Sexual abuse accusations color custody battles: consider child's age, physical or mental disabilities, feelings of alienation when evaluating allegations.
When a forensic psychiatrist evaluates potential sexual abuse of a child in a custody case, he or she considers a host of factors, including the child's age, any physical or mental disabilities, and a child's feelings of alienation toward one parent or history of siding with one parent during arguments, he said at the meeting cosponsored by the University of Texas South-western Medical Center at Dallas.
Although psychiatrists use careful questioning and information-gathering skills to evaluate children's allegations, a study of 12 professionals showed that none of them could tell the difference between true and false stories after viewing videotapes of 10 different child testimonies, said Dr. Kenan, chief forensic psychiatrist at the Psychological Trauma Center, a nonprofit organization affiliated with Cedars-Sinai Medical Center in Los Angeles.
That said, keeping some statistics and general points in mind helps interviewers evaluate children or adolescents and their allegations.
The definition of child or adolescent sexual abuse covers a range of activities: intercourse, attempted intercourse, oralgenital contact, fondling of the genitals directly or through clothing, exhibitionism, exposing children to adult sexual activity or pornography, and exploiting a child for prostitution or pornography.
The prevalence of child or adolescent sexual abuse varies as a function of its definition, but in general, 12%-35% of women and 4%-9% of men report unwanted sexual experiences by age 18 years, Dr. Kenan said at the meeting. Data from the U.S. Department of Health and Human Services show that approximately 40% of childhood sexual abuse victims are adolescents aged 12-18 years, which means that the majority of victims are younger than 12 years.
In addition, people of higher socioeconomic status may be better able to hide incidents of abuse. Race and ethnicity, however, do not appear to be risk factors for sexual abuse in parental custody cases.
Having a stepfather at home doubles the risk of sexual abuse for a girl. "That does not mean that the stepfather is the abuser. Sometimes the mother's past boyfriends abuse the girls," Dr. Kenan said. Having a mother with mental illness or alcohol or substance abuse problems also increases a child's risk of sexual abuse.
Few studies have examined the incidence of sexual abuse in custody cases. In a 1990 study of 12 family law courts across the country, investigators asked the courts to report all sexual abuse cases during a 6-month period and found that less than 2% of all custody disputes in eight of the courts involved allegations of child sexual abuse. Although small, the incidence of child sexual abuse in the custody cases was six times higher than the incidence of sexual abuse in the general population (Child Abuse Negl 1990; 14:151-63).
If allegations of child or adolescent sexual abuse arise in custody cases, the court usually orders an evaluation. If the allegation is later found to be false, the relationship between the child and the accused parent can be subjected to unnecessary strain, but if the court does not investigate and remove the child from a dangerous situation or order supervised visits, there is a risk that he or she will be abused again, Dr. Kenan explained.
Remember that a child can make false accusations for different reasons. "I've had cases where Child Protective Services has supported the interviews and got it all wrong, and it later surfaced that no abuse occurred," he said.
Parental alienation--when one parent programs a child against the other parent--is one reason for false allegations of abuse by a child: one parent encourages the child to accuse the other. The parent can be subtle in encouraging the child to make sexual allegations by not supporting the child's relationship with the other parent and by criticizing the other parent in the child's presence, which can cause the child to adopt one parent's negative view of the other. However, it is important to avoid jumping to conclusions that the accused parent is guilty, or that the other parent is behind the allegations.
Adolescents may fabricate stories of abuse to serve their own purposes. They can become so angry with the parents for divorcing that they reject one parent or campaign against the stricter parent by making allegations. This is more likely if the child has additional psychiatric problems. At times, the adolescent sees one parent as more depressed and blames the other parent. In addition, adolescents may feel responsible for the divorce, Dr. Kenan noted.
In cases involving younger children, parents may be naive and interpret normal childhood sexual play as an indication of sexual abuse, and parents who were molested themselves as children are more likely to perceive their children's words or actions as evidence of sexual abuse.
As for treatment, cognitive-behavioral therapy is currently accepted as the most effective method, Dr. Kenan said. One key to successful therapy is identifying true vs. false allegations. Overall, a longer duration of abuse, the use of force, abuse involving sexual penetration, and abuse by a father or stepfather have been associated with an increased risk of long-term harm.
RELATED ARTICLE: Tips for Interviewing Children, Teens
A review of the literature about the testimony of children, conducted by the American Psychological Association in 2002, yielded several guidelines for professionals who interview children about sexual abuse by parents or others:
* Younger children are more susceptible to suggestion than older children; preschoolers are the most vulnerable to suggestion.
* Children often resist talking about specific events that involve their own bodies, compared with other details of a time and place, but some preschoolers do readily report inappropriate touching.
* In the case of children, the presentation of misinformation tends to result in erroneous responses from the kids to specific or misleading questions.
* Factors that impair memory--such as delays between events and the introduction of misinformation--increase the child's vulnerability to suggestion.
* Interviewers who have a preexisting bias about what happened tend to elicit false information from children.
* Open-ended questions generally yield the most information ("Tell me about that day when ..."), but they do not guarantee accuracy, especially if the children have been exposed to misinformation in prior interviews.
* Errors caused by misinformation tend to drop out of children's reports more often than accurate statements over time and repeated interviewing, but some errors will persist.
RELATED ARTICLE: Evaluating Abuse Allegations
What is an evaluator to do? In addition to talking with the child or adolescent, Dr. Kenan advised the thorough evaluator to do the following:
* Review Child Protective Services records.
* Review criminal records of the adolescent and/or parent.
* Review the initial statement made by the child or adolescent, if it is available as a videotape, audiotape, transcription, or police report. "The first interview done by police and CPS is often videotaped. If that is available, watch it. The more the child or adolescent repeats the statements, the less reliable the statements are. If you are able to view an older interview, it may be more truthful than your own interview with the child," he said.
* Review the family court file, noting any history of parental alienation.
* Review additional accounts of abuse and compare for consistency.
* Interview the child or adolescent victim, family members, and the alleged perpetrator.
* Review school records.
* Speak with teachers and other school personnel about the child's credibility and whether they have a history of lying.
* Review lie detector data and plethysmograph data, if any.
* Review the child's medical exam or rape exam, if any.
BY HEIDI SPLETE
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|Title Annotation:||Forensic Psychiatry|
|Publication:||Clinical Psychiatry News|
|Date:||Jun 1, 2005|
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