True And False Allegations Of Child Sexual Abuse

Assessment & Case Management

Tara Ney, Tara Ney

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781134862337
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

It is important for society that the backlash does not result in the reburial of the problem of child sexual abuse. 'True and False Allegations of Child Sexual Abuse' represents an important contribution to that effort. This book is about conducting evaluations of allegations of child sexual abuse that take into account research knowledge and practice wisdom. It is not a cookbook about how to do evaluations. Rather, it provides a great deal of food for thought and is aimed at child abuse professionals who can critically read and test the material against their experiences in the field. It includes a wide spectrum of information, approaches, and opinions about child sexual abuse evaluation.

PART II

Child Development Issues

3

Assessing Young Children's Sexual Behaviors in the Context of Child Sexual Abuse Evaluations

Toni Cavanagh Johnson

and Coleen Friend

Assessing children's sexual behavior for the purpose of examining whether they are within the natural and healthy range, or signify distress, is discussed. Fifteen guidelines are provided to help determine children's sexual behaviors that are of concern and require further evaluation. As problematic sexual behaviors in children can be an indication of sexual abuse or other disturbance in the family, methods of utilizing information regarding the child's sexual behaviors during evaluations are described.

When it is alleged that a child has been sexually abused, a thorough assessment of the child and family is often warranted. Evidence shows that children who have been sexually abused often show an increase in their sexual behaviors (Deblinger, McLeer, Atkins, Ralphe, & Foa, 1989; Finkelhor, 1979; Friedrich, 1991; Friedrich, 1993; Friedrich, Beilke, & Urquiza, 1988; Friedrich, Grambsch, Broughton, Kuiper, & Beilke, 1991; Friedrich, Grambsch, Damon, Hewitt, Koverola, Lang, Wolfe, & Broughton, 1992; Gale, Thompson, Moran, & Sack, 1988; Kolko, Moser, & Weldy, 1988; White, Halpin, Strom, & Santilli, 1988). This aspect of the child's behavior is often assessed in the evaluation, but with little understanding of normal sexual behavior. Johnson (Gil & Johnson, 1993) points out that children's sexual development proceeds along seven distinct developmental lines: biological, sensual/erotic, behavioral, gender-related, cognitive, relational, and sexual socialization.

When a child has been sexually misused, abused, or overly exposed to adult sexuality, disruptions in multiple areas of the child's sexual development may occur. For example, the child may be prematurely eroticized or overly concerned about his or her gender identity or gender object choice, or be too knowledgeable about sex or have confused ideas about sexual relationships. A child who has lived in an incestuous home or in a home with poor boundaries may not have been adequately socialized regarding sexuality. Disruptions in any of these developmental lines may result in increased or problematic sexual behaviors.

This chapter examines problematic sexual behaviors and compares them with more natural and healthier sexual behaviors in children. A discussion of the assessment of young children's sexual behaviors in the context of child sexual abuse evaluations is presented, and specific recommendations for assessing these behaviors are made.

The authors caution that there are very little empirical data available regarding children's sexual behaviors and their meaning. The data provided in this chapter, when not specifically noted as research data, are derived from clinical practice and thus have not been subjected to empirical validation. Caution should be exercised in their use.

There are many aspects to interviewing children. The authors assume that the reader is familiar with the intricacies and legal issues related to evaluations of children when there are allegations of sexual abuse. This chapter builds on that knowledge, addressing only issues related to interviewing children with problematic sexual behaviors.

RESEARCH ON CHILD SEXUAL BEHAVIORS AND SEXUAL VICTIMIZATION

A fairly consistent finding in the literature is that there is a higher frequency of sexual behavior in sexually abused children than in nonabused samples (Deblinger et al., 1989; Finkelhor, 1979; Friedrich, 1991, 1993; Friedrich et al., 1988, 1991, 1992; Gale, Thompson, Moran, & Sack, 1988; Kolko et al., 1988; White et al, 1988). Yet some studies do not find this to be so (Cohen & Mannarino, 1988; Allen, Jones, & Nash, 1989; Mannarino, Cohen, & Gregor, 1989; Weinstein, Trickett, & Putman, 1989). For instance, comparisons between sexually abused children and children with psychiatric diagnoses but with no sexual abuse history show no significant differences in sexual behavior (Cohen & Mannarino, 1988). Another study, which compared precocious pubescent children, physically abused children, sexually abused children, and a control group of nonabused girls, found no significant differences among the groups (Weinstein et al., 1989).

While sexualized behaviors and PTSD are the only two symptoms that occur more frequently in sexually abused children than in clinical comparison groups of nonabused children, less than half of sexually abused children manifest sexual behaviors of concern. Across six studies of preschoolers (the age group most likely to manifest such symptoms) an average of 35% exhibited sexualized behaviors of concern. Friedrich (Friedrich et al., 1992), using the Child Sexual Behavior Inventory, found a slightly higher percentage (Kendall-Tackett et al., 1993).

An important variable relates to family disturbance. When looking at two small samples of emotionally disturbed preschoolers with similar levels of family disturbance, one group sexually abused and the other group not sexually abused, no significant differences were seen as related to sexual behaviors (Allen et al., 1989). Friedrich (Friedrich et al., 1992) found that the intensity of the children's life events was a significant predictor of sexual behaviors in children. Wolfe and Mosk (1983) observed that in families with high levels of chaos and disruption, there is an increased level of overall behavioral problems in the children, regardless of whether or not they were sexually or physically abused. In addition, Johnson and Aoki (1993) found that children who had been both physically and sexually abused engaged in a greater variety of sexual behaviors than did children who had experienced only sexual abuse. Together, these findings suggest caution when assessing the determinants of increased sexual behaviors.

Friedrich's (1991) research indicates that children with a more severe history of sexual abuse involving a greater number of perpetrators, and with whom force was used, engage in more sexual behaviors than do children whose abuse was not characterized by these features. He also found that there are no sexual behaviors that are exclusively engaged in by sexually abused children (Friedrich et al., 1992).

The studies cited here refer to a clinical population of sexually abused children. This limits the generalizability of findings: the observed sexual behaviors may only be characteristic of sexually abused children who have sought professional help. Clinical populations consist of children who are experiencing enough difficulties to seek professional help. Many sexually abused children do not receive or require psychological services, and thus would not be included in these studies. For a lengthy review of studies regarding the sexual behaviors of children as they relate to abuse, see Friedrich (1993).

CURRENT TECHNIQUES FOR ASSESSING CHILDREN's SEXUAL BEHAVIORS

Many different approaches have been taken to assessing children's sexual behaviors, including looking for depictions of the genitals in children's drawings, observing the child's play with toys or dolls, and noting sexual behaviors by the child during the interview. Unfortunately, none of these assessment approaches are supported by empirical research.

Children's Drawings

While several studies indicate a significant difference between sexually abused and nonabused children regarding the drawing of genitalia, very few sexually abused children draw genitalia. Waterman and Lusk (1993) found that 7% of a sample of ritualistically abused children drew genitalia on their pictures while none of the control children did so. Hibbard and colleagues found that 10% of an alleged sexually abused group of children drew genitalia, while only 2% of the nonabused sample did (Hibbard, Roghmann, & Hockelman, 1987). Yet, in a more recent study, Hibbard (Hibbard & Hartman, 1990) found no significant difference in the drawings of a sample of abused children compared to those of nonabused children. Therefore, the relevance of genitalia on children's drawings is not clear.

Anatomically Detailed Dolls

Observing children's sexual play with dolls or the use of anatomically detailed dolls in interviews is another method that has been used to gain information related to abuse. Although there are guidelines on the use of the anatomically detailed dolls (APSAC, 1990), there are scant empirical data that offer clear evidence regarding the behavior of abused and nonabused children's sexual behavior with the dolls.

Studies in the 1980s indicated that nonabused children under eight years of age were unlikely to demonstrate sexual acts spontaneously with anatomically detailed dolls (Jampole & Weber, 1987; Sivan, Schor, Koeppl, & Noble, 1988; White, Strom, Santilli, & Halpin, 1986). However, recent work by Everson and Boat (1990) indicates that in a demographically diverse sample of 223 children, ages two to five, who were screened for the absence of sexual abuse, touching and exploration of the dolls' genitalia were common behaviors, occurring in over 50% of the children at each age level. Explicit sexual play in the form of apparent demonstrations of vaginal, oral, or anal intercourse (i.e., penile insertion, sexual placement with “humping” motions, or mouthing a doll's genitals) was seen in only 6% of the total sample. The frequency of this explicit sexual play was significantly related to the child's age and socioeconomic status; over 20% of the four- and five-year-old, low-socioeconomic-status, black males in this sample demonstrated clear sexual intercourse of some type during the sessions. The presence of an adult did not inhibit these children from engaging in the behavior.

Boat and Everson (1988) asked child-protective-service workers, mental health professionals, law enforcement officers, and physicians to rate the normality of a list of behaviors with anatomically detailed dolls for nonabused children. The behaviors were divided into two groups: (1) the less overtly sexual behaviors, such as undressing the dolls, looking at the dolls' genitals, touching the dolls' genitals, and placing dolls on top of each other; and (2) highly sexualized behaviors, such as showing vaginal or anal penetration or showing oral-genital contact. Most of the professionals agreed that the overtly sexual behaviors were abnormal for nonabused children ages two to 5.9 years of age. There was disagreement about some of the less overtly sexual behaviors, and there were no behaviors on which there was unanimous agreement.

Kendall-Tackett's (1992) study of men and women in law enforcement and mental health who work clinically or in an investigatory role with sexual abuse victims is instructive regarding the use of observations of children's play with anatomically detailed dolls. When Kendall-Tackett asked which sexual behaviors demonstrated by a child with the dolls were normal, questionable, or abnormal, she found differences based on profession, experience with child victims, length of experience, and gender. As in the Boat and Everson (1988) study, there was more agreement on the abnormality of the more highly sexual behaviors but less on those that were less overtly sexual.

There are no clear guidelines based on research and no consensus among professionals regarding what constitutes normal, questionable, and abnormal doll play among abused and nonabused children. Presently, the most reliable use of anatomically detailed dolls in evaluations is as a tool for children to demonstrate what happened to them after verbally disclosing some history of abuse. In this way, the professional is not extrapolating from a child's free play with the dolls, but getting a visual and verbal representation of what has occurred. Each...