Professional Issues Related to Allegations and Assessment of Child Sexual Abuse in the Context of Family Court Litigation

This article focuses on the challenge of dealing with allegations of child sexual abuse in the context of the Family Court of Australia. Of all cases that come before the Court, those involving such allegations are relatively uncommon. they tend to be the most difficult cases, however, and are more likely to require a trial and the involvement of qualified practitioners. The review establishes that parental separation is a special circumstance in which sexual abuse may be more likely to occur, and many allegations of sexual abuse are found to be true. There is evidence, however, that a proportion of allegations made by people other than the child concerned may be false. Whether these false allegations are well intentioned and genuinely believed, or maliciously motivated has been a contentious issue. Issues considered include the mishandling of cases, the failure by professionals to consider equally plausible alternative hypotheses than the sexual abuse of a child, confirmation bias, and the profound repercussions of allegations for all members of the family. It is concluded that all allegations of child sexual abuse must be evaluated in a thorough and sensitive manner to separate the few false allegations from the many that are true.     

The assessment of custody and access disputes in cases of sexual abuse allegations

Sexual abuse allegations directed at one parent can arise in the context of custody and access disputes. The role of the clinician, when such allegations occur, is to provide an assessment of the total situation, taking the allegations into account. To assess the probability that sexual abuse has occurred involves a thorough assessment of the accuser, the accused, the accusation, the child, and different family subsystems. Particular attention should be paid to interviewing the young child with detailed focus on the interviewing process, how the interviews are reported and what conclusions may be drawn from them. Following a thorough assessment, the clinician may reach one of three conclusions: that the sexual abuse has probably occurred, has probably not occurred, or is unsure. A strong caution is given against becoming entangled in an endless process of trying to find out whether the allegations are true or false. Whatever conclusions are reached are but one factor in the recommendation regarding custody and/or access. Ultimately the recommendation will be made according to the best interests of the child, taking into account the child's relationships and attachments, as well as the sexual abuse allegations.     

False allegations of sexual abuse by children and adolescents

The frequency of false allegations of sexual abuse by children and adolescents is of significant legal and clinical importance. The rate of false allegations of sexual abuse is examined in a large sample of Child Protective Services (CPS) cases. The criteria used by CPS workers in judging the validity of allegations are considered, and the relationship between substantiation rates and attitudes about the trustworthiness of child reports of abuse is explored. Many professionals in the field of child sexual abuse are more skeptical of child and adolescent claims of sexual abuse than available research suggests is warranted.     

Responding to therapists' sexual abuse of adult incest survivors: ethical and legal considerations

Adult survivors of incest are high-risk candidates for subsequent sexual abuse by their therapists. As with incest, therapists' sexual abuse of their patients has become known as "the problem with no name." In addition, many of the ways in which the profession of psychology and the judicial system respond to patients' allegations of sexual abuse by their therapists often parallel the responses family members and authority figures made to the original allegations of incest. This article discusses some of the complex interactions among therapeutic dynamics, ethical and legal issues associated with this professional dilemma, and outlines ways in which the profession might begin to address this dilemma.     

Criteria and methodology for assessing credibility of sexual abuse allegation

This paper will consider three types of interview that are held with sexually abused children. After discussing common problems in technique, it will suggest a methodology designed to help determine a child's credibility and assist in forming and demonstrating a reliable expert opinion for court purposes. Next, it will describe three types of data crucial in investigating allegations of sexual abuse, and will suggest clinical criteria useful in distinguishing true from false allegations. Finally, it will examine the validity of these criteria, comparing them to those of other workers in the field.     

Understanding Children's Medium for Disclosing Sexual Abuse: A Tool for Overcoming Potential Misconceptions in the Courtroom

Complainants in child sexual assault trials are often questioned by the defence about disclosure of the alleged abuse. The defence will often ask the child how they disclosed the alleged sexual abuse, including to whom the initial disclosure was made. Such questions are legitimate and directed towards testing the complainant's allegations. Sometimes, such questions are used to impeach the complainant's credibility. It is not uncommon in such instances for the defence to suggest that certain modes of disclosure are more consistent with having been sexually victimized and that a complainant who has disclosed otherwise is more likely to have fabricated the allegations of abuse. This article reviews the findings of empirical research on whom victims of child sexual abuse most commonly disclose their abuse to and by what means such disclosure is commonly made. This understanding is important to challenge misconceived views about how victims disclose child sexual abuse.     

Recognition and treatment of psychological disorders during military service in the UK armed forces: a study of war pensioners

Purpose

Little is known about the detection and treatment of psychological disorders arising during military service. We investigated whether personnel who developed disorders while serving in the UK armed forces came to the attention of medical services for these problems, received corresponding diagnoses, and were treated.

Methods

For this retrospective record-based study 132 veterans in receipt of a war pension for psychological or physical problems received a lifetime diagnostic interview. Those with onsets of PTSD, depression, or alcohol abuse while in service were compared with those who never developed any condition or only developed it after discharge. Their medical records were inspected for contemporaneous contacts, diagnoses, and treatment.

Results

PTSD and depression, but not alcohol abuse, were independently associated with mental health contacts while in service. The median time from PTSD onset to first contact was 1?month. Under half of personnel meeting criteria for these disorders received a corresponding diagnosis, and alcohol abuse was more likely to be recognised in the context of comorbid PTSD. PTSD was as well recognised in earlier as in later years covered by the study. Most personnel with disorders received treatment, and those treated were more likely to be medically downgraded or discharged.

Conclusions

War pensioners are more likely than not to have had their psychological problems acknowledged and treated while in service. The fact that these problems are still largely present 10?years later raises questions over the continuity of care associated with the transition to civilian life.     

Axis I phenomenology of borderline personality disorder

The Axis I phenomenology of 50 outpatients meeting both Diagnostic Interview for Borderlines (DIB) and DSM-III criteria for Borderline Personality Disorder (BPD), 29 outpatients meeting DSM-III criteria for Antisocial Personality Disorder (APD), and 26 outpatients meeting DSM-III criteria for Dsythymic Disorder as well as DSM-III criteria for some other type of Axis II disorder (dysthymic OPD) was assessed blind to clinical diagnosis using the Structured Clinical Interview for DSM-III (SCID). Borderlines were significantly more likely than antisocial controls to have met DSM-III criteria for an affective disorder, particularly Dysthymic Disorder, and an anxiety disorder. They were also significantly more likely than dysthymic OPD controls but significantly less likely than antisocial controls to have met DSM-III criteria for alcohol abuse/dependence and drug abuse/dependence. The authors conclude that: (1) the link between BPD and unipolar affective disorders is less specific than previously suggested, and (2) there is a link between BPD and impulse disorders that may be of equal, if not greater, importance.     

Filial dependency and recantation of child sexual abuse allegations

OBJECTIVE: Controversy abounds regarding the process by which child sexual abuse victims disclose their experiences, particularly the extent to which and the reasons why some children, once having disclosed abuse, later recant their allegations. This study examined the prevalence and predictors of recantation among 2- to 17-year-old child sexual abuse victims. METHOD: Case files (n = 257) were randomly selected from all substantiated cases resulting in a dependency court filing in a large urban county between 1999 and 2000. Recantation (i.e., denial of abuse postdisclosure) was scored across formal and informal interviews. Cases were also coded for characteristics of the child, family, and abuse. RESULTS: A 23.1% recantation rate was observed. Multivariate analyses supported a filial dependency model of recantation, whereby abuse victims who were more vulnerable to familial adult influences (i.e., younger children, those abused by a parent figure and who lacked support from the nonoffending caregiver) were more likely to recant. An alternative hypothesis, that recantations resulted from potential inclusion of cases involving false allegations, was not supported. CONCLUSION: Results provide new insight into the process by which children reveal interpersonal trauma and have implications for debates concerning the credibility of child sexual abuse allegations and treatment in dependency samples.     

Implications of childhood sexual abuse for adult borderline personality disorder and complex posttraumatic stress disorder

OBJECTIVE: This study examined whether women with a history of early-onset sexual abuse or those with late-onset sexual abuse were more likely to meet diagnostic criteria for both borderline personality disorder and complex posttraumatic stress disorder (PTSD). METHOD: The Revised Diagnostic Interview for Borderlines and the Trauma Assessment Package were administered to 65 women from three outpatient clinics in a metropolitan area. Thirty-eight subjects met criteria for early-onset abuse, while 27 subjects met criteria for late-onset abuse. RESULTS: The diagnoses of both borderline personality disorder and complex PTSD were significantly higher in women reporting early-onset abuse than in those with late-onset abuse. The trauma variables sexual abuse and paternal incest were significant predictors of both diagnoses. CONCLUSIONS: In contrast to those with comorbid diagnoses, some women with a history of childhood sexual abuse may be extricated from the diagnosis of borderline personality disorder and subsumed under that of complex PTSD.     

The role of childhood abuse in Axis I and Axis II psychiatric disorders and medical disorders of unknown origin among irritable bowel syndrome patients

OBJECTIVE: High rates of early abuse and psychopathology are commonly reported among treatment-seeking patients with irritable bowel syndrome (IBS). The purpose of this study is to further explore the relations among IBS, early abuse, Axes I and II psychopathology, and other medically unexplained disorders. METHODS: One hundred and ninety-six IBS patients seeking nondrug treatment for their symptoms were characterized in terms of their gastrointestinal (GI) status, psychiatric status (Axis I and Axis II), early abuse status, and the presence of other functional disorders. Patients were divided into two groups based on early abuse status. RESULTS AND CONCLUSION: No significant differences emerged between abused and nonabused groups on either the presence of Axis II disorders or other functional health conditions, although there were high levels of both in the IBS population. Patients with a history of abuse were significantly more likely to meet criteria for an Axis I disorder, especially substance abuse disorders, dysthymia, and generalized anxiety disorder.     

Evaluating children's reports of sexual abuse: results from a survey of professionals

Two hundred and twelve professionals were surveyed on their assessment and validation procedures in cases of children's sexual abuse allegations. Specific questions garnered information about practices in interviewing children and accused adults, assessment protocols, criteria used to substantiate the allegations, and factors that might distort children's responses.     

Incarceration and hospital care

Risk for jail or prison recidivism is well documented among incarcerated individuals with schizophrenia. However, it is less clear that risk is also high for psychiatric hospital readmission after accounting for mediating influences such as psychopathology severity, functioning level, substance misuse, and demographic characteristics. Relative to counterparts without prior time in jail, this study therefore assessed whether formerly incarcerated individuals with schizophrenia were more likely to repeatedly use hospital care after controlling for level of functioning and symptomatology. Among 315 inpatients, former inmates had a greater mean number of previous hospital stays than other patients (t = -2.13; df = 305; p = 0.03) and were more likely to visit the emergency room or be rehospitalized within 3 months of discharge (chi2 = 8.83; df = 1; p = 0.003). They were twice as likely to be readmitted, moreover, even after accounting in logistic regression for age, sex, race, global functioning, psychopathology severity, alcohol abuse or dependence, and drug abuse or dependence (OR = .49; CI = .26-.95). Implications for community care are discussed, and the suggestion is made that jail diversion programs should be renamed and refocused as "jail and hospital diversion."     

Victimization of children with disabilities

Children with disabilities (CWDs) are more likely to be victims of child abuse but may have more difficulty than their typically developing (TD) peers reporting their experiences. In this study, the authors examined the characteristics of abuse reported by CWDs based on forensic statements made by 40430 alleged abuse victims, 11% categorized as children with minor disabilities, and 1.2% categorized as children with severe disabilities. Proportionally more of the CWDs than of the TD children were allegedly victims of sexual rather than physical abuse. CWDs failed to disclose abuse and delayed disclosure more often than TD suspected victims. CWDs were more likely than TD children to be abused by parent figures and to experience physical abuse resulting in body injury or serious sexual offenses, including those involving penetration, repeated abuse, use of force, and threats. Higher levels of disability were associated with increased risk of sexual abuse. Both the heightened incidence of severe abuse among and the failure to disclose abuse by CWDs should be sources of considerable concern to social welfare and criminal justice agencies.     

Can multiaxial diagnosis predict future use of psychiatric hospitalization?

Demographic and diagnostic intake data on about 10,000 patients at a public psychiatric facility were used to assess whether information recorded on various DSM-III axes could predict the frequency of patients' psychiatric hospitalizations over a follow-up period. Compared with patients who had been hospitalized only once or not at all, patients with three or more hospitalizations during the study period were more likely to be single and black and to come from lower social classes. They were more likely to have an axis I diagnosis of an alcohol-related disorder, a substance use disorder, or a psychotic disorder. When samples from the patient groups were matched on key demographic variables and primary axis I diagnosis, the multiaxial resources of DSM-III were not helpful in predicting future use of hospitalization. The results reinforce the importance of axis I diagnosis and demographic characteristics in assessing course and prognosis.     

Evolution of diagnostic criteria for schizophrenia

Many operational diagnostic criteria for schizophrenia, which are rooted to various degrees in the concepts of Kraepelin, E. Bleuler and K. Schneider, have been developed during the last two decades. They often incorporate prognostic factors to which Langfeldt in particular had drawn attention. These recent criteria vary considerably according to the attitude taken with regard to Jasper's hierarchical principle, which accords a diagnostic superiority to schizophrenic symptoms over affective symptomatology. Attribution to schizophrenia is very different depending upon whether the systems uphold, reject or reverse this principle. One should distinguish between classifications based upon a consensus of experts or experienced clinicians on the one hand and diagnostic research criteria destined to test etiopathogenetic hypotheses on the other. The important principles of attribution of DSM III and DSM III-R are outlined as well as their shortcomings, the latter leading to the conclusion that one should not restrict oneself to employ solely the American classification, but utilize it along with other classifications, such as the French empirical criteria or the Vienna research criteria, in order to see more clearly whether the very broad definitions of schizophrenia do not camoufly particular etiopathogenetic entities which ought to be identified.     

A practical approach to sexual abuse allegations: Netherlands Expert Committee for Equivocal Sexual Abuse Allegations

Equivocal sexual abuse allegations are those in which the details of the alleged offence(s) are uncertain. The circumstances are ambiguous, there is limited evidence, and it is unclear how police investigations should proceed. This article discusses the challenges such allegations pose for police, prosecution, judges and mental health experts, and advocates for the use of multidisciplinary expert opinion during the investigation. The practical application of this approach by the Netherlands Expert Committee for Equivocal Sexual Abuse Allegations (LEBZ) is described, which has assessed over 900 cases since its inception in 1999. The LEBZ approach represents a significant innovation in police and criminal justice responses to equivocal allegations of sexual assault, which warrants consideration in other jurisdictions.Key words: expert testimony, investigative psychology, multidisciplinary approach, sexual abuse allegations     

Veterans who may need a payee to prevent misuse of funds for drugs

OBJECTIVE: This study sought to determine the possible need for a payee among Department of Veterans Affairs (VA) inpatients with substance use disorders who receive public support payments. METHODS: A total of 290 veterans hospitalized in VA psychiatric units completed a survey designed to identify patients who may be in need of a payee because of excessive expenditures for substances of abuse. Level 1 screening identified patients with a general likelihood of needing a payee because they received public support payments, did not have a payee, and had a substance abuse diagnosis. Level 2 screening identified level 1 patients for whom there was further evidence of need for a payee because, in addition to spending substantial amounts of money on substances of abuse, they reported either difficulty meeting basic material needs or substantial harm from substance use. RESULTS: Of 290 patients surveyed, 78 (27 percent) met level 1 criteria. Altogether, 35 patients (45 percent of level 1 patients and 13 percent of all surveyed patients) met the more specific level 2 criteria, indicating that they were likely to be in need of a payee. As expected, veterans who met the level 2 criteria were more likely than those meeting only the level 1 criteria to have both self-rated and clinician-rated difficulties managing money. However, clinicians did not rate these veterans as more likely to benefit from a payee. CONCLUSIONS: A substantial proportion of veterans who have not been assigned a payee may need one. More effective approaches to money management in this population are needed.     

The intimate connection between antisocial personality and substance abuse

There is a powerful association between antisocial behavior and substance abuse. What is still uncertain is whether the association between the two is causal, so that one disorder leads to the other, or is explained by shared symptoms or shared risk factors, or suggests that the two disorders are not distinct, but are actually variants of the same underlying disorder. Each of these hypotheses is shown to be plausible. The paper considers four criteria for causality: precedence, coherence with existing knowledge, dose-related liability, and understandability of mechanisms. Problems are noted with each of these criteria. Conduct disorder as a cause of substance abuse fulfills these criteria more obviously than does substance abuse as a cause of antisocial behavior, but both have plausibility. A similarity is noted between the tasks of deciding whether one disorder causes another and deciding whether early symptom patterns predict the later course of a single disorder. The dearth of information about effect of the early symptom profile on the later course can be overcome with careful study design. Such studies promise important gains in patient management. The necessary data are outlined and instruments to collect such data are noted to be newly published or in development. Received: 18 February 1998