Dreamcatchers For Abused Children
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Posted by Sandra On January - 19 - 2010

Techniques For The Child Interview And A Methodology For Substantiating Sexual Abuse

Because of the central role played by the child interview in substantiating sexual abuse, it is addressed in greater depth than some of the other aspects of child sexual abuse practice.
As noted in the previous chapter, child interview data may be gathered in one or more interviews, depending on the particular child, the professional conducting the interview, and the safety of the child’s living arrangement. The interviewer must initially spend time getting to know the child. This allows the interviewer to learn about the child’s life circumstances and possible context of abuse and to ascertain the child’s developmental level, modes of communication, the child’s affective or emotional state(s), and overall functioning, including the child’s competency. With young children, this part of the assessment usually involves play activity with some questions. With older children, the interviewer is likely to rely primarily on talking to the child and asking questions. At this point, questions are usually about the child’s life in general and are neutral. They might include queries about the child, as well as her/his school, friends, and family.
Either before, during, or following this general discussion, the interviewer speaks to the child about why she/he is being seen and how the information the child gives will be used. If the interview is to be taped or there are people behind the one-way mirror, the child should be informed. This material is communicated at the child’s developmental level and varies with the circumstances of the case.
Information elicited, statements recorded, and behavior observed during this initial phase of the interview often lead naturally into discussion of possible sexual abuse.
Techniques for Interviewing the Child
A variety of techniques can be used in trying to elicit information from the child. The focus here is on techniques most useful with young children. Appropriate questions and several types of media or props – anatomically explicit dolls, anatomical drawings, picture drawing, story telling, and the doll house – are discussed.
Although appropriate questions will be the first technique discussed, they are no more important than the media that will be described. In many cases, what children demonstrate with media is far more compelling than what they say. It is also somewhat artificial to treat questioning as a separate undertaking. Although questions can be used by themselves, as will become clear, questions are always asked in the process of using media, and the limited research suggests children communicate more accurately when questioned using props than when questioned without them.
It is a good practice to use more than one technique in eliciting information, even if it is only the combination of the use of anatomical dolls and questions. Some of these techniques, such as story telling, are rightfully the province of mental health professionals and should not be used by Child Protective Services (CPS) caseworkers and law enforcement personnel. However, the other techniques can be used by all professionals likely to interview children, provided they have adequate training in their use.
Use of Questions
It is prudent to avoid leading questions in case they might cause a false accusation and in order to preclude challenges to interviewing techniques. The interviewer should assume that the more open-ended the question, the greater confidence he/she should have in the child’s responses. A continuum consisting of five types of questions, from most open-ended to most close-ended, is presented in the following discussion. This framework is fairly consistent with other clinical writing on questioning strategies.74 75 The types of questions are as follows:
general questions,
focused questions,
multiple-choice questions,
yes-no questions, and
leading questions.
General Questions
General questions are frequently used as opening questions when an adult comes in for assessment or treatment. For example, if an adult rape victim comes to a mental health professional, the therapist might begin by asking, “Tell me why you came to see me today.” This question is likely to elicit an account of the rape.
Interviewers attempting to determine if a child has been sexually abused usually ask comparable general questions early in the interview. They might ask, “Did anyone tell you why you are coming to see me today?” With adolescents and late latency-aged children, general questions often produce some information about sexual abuse. Unfortunately, these general questions are less useful with young children. Typical responses from them are, “No,” or “I don’t remember” (despite the care the accompanying adult might have taken in preparing the child). Alternatively young children may acknowledge that they know why they are being interviewed but say they don’t want to talk about it. The children may also give vague responses such as “to talk about the bad things” or “to say what Grandpa did.” However, they may fail or refuse to elaborate. More directive questions are needed.
Focused Questions
Clinical experience suggests focused questions are optimal. They often elicit relevant information, but they are not leading. There are three types of focused questions:
questions focused on people,
questions focused on the circumstances of the abuse, and
questions focused on body parts.
Within each type, questions focused on daily routine and care activities may produce important information. For example, questions about bathing may elicit details about the body, the “helping” parent, and the abuse setting.
Questions focused on persons will include questions about the alleged offender. It is a good strategy to begin by asking questions that will not be difficult. Thus, focused questions might first be asked about siblings, then about the mother, and finally about the alleged offender. A series of focused questions about an alleged offender might be the following:
“Where does Joe (mother’s boyfriend) live?”
“What kind of things does he do with the family?”
“Are there things he does especially with you?”
“Are there things Joe does that you like?”
“Are there any things he does that you don’t like?”
“Does he ever do anything with you that you don’t like?”
There are two types of focused questions about the possible circumstances of the sexual abuse that many interviewers use.
“Are there any secrets in your family?”
“Does ______ ever play games with you?”
These questions are commonly used because often children are told that the sexual abuse is a special secret between themselves and the offender. Alternatively, offenders may induce children’s cooperation or normalize the behavior by defining the victimization as a game.
However, there are other potentially productive focused questions related to the circumstances of the abuse. These questions are suggested by the information the interviewer gathers before seeing the child. Examples might be as follows:
“What do you do when Grandpa babysits?”
“How does Daddy take care of you when Mom is at work?”
“What happens when you are in the bath?”
Questions that focus on body parts are generally used in conjunction with anatomically explicit dolls or anatomical drawings. The interviewer has the child give names for the various body parts. Then focused questions can be asked. For example, the interviewer might ask the following questions with regard to the penis:
“Did you ever see a ‘dinky’ (penis)/anybody else’s ‘dinky’?”
“Whose did you see?”
“What does a ‘dinky’ do?”
If the child responds, “It goes ‘pee’,” the interviewer might ask,
“Does it do anything else?”
Comparable questions might be asked of a female victim about the vagina:
“Did you ever see anyone else’s ‘peepee’?”
“Did anyone ever ask you to touch their ‘peepee’?”
“Did anything ever happen to your ‘peepee’ that you didn’t like?”
“Does it ever hurt?”
“What makes it hurt?”
“Does anyone ever touch it?”
If the child responds that she touches it, the interviewer might ask:
“Does anyone else touch it?”
If the child names someone, the evaluator might follow with:
“When does he touch it?”
In some cases or at certain points during an interview, children may not respond to focused questions, or they may reply, “I don’t know,” or “I don’t remember.” In these cases, more directive questions are necessary.
Multiple-Choice Questions
When information is not forthcoming with a focused question, the interviewer may resort to a multiple-choice question. There are several caveats for their use. First, young children may have difficulty with this format, and they will have more difficulty the more options given. Second, interviewers must be sure to include a correct response, so that the child is not given the choice between two or more incorrect responses. Thus, in a case in which the victim has affirmed that another child was there, but did not respond when asked who it was, the interviewer might ask, “Was it one of your friends or someone else?” in case it was someone the child did not know. Third, it is advisable to limit the use of multiple-choice questions to the circumstances of the sexual abuse and, if possible, not to use them to ask about the abuse itself. For example, the interviewer might ask:
“Do you remember if you were wearing your day clothes or your night clothes?”
The interviewer would avoid asking:
“Was it your dad, your stepdad, both, or someone else who hurt your butt?”
Yes-No Questions
Despite the fact that research indicates that even young children provide quite accurate information in response to yes-no questions,76 they are generally used in investigative interviews only when more open-ended questions are not productive, but the interviewer continues to have concerns about abuse. The reason for reservations about yes-no use is concern that they may elicit “social desirability” responses, especially in young children. That is, the child may answer in the affirmative because she/he thinks a positive response is desired. Alternatively, the child may not understand the question and nevertheless answer yes.
Unlike focused questions, yes-no questions usually identify both the alleged offender and the sexual behavior in question. (Focused questions, except those about the circumstances of the abuse, contain one or the other.) Examples of yes-no questions are as follows:
“Did your mom put her finger in your vagina?”
“Was it your stepfather who made your ‘bum’ (anus) bleed?”
Leading Questions
A leading question is one in which the desired answer is specified in the question. Leading questions are commonly encountered by witnesses when they are cross-examined in court. However, they are not appropriate to investigative interviewing of children. Leading questions are usually not necessary and may be perceived as coercive because they convey the interviewer’s own view of events. Interrogations using leading questions also may influence children’s interpretations of events77 and are likely to lead to an attack on the validity of the interview findings. Examples of leading questions are as follows:
“Your dad sucked your penis, didn’t he?”
“Isn’t it true your grandmother told you to say your stepdad put his ‘dick’ in your sister?”
Strategic Use of Questions
The interviewer should use as many open-ended questions as possible. That is, the interviewer endeavors to use general or focused questions and only resorts to multiple-choice or yes-no questions if the former are not eliciting any information. As more close-ended questions are employed, it is prudent to have less confidence in the replies. When information is elicited in response to, for example, a multiple-choice question, the interviewer then reverts to a more open-ended approach, perhaps asking a focused question.
The following series of questions is illustrative: The interviewer asks the child where mom was when the abuse occurred (a focused question), and the child does not reply. The interviewer then asks whether mom was there or not (a multiple-choice question). The child replies that mom was there. The interviewer then asks, “What was she doing?” (a focused question). The child responds, “She was helping my dad.” The interviewer then asks how the mom helped (another focused question). The child says, “It’s hard to say.” The interviewer responds, “Well, did she do any of the touching?” (a yes-no question). The child nods. The interviewer then asks where the mother touched (a focused question).
For a chart that illustrates the continuum of questions, see Appendix C.
Use of Anatomically Explicit Dolls
Anatomical dolls are the most widely employed of the media.78 Although most appropriate for use with children aged 2 to 6, anatomical dolls may be used with children of any age. In this section, the challenges to the dolls, their advantages, and techniques for their use will be discussed.
Challenges to Anatomically Explicit Dolls
The dolls have been challenged, generally by defense attorneys and their expert witnesses, as being “leading,” that is, triggering allegations of sexual abuse because they are “suggestive.” However, research indicates that they do not elicit sexual responses from children who do not have prior sexual knowledge,79 80 and in the few studies that compare the responses of children believed to be sexually abused to those of children not so found, the former are significantly more likely to engage in sexualized behavior with the dolls than the latter.81 82 However, many children believed to have been sexually abused do not engage in sexualized behavior with the dolls.
Nevertheless, a definitive determination of sexual abuse is made not merely on the basis of what the child does with the dolls. Children may learn about sexual activity in ways other than being abused, for example, from consensual involvement with peers, from viewing erotica or pornography, or from sex education classes. Therefore, if the child spontaneously demonstrates sexual activity with the dolls, the interviewer needs to ask questions to clarify the source of the child’s knowledge.
That is, if a child puts the penis of the adult male doll into the vagina of the female child doll, such behavior is certainly suggestive but not conclusive. In response to such a demonstration, the interviewer might ask, “Who does that?” in order to find out whether or not the child has been sexually abused.
In addition, anatomically explicit dolls have been criticized because they have not been subjected to the validation process employed with psychological tests. As noted above, there have been studies employing the dolls with general populations of children and a small number of studies that compare the responses of children assumed to have been sexually abused to those assumed to have not been abused.83 However, the dolls are not meant to be a psychological test, any more than Barbie™* dolls are. Rather, they are a medium through which interviewers may communicate with children, just as language is.
Advantages of Anatomically Explicit Dolls
The dolls are not a magical instrument that makes disclosure of sexual abuse automatic. In addition, the small number of studies comparing anatomical dolls to other media, for example, regular dolls, suggest thus far no particular superiority of the dolls over other media. However, the advantages noted by clinicians include:
For young children, the dolls may be a more familiar medium than speech, and often one in which they are more accomplished, because children generally interact with toys, including dolls, before they have a lot of language.
The dolls’ explicit parts may serve as a stimulus to remind the child of sexual abuse.
Their genitalia, breasts, mouth openings, and anal openings allow for more precise communication than speech or nonexplicit dolls.
For many children, who actually have the language to communicate, showing what happened with the dolls may be easier than telling.
How to Use Anatomically Explicit Dolls
There is no scientifically demonstrated right or wrong way to use the dolls. Everson and Boat 84 have reviewed the various guidelines for using anatomical dolls and have determined that there are five different functions they may serve – comforter, ice-breaker, anatomical model, demonstration aid, or memory stimulus. The most commonly endorsed functions are as an anatomical model, as a demonstration aid, or as a memory stimulus.
When the dolls serve different functions, they may be used in different ways. Three methods of using the dolls and the functions they serve are described.
Scenario in which the child spontaneously engages with the dolls. Some interviewers have the dolls available in the room with their clothing on. Children will sometimes pick up the dolls and begin playing with them. Depending on the stage of the interview, the interviewer may encourage the child to examine the dolls more closely. This process may involve the use of several dolls, usually four, and may include identifying them by gender and whether adult or child, undressing them, and identifying body parts, including the private body parts. In this process, the dolls may serve as a memory stimulus.
The interviewer may interpret unusual reactions to the dolls, for example, marked fear or sexualized behavior, as indicative of possible sexual abuse, and will want to pursue these reactions further. The child might be asked why seeing the doll caused her/him to be so upset. If sexualized behavior was noted, the child might be asked who does that and additional questions about the acts the child has demonstrated.
Similarly the sight of the genitalia on the dolls may serve as a memory stimulus and result in a statement about sexual abuse or something indicating advanced sexual knowledge. Again the interviewer will pursue these leads by asking for specifics and further information.
When the mere sight of the dolls with genitalia does not lead to any information, the interviewer may use them as an anatomical model. Using the names the child has given for the genitalia, the interviewer asks questions about the dolls and their genitalia. Below are sample questions about the penis and possible responses. It is important that the interviewer have in his/her repertoire a range of ways to approach the child, but the interviewer should allow the child ample time to respond and avoid a barrage of questions.
“Who has a ‘dingdong’?” “Did you ever see one?” “Whose did you see?” “Does anything ever come out of the ..dingdong’?” If the child responds yes, “What color is it?” If the child says white, milk, or like snot, “Did any ever get anywhere on or in you?”
“Did anyone ever try to do something to you with a ‘dingdong’?” “What did he try to do?” “Can you show me with the dolls?”
“Did anyone ever want you to do something to or with his ‘dingdong’?” “Can you show me with the dolls what he wanted you to do?” “Did you have to do it?”
“Do you know what a ‘dingdong’ feels like?” “Does it ever change?” “Does it ever get bigger?” “Is it hard or soft?” “Is it hanging down, or does it stick up?” “Can you show me with the dolls how it goes?”
Similar questions can and in many cases should be asked about other genitalia and the anus. However, caution should be used in asking questions about erections, semen, and how the semen tastes when there is no independent information that the child is likely to possess such knowledge. This will avoid a circumstance in which the interviewer introduces the child to advanced sexual knowledge.
In cases in which the child spontaneously picks up the dolls, they can be used somewhat differently as an anatomical model as follows: rather than asking children about their own experiences, once the dolls have been undressed, children can be asked what might have happened to the doll, or the doll can be named (using a name other than the child’s) and then questions asked about its experiences. This may make the discussion less threatening. Thus, instead of asking a female victim about her own vagina, the interviewer might ask about “this girl’s ‘peepee’.” If positive information is elicited, it is important to ask if something like that happened to the child and, if so, with whom.
Comparable questions can be asked about the naked dolls, rather than their parts. Examples might be:
“What do they do when they have their clothes off?” inviting the child to demonstrate.
“Do the mom and dad ever do anything when they’re naked?”
“Show me how they take a bath.”
“Does the daddy ever do anything to the girl when she’s naked?” If the child affirms, “Can you show me that?”
Again, the interviewer must ascertain that the child is speaking about her/his own experience if the child reveals any knowledge of sexual activity.
Scenario in which the dolls are introduced during the discussion of sexual abuse. Another way the dolls can be used is during the course of verbal disclosure. In this instance, the dolls are used as a demonstration aid. There are several circumstances in which they can be used in this manner. If a child is saying, “I don’t want to talk about it,” the interviewer may ask the child if she/he prefers or would find it easier to show. Second, the dolls may be used to clarify or obtain more detail about a verbal disclosure, for example, what exactly “humping” is. Third, the dolls may be used as a medium to corroborate the child’s verbal statements. It is especially important, with children who are 2 to 6 years old, to get them to clarify or corroborate any verbal disclosures with the dolls. With children aged 6 and older, the evaluator may ask if they prefer to show what happened with dolls, draw a picture, or tell about it.
To introduce the dolls, the interviewer may say to the child that she/he has some dolls that are a little bit different. The interviewer may then select relevant dressed dolls and might ask the child if she/he has ever seen dolls like these before, as they are undressed. Alternatively, the evaluator may introduce one doll, undressing it to show the child how the dolls are different, and then have the child choose the dolls to use to “show what happened.” Children may demonstrate by using two (or more) dolls, or they may use the doll and their own bodies.
For example, one 3-year-old girl, when asked to show how Daddy hurt her, using the dolls, picked up the naked adult male doll and thrust his penis into her crotch, saying “unh, unh, unh.”
In such a situation, questions can be asked to obtain specific detail, such as:
“Can you show me how far his ‘dick’ went into your mouth?” “Did anything come out of his ‘dick’ when he did that?”
“Do you remember what room you were in?” “Were you on the bed or somewhere else?” “Can you show how he did it?”
Some children will not respond when asked to use the dolls to demonstrate the alleged abuse. The interviewer then may proceed to less spontaneous approaches. For example, the child may be asked to point to the place on the child doll where something happened to her/him, and if the child does point, then the child may be asked what exactly happened. Similarly, the interviewer may ask the child to point to the part of the adult doll’s body that was used in the encounter, assuming some sort of an encounter has been affirmed. If the child designates a body part, the child is then asked to demonstrate exactly what happened.
Finally, if no information is forthcoming from the approaches already described, the interviewer can ask the child if she/he will answer “yes” or “no” if the interviewer points on the child doll to the parts of the child’s body that might have been involved. Alternatively, the interviewer can use the adult male doll to ask the child to reply “yes” or “no” to the parts of the alleged offender’s body that might have been involved. These are yes-no questions and therefore fairly close-ended. It is advisable to point to some body parts very unlikely to be involved in order to test for possible “social desirability” responses. If confirming information is elicited, then, of course, the interviewer reverts to more open-ended questions.
Scenario in which the dolls are introduced without any cues. Finally, the dolls can be introduced independent of any opening by the child. If no opportunities for a discussion on sexual abuse have arisen, some professionals will introduce the dolls toward the middle of the interview. However, others prefer to introduce the dolls rather early to elicit material about possible sexual abuse. When used in this manner, the dolls may serve as a memory stimulus or a diagnostic screen, but their major use is as an anatomical model.
Some professionals use the dolls to assist in identifying private (where it’s “ok” to touch yourself in private, but where others should not touch you) versus other body parts, or good and bad touch areas. Sometimes touch is differentiated as good (e.g., a hug), bad (e.g., a slap), and trick – which feels good but is bad because it is in a private area. Then the child is asked about any experiences of touching in the private area or bad or trick touching.
Objections have been raised to the concept of good and bad touch, and it may be advisable to avoid using this concept for three reasons. First, the term “touch” is confusing to young children and may foreclose consideration of some types of activity (e.g., licking and object or penile intrusion). Second, the terms, “good” and “bad” may be too vague in that they do not connote the actual body parts. Third, the use of good and bad to refer to breasts, genitalia, and anus may lead to negative perceptions of the private body parts. However, these views of good and bad touch represent professional preference. There is no evidence that the use of the “good touch/bad touch” approach either contaminates or invalidates an interview.
Use of Anatomical Drawings
Anatomical drawings are pictures of adults and children, males and females, at different developmental stages – elder, adult, adolescent, latency age, and preschooler, without clothing and with primary and secondary sex characteristics. These drawings may have the frontal position presented on one side of the page and the dorsal on the other. 85 They are used like skin maps; therefore, relevant pictures are used for each child interviewed.
In many respects, the use of anatomical drawings parallels the use of anatomically explicit dolls. Anatomical drawings are useful with the same age range of children as the dolls; they are particularly useful with very young children but also appropriate with older children. Appropriate pictures are chosen by either the child or the interviewer. The child can be asked to mark on the drawing or point to the part on the drawing that was involved.
The disadvantage of pictures is that it is more difficult for the child to enact any sexual behavior with pictures. However, children may make clothing for the pictures in order to demonstrate how clothing was removed, put one drawing on another to show “humping” (intercourse), and draw arrows and lines between genitalia in order to indicate intercourse.
On the other hand, anatomical drawings have the considerable advantage of being a permanent, visual record. They become part of the interviewer’s case record and, as such, are admissible in court. In addition, the drawings have not been challenged as the anatomical dolls have.
Because of the potential use of drawings as evidence, it is advisable for professionals to put as much information as possible on the drawings. Professionals should have the child write the name of the person whom the particular drawing represents, if the child can do so. If the child cannot write, the interviewer should write the name. The interviewer should encourage a child to write or draw on the pictures to illustrate aspects of the abuse. For example, if the child indicates the offender used a finger to hurt her vagina, the interviewer should have her circle or mark the appropriate finger(s), and then the child or the interviewer should write beside the finger that it is the one that went in her vagina. Professionals should write on the picture the questions asked and the child’s responses. For example, in a situation involving sexual abuse in day care, a 4-year-old girl marked the penis, the head, and the feet on the anatomical drawing representing her little brother. These were the places “the teachers did bad things.” Beside each of the child’s marks was written “a place the teachers did bad things.” The questions and the child B’s whispered responses were written beside the penis on the picture representing B’s brother:
Int.: “Who did something to his penis?”
B.: “Miss Rose.”
Int.: “What did she do?”
B.: “Bit it.”
Int.: “How do you know?”
B.: “I saw her.”
Use of Picture Drawing
Although a few clinicians have made observations about the characteristics of drawings of sexually abused children,86 87 there has been no systematic exploration of their content. Nevertheless, many types of pictures can be helpful. Drawing is most useful as a diagnostic technique with latency-aged children. However, children as young as age 4, and in some cases 3, can produce useful drawings as long as the various items in the picture are labeled and explanations are written on the picture. Some adolescents will prefer to draw a picture of what has occurred rather than to describe it verbally.
Drawing can have uses other than gathering information about possible sexual abuse. For instance, drawing can be employed to reduce tension, to understand issues other than sexual abuse, and to assess the child’s overall functioning.
The interviewer may employ pictures either indirectly or directly to gather information that may be related to the child’s victimization. Asking the child to draw any of the following pictures may indirectly result in findings:
“Draw me a picture of anything.”
“Draw me a picture of yourself.”
“Draw me a picture of a person.”
“Draw me a picture of your family.”
“Draw me a picture of your family doing something.”
“Draw me a picture of (possible perpetrator).”
Sometimes sexual content (e.g., genitalia or sexual acts) is noted in the pictures. If this is the case, questions should be asked about this content. The child’s responses may provide information about sexual abuse. For example, a 5-year-old child, when asked to draw “anything,” drew a picture of “Daddy” with a large “peanuts” (penis). When asked what the “peanut” was and if she had ever seen one, she eventually described her father taking her into his bed and fondling her as he fondled himself.
Alternatively, asking the child to talk about the picture may elicit information about abuse. For example, the interviewer might ask what is happening in the picture or what makes the person in the drawing happy, sad, angry, and scared. A 5-year-old drew a picture of her mother and her mother’s boyfriend and then scribbled over the drawing. When asked what they were doing, she indicated the scribbles meant they were having sex.
If the child fails to provide any information about sexual abuse in response to queries about drawings, then caution should be exercised in their interpretation. Although the specifics of the pictures and other information about the case must be taken into account, pictures of genitalia do not necessarily mean the child has been sexually abused, and a sad drawing could have a wide range of significance.
The following drawing requests are aimed at gathering information directly and may be used when the child has already indicated something happened.
“Draw me a picture of (identified perpetrator).”
“Draw me a picture of where (the abuse) happened.”
“Draw me a picture of what (the perpetrator) did.”
“Draw me a picture of the (instrument/body part) he used.”
These requests may be used when children are having difficulty disclosing, when there is a need to clarify what the child has said or demonstrated, or when the interviewer wants to corroborate disclosures using the medium of drawing.
To facilitate disclosure, the interviewer may ask the child if she/he would rather draw when the child says she/he doesn’t want to talk. Further, if the child claims not to remember very much, asking the child to draw the location of the alleged abuse may trigger recollection of detail and free the child to discuss the abuse.
Drawings that may be particularly helpful for clarification are pictures of what the offender used (instrument or body part) and of what happened. A 5-year-old with vaginal injury referred to an instrument used in her abuse as “Daddy’s stick” but could not give further detail. The police officer interviewing her asked her to draw it, and she drew what appeared to be a ruler. Her mother was able to say where in the house it would be found, and the officer got a warrant and seized the physical evidence.
Like anatomical pictures, the child’s drawings become part of the case record and can be submitted into evidence. Therefore, the interviewer should have the child label various parts of the drawings and write relevant comments. Again, if the child is unable to do this, the interviewer should label the drawings.
The Dollhouse
Very little has been written about the use of the dollhouse in interviewing children alleged to have been sexually abused. Nevertheless many mental health professionals and some CPS workers use it in investigative interviewing. It is especially useful with preschoolers.88
Larger dollhouses, with sturdy furniture and people 3 to 6 inches tall, are optimal. The bigger the people, the easier it will be for the child to show activities and for the interviewer to see them. Most dollhouse people do not have removable clothing, which makes it difficult for the child to demonstrate some sexual abuse. However, the dollhouse provides a better opportunity to address the issue of the context of the sexual abuse than most other media.
Like drawings, dollhouse play can have goals other than data gathering about possible sexual abuse. For example, dollhouse play can be used to get to know the child and to understand something about how the child generally perceives families and family activity. And again like drawings, the dollhouse can be used indirectly and directly to gather information about possible sexual abuse.
Indirect use could involve observing the child’s dollhouse play and then commenting or asking questions when themes possibly related to sexual abuse are present. For example, the child might repeatedly have the little girl doll going to bed with the adult male. The interviewer might ask what is happening when they go to bed.
The interviewer might use the dollhouse more directly to gather information if he/she has some background about the context of possible abuse. In a case involving a little girl who had just turned age 3, the mother thought the father had inserted something into the child’s vagina one evening when the mother was lying ill on the couch and the father gave their daughter a bath. During the second session with the child, the interviewer structured the dollhouse situation so the mother doll was on the couch, the little girl doll in the bathtub, and the father in the bathroom. When the child approached the dollhouse, familiar to her from the previous session, she froze and began to shake. Later she demonstrated sexual abuse by her father.
Other examples of using contextual information might involve setting up a scenario around bedtime or watching television and then asking the child to show what happens at bedtime or TV time and other relevant questions.
Research on the Reliability and Suggestibility of Child Witnesses
Along with other challenges to allegations of sexual abuse have come challenges to the credibility of children as witnesses. Questions regarding the accuracy of their memories and their suggestibility have been raised.
Fortunately for professionals concerned about the sexual abuse of children, these questions have been addressed through a series of experiments that simulate some of the circumstances of sexual abuse. In general, these studies indicate that children can remember and that they are resistant to suggestion.
Children’s Memories
Older children have more complete recall than younger children. However, studies indicate children as young as 3 years old can recall experiences comparable to those found in sexual abuse. Young children remember fewer details and recall central rather than peripheral events when compared to older children.89 Moreover, although children may not volunteer information about concerning events (a genital exam) or traumatic events (an inoculation or having blood drawn),90 similar in some respects to sexual victimization, such events are recalled as well by children as adults.91 Children’s ability to provide accurate accounts appears to be facilitated by the availability of “props,” such as anatomically explicit dolls, regular dolls, and anatomical drawings.92 93 As noted in the discussion of appropriate questions, children may require fairly direct questions in order to provide information. Children’s memories will fade over time, but their recall can be enhanced by periodic recall of the events in question.
Children’s Suggestibility
The research indicates that most children are resistant to giving false positive responses to leading and suggestive questions. When they do provide false positives, they are generally limited to a nod or a simple “yes.” Older children are more resistant to suggestion than younger ones.94 Children are much more likely to deny actual experiences, which are perceived as traumatic or unacceptable, than to make false assertions about events that did not occur.
However, one study found that children are suggestible, not with regard to factual data but as to the interpretation of the facts. In a study involving 75 children, Clarke-Stewart had a cleaning man interact with toys. In one condition, the man described his activities as cleaning and in the other as playing. The children were then interrogated by an interviewer who pressured the child to interpret the man’s behavior as either cleaning or playing. The researchers found that children did not change their statements regarding what had actually taken place, but most children were highly influenced by the interviewer’s interpretation of the cleaning man’s acts (cleaning versus playing). The implications of this study are clear. They reiterate the importance of using open-ended questions as much as possible and caution professionals to be careful about interpreting behavior, especially child care behaviors.95
Criteria To Be Used To Substantiate Sexual Abuse
Once data have been gathered from the child interview and other sources, the interviewer must decide whether, in her/his opinion, the child was sexually abused. A number of writers have addressed this issue.96 97 98 99 100 101 102 103 104 All of these authors are of the opinion that substantiating information must go beyond affirmative responses to one or two questions, and most suggest some combination of descriptive detail and emotional reaction to the content. Indeed, there is a fair amount of consensus among these writings about the characteristics of a true account of abuse.
However, there has been very little research on the extent to which these clinical criteria are actually present in true cases, in large part because it is so difficult to isolate cases that are proven to be true. The criteria developed by Faller105 will be presented here because there is one research study that examines the extent to which they are found in cases substantiated by offender confession, because they are parsimoniously organized, and because they are fairly consistent with the criteria developed by other writers.
There are three general categories of information that should be assessed in the child’s statements and/or behavior:
a description (either verbal or behavioral) of the sexual behavior;
information about the context of the sexual abuse; and
an emotional reaction consistent with the behavior being described, the child’s functioning, and the circumstances of the interview.
A Description of the Sexual Abuse
In assessing the child’s description of the sexual activity, the interviewer is looking for:
sexual knowledge beyond that expected for the child’s developmental stage;
an account consistent with a child’s perspective; and
an explicit description of the sexual acts.
Advanced sexual knowledge and a child’s perspective are, of course, more persuasive findings with younger children. An explicit account is relevant for children of all ages.
Information About the Context of the Sexual Abuse
Information about the context of the sexual abuse might include:
where it happened;
when it happened;
where other people in the family were;
what the offender might have said to involve the child;
what the victim and offender were wearing and what clothing was removed;
the frequency and/or duration of the abuse;
whether the offender said anything about telling or not telling;
whether the child told; and
if so, whom did the child tell and that person’s response.
The child may have been sexually abused many times and, therefore, may not remember details about all instances. It is best to ask the child to tell about the last time in order to obtain contextual information. In the research on these criteria, the child was considered to have provided sufficient contextual material if she/he gave three pieces of contextual information.
Preschool children will probably have a hard time focusing on and describing the most recent incident. In addition, they will not have the ability to abstract and say, for example, “Sometimes it happened in the bathroom, at other times in the basement, and once at my grandmother’s house.” As a consequence, their accounts of the context (and the abuse, itself) may be confusing and apparently inconsistent. What may be happening is the child may be recalling different incidents when being questioned at different times or by different people. These problems may occur when preschool children are interviewed by different people and/or at different times, or when they recount two or more different incidents, or parts of them, in the same interview.
An Emotional Reaction Consistent With the Abuse Being Described
Children may have a variety of emotional reactions to sexual abuse, depending on the characteristics of the child and the abuse. The following are common emotional reactions and associated child or abuse characteristics:
reluctance to disclose: characteristic of most children except possibly for very disturbed or very young children;
embarrassment: a rather mild response often found in disturbed and young children;
anger: more characteristic of boy victims (but not always evident);
anxiety: noted frequently in adolescent girls;
disgust: a typical reaction to oral sex;
depression: often present in victims who care for the abuser or feel they are responsible;
fear: typical of cases in which the child has been injured or threatened during the course of the victimization; and
sexual arousal: another response sometimes found in disturbed and young children.
Situations In Which the Clinical Criteria May Not Be Found
The small number of studies that examine clinical criteria in proven cases (which are usually substantiated with offender confession) find that a substantial number of children’s accounts lack the expected criteria.106 107 108 For example, in Faller’s study, only 68 percent of accounts contained all three criteria. Young age of the victim and being a boy were associated with not satisfying the expected criteria. Younger children were less likely to provide contextual detail and to evidence an emotional response consistent with the account. Similarly, boy victims were less likely to describe the abuse and to exhibit affect.
There can be other good reasons why children fail to manifest the expected clinical criteria. Affect may be absent because the child dissociates, the child has told about the abuse many times, or the trauma has already been addressed in treatment. In addition, emotionally disturbed children, who have suffered many other traumas, may not become upset about sexual abuse because, compared to their other life experiences, it is not as bad. Detail may be absent because the abuse has been repressed or because it happened long ago and has been forgotten.
It is legitimate to substantiate a case with only a description of the sexual abuse.
Moreover, it is important for interviewers to appreciate that a child’s inability to describe sexual abuse does not mean it did not happen. It means that sexual abuse cannot be confirmed, but that is different from it not having happened. Research on adult survivors indicates that many victims never tell.
Criteria for Confirming an Allegation From Other Sources
There are other sources of information that can support a finding of child sexual abuse.
Suspect’s Confession
The most definitive finding is the suspect’s confession. Unfortunately it is uncommon, particularly at the point of investigation, when the alleged offender may be very frightened and concerned primarily with his own well-being.
An operational definition of a full confession is that the alleged offender admits to all or more sexual activity described by the child. As a partial confession, the suspect may make “incriminating” statements by admitting to some but not all of the child’s allegations. Alleged offenders may minimize their behavior by admitting to “just touching,” may deny acts involving severe penalties, or may not admit to certain behavior they find particularly shameful. These incriminating statements deserve attention because they may be found in cases in which the suspects are frightened to admit. There appear to be several types:
The alleged offender may claim diminished capacity.
“I don’t remember what I do when I’ve been drinking.”
The suspect admits to the behavior but says it was not intended to be sexually abusive. There are actually two types of cases that fall within this category, those in which the suspect says the mistake was on his part and those in which he insists his behavior has been misinterpreted. Examples follow:
“I forgot my daughter was in the bed with me. I thought she was my wife.”
“I was only trying to show her the difference between men’s privates and little girls’.”
The evaluator must use common sense in assessing the probability that the alleged offenders’ explanations are likely and feasible. There will be cases, especially those involving child care activities, where this is quite difficult.
In addition, the suspect may admonish professionals to attend to the accounts of others.
“My daughter would never lie about a thing like that.”
Finally, the alleged offender may say that he didn’t abuse the child, but he is confessing to it to get on with treatment or to keep his daughter from having to testify against him in court.
Medical Evidence
As noted in the previous chapter, there has been considerable progress in the documentation of physical findings from sexual abuse.
Other Physical Evidence
In some cases, the police and sometimes others will have obtained physical evidence such as pornography or instruments used in the abuse.
Occasionally, there will be eyewitnesses to sexual abuse. These may be other children who were also abused or who observed abuse. They may also be adult eyewitnesses, sometimes the spouse of the offender.
Forming a Conclusion About Sexual Abuse
In order to arrive at a conclusion about the likelihood of sexual abuse, the professional weighs the clinical findings from the child’s interview as well as confirming evidence from other sources. Rarely is the professional 100-percent sure that the abuse occurred as described, with absolutely no room whatsoever for doubt. On the other hand, it is extremely difficult to determine without any doubt that the sexual abuse did not occur. In this regard, Jones has developed a useful concept, a continuum of certainty. Cases fall somewhere along a continuum from very likely to very unlikely.109
For guidelines that can be used to establish the likelihood of an occurrence of sexual abuse, see Appendix D.

By the time you finish reading this, 15 children will have been abused; In the next five minutes, 30 more; Within the next hour, 360 more; And by tonight, close to 8,000+ children will have suffered from abuse, 5 of which will die. Child abuse has increased 134% since 1980 and is now considered a worldwide epidemic. The high jump in child abuse deaths and the shocking increase in statistics highlights the frightening lack of public knowledge.
Educate Yourself--Learn the Facts--It may Just Save a Child's Life!!

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