for males. Male survivors were two times more likely than female survivors to experience their first sexual assault in childhood. The vast majority of survivors sought help many years after being sexually assaulted, and male survivors waited an average of 3 years longer from the last sexual assault before seeking therapy.

CONCLUSIONS

The majority of survivors of sexual abuse and sexual assault live with the consequences for many years before they seek help, and a large proportion of male survivors are not likely to seek help.

Kompetenzerleben von Psychotherapeut_innen im Umgang mit Kindern und Jugendlichen mit Gewalterfahrungen und Traumafolgestörungen

Zusammenfassung. Theoretischer Hintergrund: Die psychotherapeutische Versorgung von Kindern und Jugendlichen mit psychischen Störungen nach Gewalterfahrungen ist ungenügend. Zu ihrer Verbesserung wird eine routinemäßige Exploration von Gewalterfahrungen und Traumafolgestörungen und eine evidenzbasierte Behandlung empfohlen. Behandelnde berichten jedoch Unsicherheiten und Befürchtungen dahingehend. Fragestellung: Beeinflusst das therapeutische Kompetenzerleben das konfrontative Vorgehen, den Einbezug von Bezugspersonen, die berufliche Belastung und das Interesse an Weiterbildungen? Methode: 323 Psychotherapeut_innen nahmen an der Online-Umfrage teil. Zur Beantwortung der Fragestellung wurde ein Strukturgleichungsmodell spezifiziert und geprüft. Ergebnisse: Ein höheres Kompetenzerleben ist mit einem konfrontativeren Vorgehen, einem häufigeren Einbezug von Bezugspersonen und einer geringeren beruflichen Belastung assoziiert, nicht jedoch mit einem geringeren Weiterbildungsinteresse. Organisatorische Aspekte werden als häufigste Gründe gegen Weiterbildungen genannt. Diskussion und Schlussfolgerung: Es ergeben sich praktische Implikationen für die inhaltliche und organisatorische Gestaltung von Weiterbildungen und Supervisionen.

Early Physical Abuse and Adult Outcomes

BACKGROUND

Because most physical abuse goes unreported and researchers largely rely on retrospective reports of childhood abuse or prospective samples with substantiated maltreatment, long-term outcomes of physical abuse in US community samples are unknown. We hypothesized that early childhood physical abuse would prospectively predict adult outcomes in education and economic stability, physical health, mental health, substance use, and criminal behavior.

METHODS

Researchers in two multisite studies recruited children at kindergarten entry and followed them into adulthood. Parents completed interviews about responses to the child's problem behaviors during the kindergarten interview. Interviewers rated the probability that the child was physically abused in the first 5 years of life. Adult outcomes were measured by using 23 indicators of education and economic stability, physical health, mental health, substance use, and criminal convictions reported by participants and their peers and in school and court records.

RESULTS

Controlling for potential confounds, relative to participants who were not physically abused, adults who had been abused were more likely to have received special education services, repeated a grade, be receiving government assistance, score in the clinical range on externalizing or internalizing disorders, and have been convicted of a crime in the past year (3.20, 2.14, 2.00, 2.42, 2.10, and 2.61 times more likely, respectively) and reported levels of physical health that were 0.10 SDs lower. No differences were found in substance use.

CONCLUSIONS

Unreported physical abuse in community samples has long-term detrimental effects into adulthood. Pediatricians should talk with parents about using only nonviolent discipline and support early interventions to prevent child abuse.

Comparing Children's and Caseworkers' Reports of Physical Violence

In cases of suspected child maltreatment, the caseworkers' evaluations of the harm and risk to the child are vital in determining if children are being abused and ultimately whether services are provided to the family. These evaluations are dependent on information caseworkers are able to uncover during their investigation, but may not reflect the experiences of the child. Using data from the National Survey of Child and Adolescent Well-Being (NSCAW-I), this study first compares how consistent children's claims of physical victimization are with caseworkers' assessments of harm, severity of risk, and whether there is physical abuse occurring. Second, we examine whether any discrepancies are influenced by the demographic characteristics of the child. Based on cross-tabulations, mean tests of difference, and one-way ANOVA, we find a high degree of overlap in children's reports of violence with caseworkers' reports of harm, the potential for risk, and the presence of physical abuse. However, there are also important differences. Among children who reported acts of physical violence occurred "lots of times," 23% of the cases were viewed by the caseworker as causing "no harm" to the child and over 60% were not regarded as physical abuse. The children's age and sex are both significant predictors of discrepancies, with more discrepancies between caseworkers and young children or teens as well as boys. Implications of this study are that additional training is needed to help caseworkers build rapport with the children. We also suggest that Child Protective Services (CPS) should implement alternative ways for children to report their experiences other than face-to-face interviews with caseworkers.

A review of adolescent autobiographical memory and the implications for assessment of unaccompanied minors' refugee determinations

The number of unaccompanied asylum-seeking children (UASC) is increasing, and unlike those who arrive with their parents, UASC are subject to interview to determine refugee status. The limited amount of objective evidence available in most asylum claims means that the UASC's account of their experiences often becomes key in deciding whether or not the young person is granted protection. Research indicates that assumptions about human memory influence decision-makers' views on asylum seekers' accounts; however, these do not necessarily appear to fit with the published research on autobiographical memory and may lead to an unfair decision. Therefore, understanding the nature and limitations of autobiographical memory is key to a fair refugee determination process. A literature review of published research on autobiographical memory among adolescents was undertaken across four databases. In total, 45 papers were identified which were thematically organised into three areas: development of autobiographical memory, contextual influences and impact of psychopathology. From this review, conclusions are drawn about what can be reasonably expected of an adolescent's autobiographical memory generally and more specifically when the unique characteristics of UASC are taken into account. We also discusss how commonly used credibility indicators in refugee status determinations for minors are problematic in light of this research. It is important that the psychological evidence on the nature of autobiographical memory in adolescents is considered in asylum processing of UASC.

The Child Witness in the Courtroom

Beginning in the 1980s, children have increasingly served as witnesses in the criminal, civil, and family courts; currently, >100 000 children appear in court each year. This statement updates the 1992 American Academy of Pediatrics (AAP) policy statement "The Child as a Witness" and the subsequent 1999 "The Child in Court: A Subject Review." It also builds on existing AAP policy on adverse life events affecting children and resources developed to understand and address childhood trauma. The purpose of this policy statement is to provide background information on some of the legal issues involving children testifying in court, including the accuracy and psychological impact of child testimony; to provide suggestions for how pediatricians can support patients who will testify in court; and to make recommendations for policy improvements to minimize the adverse psychological consequences for child witnesses. These recommendations are, for the most part, based on studies on the psychological and physiologic consequences of children witnessing and experiencing violence, as well as appearing in court, that have emerged since the previous AAP publications on the subject. The goal is to reduce the secondary traumatization of and long-term consequences for children providing testimony about violence they have experienced or witnessed. This statement primarily addresses children appearing in court as victims of physical or sexual abuse or as witnesses of violent acts; most of the scientific literature addresses these specific situations. It may apply, in certain situations, to children required to provide testimony in custody disputes, child welfare proceedings, or immigration court. It does not address children appearing in court as offenders or as part of juvenile justice proceedings.

Evaluation of forensic medical history taking from the child in cases of child physical and sexual abuse and neglect

BACKGROUND

Suspected child physical abuse, sexual abuse and neglect are not uncommon presentations. As part of the assessment of these cases, a forensic medical history may be taken. This forensic history is used not only to determine the steps necessary to address the child's wellbeing but also to direct the forensic examination. Currently, there is no clear consensus on whether or not a forensic medical history should consistently be considered an integral element within the paediatric forensic evaluation. This study examines the value derived by the medical practitioner taking a forensic medical history rather than relying on hearsay evidence when a child presents for an assessment.

METHODS

A retrospective review of paediatric cases seen by the Victorian Forensic Paediatric Medical Service (VFPMS) between 2014 and 2015 was undertaken. 274 forensic case reports were reviewed and the data was entered into an Excel spread sheet and analysed using chi squared tests within STATA^®.

RESULTS

With increasing age of the child, a forensic medical history is significantly more likely to be taken. Additional information is made available to the medical practitioner what would otherwise have been provided if the medical practitioner relied only on the interview conducted by the police. Discrepancies observed between the official third parties (police or child protection) report of what a child has said and what the child says to the medical practitioner decrease with age, as do discrepancies observed between the child's version of events and a third party's (eg. parents, caregivers, friends) version of events.

CONCLUSIONS

The study showed that by taking a forensic medical history from the child additional information can be obtained. Further, that there is a value in the examining medical practitioner taking a forensic medical history from children in cases of child physical and sexual abuse and neglect.

Disclosure as Discourse

Conventional frameworks conceptualizing children's disclosures of sexual abuse are helpful in drawing links between the dynamics of abuse and its subsequent reporting (e.g. Summit, 1983) and in articulating developmental impediments to disclosure (e.g. Bussey & Grimbeek, 1995). But these models underemphasize the discursive (and, hence, social) basis of children's reports in that patterns of disclosure are depicted as individualistic phenomena. This article proposes a discursive reformulation of children's reports of sexual abuse. The concept of co-construction is applied to the research traditions of conversation analysis (e.g. Nofsinger, 1991), the discourse action model (Edwards & Potter, 1992), narrative analysis (e.g. Bruner, 1991), positioning theory (e.g. Harré & van Langenhove, 1992) and cultural discourses (e.g. Burman, 1995) to theorize children's reports of sexual abuse as socially situated collaborations. The implications of a discursive approach for concerns of power and social justice are discussed.

Schools as Criminal “Hot Spots”

Americans are deeply concerned about crime. Increasing crime problems in America's schools and expanding youth involvement in crime are two reasons. These trends should be linked to criminological developments regarding crime incidents and the places where they occur. Routine Activities Theory emphasizes the conditions and locations where crime occurs. Research also indicates crime is concentrated in small areas called “hot spots,” often centered on locations integral to the offender's routine activities. Schools are one focal point for the routine activities of youth. Accordingly, using Tobit analysis of block-level burglary rates, this research examines the importance of different types of schools as focal points of acquisitive crime.

Judges' views of child sexual abuse: evaluating beliefs against research findings in a Finnish sample

Beliefs impact our decision-making and different professionals have been shown to have beliefs about child sexual abuse (CSA) that do not coincide with scientific findings. In the present study, judges' beliefs regarding CSA were explored. Finnish judges (N = 104) answered a questionnaire about CSA related issues as well as questions regarding their professional experience of CSA cases. The judges held both correct and incorrect beliefs; while their CSA prevalence estimates were rather well in line with research findings, half of the participants estimated that no professionals use suggestive methods when interviewing children and more than 40% thought suggestive methods can be useful when trying to get a child to tell about real events. Judges correctly assumed symptoms cannot be used to assess a CSA case, however, the majority thought play observations were appropriate means for evaluating such suspicions. Experience seemed to lead to more confidence in their own expertise but not in an actual increase in knowledge, namely, judges thought themselves more expert when more experienced although their expertise as measured by the questionnaire did not improve. Overall, the judges had both correct and erroneous beliefs but while experience did not improve the situation, gaining information about CSA did. More research about the beliefs of judges and how such beliefs impact legal decision-making is needed.

Children's conceptions of their parent's lung transplant

There has been no research that has investigated the psychosocial impact on children whose parents have undergone a lung transplant. The aim of this qualitative study was to describe children's concerns and understandings of their parent's transplant surgery. Artwork was used as a creative medium to enable children to portray their experiences in a safe, non-threatening environment. This was used as a visual primer for follow-up interviews. All children expressed similar and complementary views about uncertainty and anxiety, separation, disruption to family life, their desire for normality, and the importance of social support. Differences were evident in the way that some children managed well by adapting to the changing situations, whereas others tended towards avoidance. The findings provide several themes that may be used as a framework for family support and counselling by nurses, social workers, and other healthcare professionals who are caring for patients and their families during the transplant process.

Body maps do not facilitate older children's report of touch

In a single experiment, we assessed the effect of body maps on reports of touch by 5- and 6-year-olds, 9- and 10-year-olds, and adults. Children and adults participated in a staged event in which they were touched four times. Immediately following the event, children and adults were asked to either show using a body map or show using their own body where they had been touched. Consistent with prior research, body maps were ineffective with 5- and 6-year-olds. Furthermore, although older children and adults reported more touches and were more accurate than younger children, body maps did not enhance the quality of their reports. We conclude that the provision of a body map does not facilitate reports of touch by any age group, raising serious questions about their use in forensic contexts.

Children's eyewitness memory: repeating post-event misinformation reduces the distinctiveness of a witnessed event

Children may incorporate misinformation into reports of witnessed events, particularly if the misinformation is repeated. One explanation is that the misinformation trace is strengthened by repetition. Alternatively, repeating misinformation may reduce the discriminability between event and misinformation sources, increasing interference between them. We tested trace strength and distinctiveness accounts by showing 5- and 6-year-olds an event and then presenting either the "same" or "varying" items of post-event misinformation across three iterations. Performance was compared to a baseline in which misinformation was presented once. Repeating the same misinformation increased suggestibility when misinformation was erroneously attributed to both event and misinformation sources, supporting a trace strength interpretation. However, suggestibility measured by attributing misinformation solely to the event, was lower when misinformation was presented repeatedly rather than once. In contrast, identification of the correct source of the event was less likely if the misinformation was repeated, whether the same or different across iterations. Thus a reduction in the distinctiveness of sources disrupted memory for the event source. Moreover, there was strong association between memory for the event and a measure of distinctiveness of sources, which takes into account both the number of confusable source and their apparent temporal spacing from the point of retrieval.

Interviewing children versus tossing coins: accurately assessing the diagnosticity of children's disclosures of abuse

We describe a Bayesian approach to evaluating children's abuse disclosures and review research demonstrating that children's disclosure of genital touch can be highly probative of sexual abuse, with the probative value depending on disclosure spontaneity and children's age. We discuss how some commentators understate the probative value of children's disclosures by: confusing the probability of abuse given disclosure with the probability of disclosure given abuse, assuming that children formally questioned about sexual abuse have a low prior probability of sexual abuse, misstating the probative value of abuse disclosure, and confusing the distinction between disclosure and nondisclosure with the distinction between true and false disclosures. We review interviewing methods that increase the probative value of disclosures, including interview instructions, narrative practice, noncontingent reinforcement, and questions about perpetrator/caregiver statements and children's reactions to the alleged abuse.

Allegations of sexual abuse of a child: what to do when a single forensic interview isn't enough

This article describes the state of knowledge about extended assessments/forensic evaluations in situations of possible sexual abuse. It provides a critical review of the modest body of relevant research, describes two models for extended assessments, and presents descriptive survey findings of 62 professionals conducting extended assessments, most of whom conduct extended assessments intermittently as part of their other work on sexual abuse cases. Agencies should consider conducting extended assessments with young or traumatized children whose sexual abuse allegations are not resolved with a single interview as well as in complex child sexual abuse cases.

Interviewing children in custody cases: implications of research and policy for practice

Research on child interviewing has burgeoned over the past 25 years as expectations about children's agency, competence, and participation in society have changed. This article identifies recent trends in research, policy, and theory with implications for the practice of interviewing children in cases of contested divorce and for the weight to be given the information children provide. A number of fields of relevant research are identified, including studies of families who have participated in the family law system, studies of child witnesses in the field, experimental studies of the effects of interview techniques on children's memory and suggestibility, and ethnographic methods that elicit children's views of their own experiences. Finally, a set of 10 principles for practice are delineated based on the best available science.

Young Children's Competency to Take the Oath: Effects of Task, Maltreatment, and Age

This study examined maltreated and non-maltreated children's (N = 183) emerging understanding of "truth" and "lie," terms about which they are quizzed to qualify as competent to testify. Four- to six-year-old children were asked to accept or reject true and false (T/F) statements, label T/F statements as the "truth" or "a lie," label T/F statements as "good" or "bad," and label "truth" and "lie" as "good" or "bad." The youngest children were at ceiling in accepting/rejecting T/F statements. The labeling tasks revealed improvement with age and children performed similarly across the tasks. Most children were better able to evaluate "truth" than "lie." Maltreated children exhibited somewhat different response patterns, suggesting greater sensitivity to the immorality of lying.

Complex questions asked by defense lawyers but not prosecutors predicts convictions in child abuse trials

Attorneys' language has been found to influence the accuracy of a child's testimony, with defense attorneys asking more complex questions than the prosecution (Zajac & Hayne, J. Exp Psychol Appl 9:187-195, 2003; Zajac et al. Psychiatr Psychol Law, 10:199-209, 2003). These complex questions may be used as a strategy to influence the jury's perceived accuracy of child witnesses. However, we currently do not know whether the complexity of attorney's questions predict the trial outcome. The present study assesses whether the complexity of questions is related to the trial outcome in 46 child sexual abuse court transcripts using an automated linguistic analysis. Based on the complexity of defense attorney's questions, the trial verdict was accurately predicted 82.6% of the time. Contrary to our prediction, more complex questions asked by the defense were associated with convictions, not acquittals.

Legal and social service responses to child sexual abuse: a primer and discussion of relevant research

This paper provides a broad overview of legal and social service responses to child sexual abuse, the overarching legal framework provided by federal legislation, and funding mandates and the unique and shared investigative concerns of law enforcement and child protective service entities. Relevant psychological research is highlighted throughout, including research on investigator training, forensic interviewing techniques, children's suggestibility, jurors' perceptions of child witnesses, and courtroom accommodations for child witnesses.

The reliability of lie detection performance

We examined whether individuals' ability to detect deception remained stable over time. In two sessions, held one week apart, university students viewed video clips of individuals and attempted to differentiate between the lie-tellers and truth-tellers. Overall, participants had difficulty detecting all types of deception. When viewing children answering yes-no questions about a transgression (Experiments 1 and 5), participants' performance was highly reliable. However, rating adults who provided truthful or fabricated accounts did not produce a significant alternate forms correlation (Experiment 2). This lack of reliability was not due to the types of deceivers (i.e., children versus adults) or interviews (i.e., closed-ended questions versus extended accounts) (Experiment 3). Finally, the type of deceptive scenario (naturalistic vs. experimentally-manipulated) could not account for differences in reliability (Experiment 4). Theoretical and legal implications are discussed.

The contribution of children's advocacy centers to felony prosecutions of child sexual abuse

OBJECTIVE

To describe trends of felony sexual abuse prosecutions between 1992 and 2002 for two districts of a large urban city that differed primarily in their use of children's advocacy centers (CACs) for sexual abuse evaluations in children.

METHODS

Aggregate data for two districts of a large urban city were provided from 1992 to 2002 from the district attorney's office, child protective services (CPS) agency, and all CACs serving both districts. Summary statistics were calculated over time and compared between both districts for ecologic trends using negative binomial regression.

RESULTS

Over the time period of the study, substantiated reports of child sexual abuse declined: District 1 experienced a 59% decrease in the incidence of reports, while District 2 experienced a 49% decrease in the incidence of reports. Despite this decrease, felony prosecutions of child sexual abuse increased in District 1 (from 56.6 to 93.0 prosecutions/100,000 children, rate ratio 1.64, 95% CI 1.38-1.95), but did not significantly increase in District 2 (from 58.0 to 54.9 prosecutions/100,000 children, rate ratio 0.94, 95% CI 0.73-1.23); by 2002, the rate of felony prosecutions in District 1 was 69% greater (95% CI 37-109%) than the rate in District 2. In 1992, CACs in District 1 evaluated approximately 400 children, increasing to 1,187 children by 2002. The number of children evaluated by CACs in District 2 increased modestly from nearly 800 in 1992 to 1,000 in 2002.

CONCLUSION

Felony prosecutions of child sexual abuse doubled in a district where the use of CACs nearly tripled, while no increase in felony prosecutions of child sexual abuse was found in a neighboring district, where the use of CACs remained fairly constant over time.

PRACTICE IMPLICATIONS

Though many limitations exist when bringing together ecological data from different agencies, the strength of the association we observed between increased CAC use and increased felony prosecutions, and the stepwise fashion in which it occurred should support future research to confirm our findings and to delineate which attributes of CAC performance might impact the likelihood of prosecution of child sexual abuse.

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.

Global gist extraction in children and adults

The DRM paradigm was used to examine the role of global gist extraction in producing false memories in children and adults. First-graders, third-graders, and adults watched a videotape of a woman reading seven DRM lists, and then took a recognition memory test. Blocked (vs random) presentation and instructions to attend to the theme of lists were manipulated to enhance gist processing. In the first experiment, blocked presentation increased false recognition relative to random presentation in adults but not in first-graders or third-graders. In the second experiment, instructions to attend to list themes increased false recognition in third-graders and not in adults or first-graders. The results suggest a developmental pattern in which children become more adept at global gist extraction as they get older. These results are consistent with fuzzy trace theory's prediction of better gist processing as children grow older.

Dynamics of verbal interaction between interviewer and child in interviews with alleged victims of child sexual abuse

A number (n = 27) of investigative interviews with children were analyzed with a view to explore the verbal dynamics between interviewer and child. Different types of interviewer utterances and child responses were defined, and the interrelationships between these were explored. The effectiveness of different interviewer utterances in eliciting information from children as well as the type of utterance the interviewer used to follow up an informative answer by the child were investigated. Option-posing and suggestive utterances made up for more than 50% of interviewer utterances, the proportion of invitations being only 2%. Invitations and directive utterances were associated with an increase in informative responses by the child, the adverse being true for option-posing and suggestive utterances. Interestingly, even after the child had provided an informative answer, interviewers continued to rely on focused and leading interviewing methods--in spite of a slight improvement in interviewing behavior.

Criminal investigations of child abuse: the research behind "best practices"

This article reviews the research relevant to seven practices considered by many to be among the most progressive approaches to criminal child abuse investigations: multidisciplinary team investigations, trained child forensic interviewers, videotaped interviews, specialized forensic medical examiners, victim advocacy programs, improved access to mental health treatment for victims, and Children's Advocacy Centers (CACs). The review finds that despite the popularity of these practices, little outcome research is currently available documenting their success. However, preliminary research supports many of these practices or has influenced their development. Knowledge of this research can assist investigators and policy makers who want to improve the response to victims, understand the effectiveness of particular programs, or identify where assumptions about effectiveness are not empirically supported.

Improving decision making in forensic child sexual abuse evaluations

Mental health professionals can assist legal decision makers in cases of allegations of child sexual abuse by collecting data using forensic interviews, psychological testing, and record reviews, and by summarizing relevant findings from social science research. Significant controversy surrounds another key task performed by mental health professionals in most child sexual abuse evaluations, i.e., deciding whether or not to substantiate unconfirmed abuse allegations. The available evidence indicates that, on the whole, these substantiation decisions currently lack adequate psychometric reliability and validity: an analysis of empirical research findings leads to the conclusion that at least 24% of all of these decisions are either false positive or false negative errors. Surprisingly, a reanalysis of existing research also indicates that it may be possible to develop reliable, objective procedures to improve the consistency and quality of decision making in this domain. A preliminary, empirically-grounded procedure for making substantiation decisions is proposed.

Hypnosis reduces distress and duration of an invasive medical procedure for children

OBJECTIVE

Voiding cystourethrography (VCUG) is a commonly performed radiologic procedure in children that can be both painful and frightening. Given the distress that some children experience during the VCUG and the need for children to be alert and cooperative during the procedure, finding a psychological intervention that helps children to manage anxiety, distress, and pain is clearly desirable. This study was designed to examine whether relaxation and analgesia facilitated with hypnosis could reduce distress and procedure time for children who undergo this procedure.

METHODS

Forty-four children who were scheduled for an upcoming VCUG were randomized to receive hypnosis (n = 21) or routine care (n = 23) while undergoing the procedure. The sample consisted of 29 (66%) girls and 15 (34%) boys with a mean age of 7.6 years (SD: 2.5; range: 4-15 years). Ethnic/racial backgrounds were 72.7% white, 18.2% Asian, 4.5% Latino, 2.3% black, and 2.3% Filipino. The mean number of previous VCUGs was 2.95 (SD: 2.51; mode: 2; range: 1-15). Potential participants were identified through computerized hospital records of upcoming VCUGs. Parents were contacted by telephone and invited to participate if their child was eligible. To be eligible for the study, the child must have undergone at least 1 previous VCUG, been at least 4 years of age at that time, and experienced distress during that procedure, and both the child and the participating parent had to be English speaking. Each eligible child and parent met with the research assistant (RA) before the day of the scheduled procedure for an initial assessment. Children were queried regarding the degree of crying, fear, and pain that they had experienced during their most recent VCUG. Parents completed a series of parallel questions. Immediately after this assessment, those who were randomized to the hypnosis condition were given a 1-hour training session in self-hypnotic visual imagery by a trained therapist. Parents and children were instructed to practice using the imaginative self-hypnosis procedure several times a day in preparation for the upcoming procedure. The therapist was also present during the procedure to conduct similar exercises with the child. The majority (83%) of those who were randomized to the routine care control group chose to participate in a hospital-provided recreation therapy program (offered as part of routine care). The program includes demonstration of the procedure with dolls, relaxation and breath work training, and assistance during the procedure. On the day of the VCUG, the RA met the family at the clinic before the procedure, and both the child and the parent rated the child's present level of fearfulness. During the procedure, the RA recorded observational ratings of the child's emotional tone and behavior and timed the overall procedure and its phases. Immediately after the VCUG, the child was asked how much crying, fear, and pain he or she had experienced during the procedure; the parent rated the child's experience on the same dimensions and also how traumatic the procedure had been (both generally and compared with their previous one), and the medical staff rated the degree of procedural difficulty. Outcomes included child reports of distress during the procedure, parent reports of how traumatic the present VCUG was compared with the previous one, observer ratings of distress during the procedure, medical staff reports of the difficulty of the procedure overall, and total procedural time.

RESULTS

Results indicate significant benefits for the hypnosis group compared with the routine care group in the following 4 areas: (1) parents of children in the hypnosis group compared with those in the routine care group reported that the procedure was significantly less traumatic for their children compared with their previous VCUG procedure; (2) observational ratings of typical distress levels during the procedure were significantly lower for children in the hypnosis condition compared with those in the routine care condition; (3) medical staff reported a significant difference between groups in the overall difficulty of conducting the procedure, with less difficulty reported for the hypnosis group; and (4) total procedural time was significantly shorter-by almost 14 minutes-for the hypnosis group compared with the routine care group. Moderate to large effect sizes were obtained on each of these 4 outcomes.

CONCLUSIONS

Hypnotic relaxation may provide a systematic method for improving the overall medical care of children with urinary tract abnormalities and may be beneficial for children who undergo other invasive medical procedures. Because the VCUG is an essential part of the evaluation of urinary tract infections and vesicoureteral reflux in children, lower distress during the procedure may improve patient and family compliance with initial as well as follow-up evaluations. These findings augment the accumulating literature demonstrating the benefits of using hypnosis to reduce distress in the pediatric setting. The present findings are noteworthy in that this study was a controlled, randomized trial conducted in a naturalistic medical setting. In this context, we achieved a convergence of subjective and objective outcomes with moderate to large effect sizes, including those that may have an impact on patient care and procedure cost, that were consistently supportive of the beneficial effects of hypnosis-a noninvasive intervention with minimal risk. The findings, therefore, have immediate implications for pediatric care. Limitations of this study include the lack of participant and staff blindness to the child's condition assignment, which could have introduced bias into reports. However, the objective procedural time differences between groups were consistent with the other, more subjective outcome findings. The sample was also small and primarily white in ethnic/racial makeup, which may have restricted our ability to detect some differences and may limit the generalizability of findings to more representative samples. In addition, the sample comprised children who had already undergone at least 1 VCUG during which they had had difficulty. Consequently, additional research is needed to determine whether hypnosis would be helpful to those who are undergoing their first VCUG. Additional limitations, clinical observations, and directions for future research are also discussed.

"Intuitive" lie detection of children's deception by law enforcement officials and university students

Adults' ability to detect children's deception was examined. Police officers, customs officers, and university students attempted to differentiate between children who lied or told the truth about a transgression. When children were simply questioned about the event (Experiment 1), the adult groups could not distinguish between lie-tellers and truth-tellers. However, participants were more accurate when the children had participated in moral reasoning tasks (Experiment 2) or promised to tell the truth (Experiment 3) before being interviewed. Additional exposure to the children did not affect accuracy (Experiment 4). Customs officers were more certain about their judgments than other groups, but no more accurate. Overall, adults have a limited ability to identify children's deception, regardless of their experience with lie detection.

Delayed disclosure and disrupted communication during forensic investigation of child sexual abuse: a study of 47 corroborated cases

AIM

To study factors of relevance for the understanding of disclosure of child sexual abuse.

METHODS

Cases from a Swedish district court involving 47 children in which allegations of child sexual abuse had been corroborated by a confession from the defendant were studied.

RESULTS

Delayed disclosure was related to a close relationship with the perpetrator and young age at the first experience of abuse. Disrupted communication during the police interview was related to less violent abuse.

CONCLUSION

The findings highlight the importance of social factors in children's disclosure of sexual abuse.

Validity of a test of children's suggestibility for predicting responses to two interview situations differing in their degree of suggestiveness

In the present study the relative contributions of internal and external sources of variation in children's suggestibility in interrogative situations were examined. One hundred and eleven children (48 4- to 5-year-olds and 63 7- to 8-year-olds) were administered a suggestibility test (BTSS) and the most suggestible (N=36) and the least suggestible (N=36) children were randomly assigned to either an interview condition containing several suggestive techniques or to one containing only suggestive questions. The effects of internal sources of variation in suggestibility were compared with the effects of the interview styles on the children's answers. The former did influence the children, but the external sources of variation in suggestibility had a stronger impact. Influences of cognitive, developmental factors could be found, but not when abuse-related questions were asked and high pressured interview methods were used. These findings indicate that individual assessment of suggestibility can be of some assistance when interviewing children, but diminishing suggestive influences in interrogations must be given priority.

Comparisons of three different investigative interview techniques with young children

After viewing a film of a mother hitting her son, a film not seen by the college student interviewers, children were misinformed about a detail (via exposure to a misleading question) as well as explicitly coached to disclose 3 false details. The children were then interviewed by interviewers who had previously learned 1 of 3 different interviewing procedures: the Yuille Step-Wise Interview developed by J. C. Yuille, R. Hunter, R. Joffe, & J. Zapamiuk (1993); a doll play interview developed by Action for Child Protection Inc. (1994); or the Modified Structured Interview developed for this study. The Modified Structured Interview yielded more "where" information and was better at detecting if coaching had occurred. However, the interviewers were not very good at discriminating suggested versus coached versus correct witnessed information. The authors found that the deeper one digs for memories, the more one uncovers incorrect versus correct items. They concluded that although the Modified Structured Interview was superior to the techniques currently in use, cautions are necessary.

Fear of the beast: a prospective study on the effects of negative information on childhood fear

The current study examined the effects of negative information on the enhancement of childhood fear. A large group of normal primary school children aged between 4 and 12 years (N=285) received either negative or positive information about an unknown, doglike animal, called 'the beast'. Children's fears were assessed at three points in time: before, directly after, and one week after the information about the beast was provided (i.e., pre-, post- and follow-up assessment). Results showed that type of information changed children's fear of the beast in the predicted direction with negative information increasing fear levels and positive information decreasing fear levels. This was not only the case directly after the experimental manipulation but also at one week follow-up. Furthermore, fear of the beast appeared to generalize, that is, children who became more fearful of the beast after receiving negative information, also became more apprehensive of other dogs and predators.

Does the nature of the experience influence suggestibility? A study of children's event memory

Two experiments examined the effects of event modality on children's memory and suggestibility. In Experiment 1, 3- and 5-year-old children directly participated in, observed, or listened to a narrative about an event. In an interview immediately after the event, free recall was followed by misleading or leading questions and, in turn, test recall questions. One week later children were reinterviewed. In Experiment 2, 4-year-old children either participated in or listened to a story about an event, either a single time or to a criterion level of learning. Misleading questions were presented either immediately or 1 week after learning, followed by test recall questions. Five-year-old children were more accurate than 3-year-olds and those participating were more accurate than those either observing or listening to a narrative. However, method of assessment, level of event learning, delay to testing, and variables relating to the misled items also influenced the magnitude of misinformation effects.