Mental health articles

Factors affecting decisions on evaluations in sexual abuse A variety of techniques and interventions are used to determine whether sexual abuse has occurred, including the medical evaluation, the child’s interview (with or without anatomical dolls or projective techniques), and interviews with nonoffending guardians, alleged offenders, or others. Afterwards, professionals have the difficult task of determining whether the abuse occurred. Berliner and Conte (1993) discuss two different approaches used in the United States for evaluating child sexual abuse: the indicator approach and the standards approach. In the indicator approach, professionals rely upon a number of behavioral or physical indicators of abuse that increase the professional’s confidence in decisions regarding whether abuse occurred. When a child exhibits a number of these criteria, it would suggest that abuse had occurred; conversely, when a child does not exhibit these criteria, there would be less suggestion that abuse had occurred. While most professionals use these criteria simply to inform their judgments concerning whether abuse occurred (Berliner & Conte, 1993), this method has some pitfalls. First and foremost, sexually abused children have no generalized presentation, so that any given child not meeting the criteria might still have been sexually abused. For example, although a survey found that professionals attach the most importance to the existence of physical indicators (Conte, Sorenson, Fogarty, & Rosa, 1991), only a small minority of sexually abused children actually present with physical evidence (Palusci et al., 1999). Further, 90% of professionals in this survey believed that being the subject of a custody battle increased the likelihood of reporting distortions (Conte et al., 1991), a factor not supported in the empirical literature. Other factors that professionals endorsed as increasing the possibility of the child’s distortion of the report were an early childhood fantasy remembered as reality (endorsed by 49% of professionals) or a wish to punish or torture a hated adult (endorsed by 78%). Another concern of the indicator approach is that characteristics of the professional are related to their perceptions of indicators of sexual abuse. For example, Kendall-Tackett and Watson (1991) found that professionals who believed that children do not lie about sexual abuse were more convinced by behavioral indicators that sexual abuse had occurred. Further, law enforcement officials were more convinced than mental health professionals, and women were more convinced than men. Finally, this method has also been misused to establish criteria for discriminating true from false allegations. In Gardner’s Sexual Abuse Legitimacy scale (as cited in Berliner & Conte, 1993), his 26 criteria purportedly discriminate between true and false allegations. Because the underlying criteria are based purely upon the author’s personal observation and judgment and have not undergone empirical scrutiny, this method is fraught with both ethical and methodological issues. Since the indicator approach is susceptible to bias and to both false positives and false negatives, caution must be exercised in placing too much credence in the indicator approach. As mentioned previously, however, most professionals use it only to inform their judgments. The other method—the standards approach—outlines the conduct of the professionals making the evaluations. One of the most well-known of these approaches is by APSAC, which now has a series of guidelines on psychosocial evaluation, the use of anatomical dolls, and photographic documentation, as well as more lengthy study guides.7 These important resources contribute to increased validity of judgments as well as to continuity of interventions among professionals. Overall, little work has yet been done to determine how characteristics of professionals affect their evaluations of sexual abuse. This is of concern because the literature on false disclosures suggests that clinicians’ a priori beliefs can have an important influence on whether they are convinced by an abuse disclosure that abuse actually occurred. Because of the important role of the evaluator, studies that assess these factors are critical.

Tags: sexual abuse