Pergamon

Child Abuse & Neglect, Vol. 19, No. 4, pp. 475-490, 1995
Copyright 1995 Elsevier Science Ltd
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PSYCHOLEGAL ISSUES IN CHILD SEXUAL ABUSE

EVALUATIONS: A SURVEY o F FORENSIC
MENTAL HEALTH PROFESSIONALS
L o i s B. OBERLANDER
Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA

Abstract--Mental health professionals play a significant role in assessment, rendering expert opinions, and making
dispositional recommendations in cases involving allegations of child sexual abuse. Although there have been recent
efforts to develop guidelines for practice, little is known about how evaluators actually prefer to proceed in such
evaluations, or whether there is consensus with respect to how to proceed. In this study, a sample of Massachusetts
child forensic mental health professionals who specialize in conducting evaluations of children in cases involving
allegations of sexual abuse were surveyed to assess their normative evaluation and testimony practices with respect
to information gathered during clinical interviews and psychosocial assessment of the child. The survey assessed
evaluators': (a) opinions; (b) reasons for opinions; and (c) typical practices concerning psycholegal issues associated
with child sexual abuse evaluations. Survey questions covered three topics: (a) the evaluation process and methods;
(b) the limits of expert opinions and testimony; and (c) child advocacy. Results of the survey are presented, and
implications for child forensic practice are discussed.

Key Words~hild sexual abuse, Forensic assessment, Expert testimony, Standards of practice.

INTRODUCTION
MENTAL HEALTH PROFESSIONALS increasingly are asked to assist legal authorities in
cases involving allegations of child sexual abuse. The social sciences literature on evaluation
practices in unsubstantiated cases of alleged child sexual abuse is replete with mixed opinions
with respect to how to proceed in the face of complex psycholegal issues. The issue also is
complicated by the silence in criminal codes and the inconsistency in case law across cases
on the appropriate role of mental health professionals in child sexual abuse cases. Across
jurisdictions in the United States, statutes and case law governing criminal procedures are
vague concerning when and whether a mental health professional might be called upon to
assist fact finders in discerning the alleged victim's mental health functioning, whether the
child shows clinical signs and symptoms consistent with having been victimized, whether the
child presents a consistent account when describing what happened, whether the child can
name or describe the perpetrator, and whether mental health professionals can testify under
the hearsay rule with respect to the child's statements concerning the child's alleged victimization and/or the identity of the perpetrator (cf. Allison vs. State, 256 Ga. 851,353 S.E.2d 805,
1987; Commonwealth vs. Baldwin, 348 Pa. Super. 368, 502 A.2d 253, 1985; Commonwealth
vs. Green, 399 Mass. 565, 505 N.E.2d 886, 1987; State vs. Hudnall, 293 S.C. 97, 359 S.E.2d
59, 1987; Seering vs. Department of Social Services, 196 Cal. App. 3d 298, 306, 239 Cal.
Received for publication April 2, 1992; final revision receiveci March 30, 1994; accepted March 31, 1994.
Requests for reprints should be addressed to Lois B. Obedander, Ph.D., University of Massachusetts Medical School,
Department of Psychiatry, 55 Lake Avenue North, Worcester, MA 01655.
475

476

L.B. Oberlander

Rptr. 422, 427, 1987; State vs. Black, 537 A.2d 1154 Me., 1988; State vs. Reser, 244 Kan.
306, 767 P.2d 1277, 1989).
Given the silence in the law and inconsistency across case law, mental health professionals
have few guidelines for practice which stem from the law with respect to whether they will
be asked to testify, what kinds of statements are allowable in court, and how far reaching their
opinions are allowed to be. Although several highly publicized cases have highlighted the
importance of conducting thorough and nonleading clinical interviews with children who are
alleged victims of sexual abuse, social sciences researchers and social sciences ethicists only
recently have begun to address ways of conducting interviews with children that increase the
validity and reliability of assessment of children without leading the potential child witness
(cf. American Professional Society on the Abuse of Children, 1990; Ceci & Bruck, 1993;
Doris, 1991). As this study demonstrates, even the most informed of mental health professionals
tend to rely on traditional methods of assessment, which have only limited relevance to
interviewing child witnesses. Traditional methods of assessment, while providing useful information for the evaluator about the child's general functioning, lack the sensitivity and selectivity
that often is required to meet legal standards for assessing the psychological functioning, the
relative presence or absence of suggestibility, and the consistency of child witnesses (Bulkley,
1988; Doris, 1991).
Unique issues arise in the context of conducting assessment in the legal arena, such as those
involving the appropriate level and type of advocacy for child forensic evaluators; the role
and identity of the evaluator; and the scientific, ethical, and cross disciplinary concerns regarding how much specialized and scientifically sound knowledge mental health professionals have
concerning the reliability and validity of evaluation methods, testing instruments, and systems
of classification and diagnosis. The existing literature in the area of child sexual abuse reflects
efforts to integrate the information that is available to guide evaluations; however, there is
little information in the literature concerning the opinions, preferences, and experiences of
practicing mental health professionals. A survey was developed for this study to assess clinicians' normative opinions with respect to psycholegal issues in evaluations and testimony in
child sexual abuse cases. The survey was limited to the interviews and assessment of the child,
and did not address interviews of other sources such as parents.
METHOD
Participants were evaluators selected from a comprehensive multidisciplinary list of mental
health professionals who specialize in child sexual abuse evaluations in the Commonwealth
of Massachusetts. Participants were asked by mail to respond to 20 survey questions designed
to assess their opinions and evaluation practices in cases involving allegations of child sexual
abuse in which there is no corroborating physical evidence. The survey emphasized issues
that arise when evaluators work in the legal arena, either through child protective services,
through civil suits, or through court-ordered evaluations. Issues of concern included process
variables in evaluations, the methods of assessment, data interpretation, written opinions and
oral testimony, and issues related to child advocacy. Thirty-one participants (a return rate of
37%) responded to the survey. The percentage of nonresponders in each group of mental
health professionals did not differ from the base rate of surveys distributed across groups.
RESULTS
Participants had an average of 15 years of post-graduate clinical experience, and had performed an average of 25 evaluations (range 3 to 300). The sample of participants represented

Psycholegal issues in child sexual abuse evaluations

477

a range of disciplines and practice settings (public and private). The capacity in which clinicians
typically were retained for the evaluation also varied. Evaluators indicated they spend an
average of 5 hours interviewing a child, an average of 16 hours on evaluations with no
testimony, and an average of 28 hours on evaluations requiring testimony.
Results of the survey were analyzed using descriptive statistics and chi-square analyses. For
each item, participants specified their opinion using a 7-point scale. Mean item ratings and
their significa.nce are presented in the text of the following section and in Table 1. Examiners
were asked td provide reasons for their opinions. A summary of their reasons is presented in
the discussion.
Although opinions from specialists in the assessment of child victims were sought in this
study, the use of specialists limited the sample size. The results of this survey are limited in
their applicability to nonspecialists and also are limited by the sample size of this study. An
additional caveat with respect to generalization of the results is that mental health professionals
in the northeast tend to rely on psychodynamic interpretations of interview and assessment
data. Although the sample size was limited, the validity and reliability of the results were
strengthened by the fact that consistent results were found in a national survey of evaluators
who lack forensic training (the results also indicated that people with forensic training differ
in their preferred procedures). The results are forthcoming (Oberlander, in preparation).

EVALUATION ISSUES

The Evaluation Process and Methods

Building rapport. In evaluating children where there is a question of sexual abuse, some
examiners do not vary the basic rapport-building process compared to other evaluations. Others
believe that evaluations of child victims constitute special circumstances, and require a lengthy
and qualitatively distinct rapport-building process. Reasons cited for varying the process include extra time needed to establish an atmosphere of safety and trust (Green, 1986), the
necessity of gathering baseline developmental data prior to the evaluation (Walker, 1990),
special attention that must be given to the boundaries of the child, and respect for the child'~
body integrity (Green, 1986; Walker, 1990).
Evaluators were asked in the survey to indicate their opinions about rapport-building strategies in cases where there is a question of child sexual abuse by endorsing a number on a scale
of +3 to - 3 , with +3 representing " d o something different," and - 3 representing " d o nothing
different." In this sample, 45.2% said they preferred to do something different, 12.9% were
unsure or indicated a preference for case by case determinations, and 41.9% said they preferred
to do nothing different (X- = -.194, SD = 2.104, X2 = 5.871, p < .05).
Review of "case facts." Examiners have a choice of reviewing documents such as police
reports and victim statements prior to the evaluation, on an ongoing basis, or after the evaluation
has been completed. The documents then are used to support or challenge the professional's
opinion (Walker, 1990). Those who prefer to review materials prior to the evaluation cite the
importance of conducting a thorough clinical interview that covers crucial questions. Those
who prefer to wait until the evaluation is completed are concerned that knowledge of the case
facts may inadvertently cause the examiner to sway the child's responses in subtle ways.
Waiting makes it easier for the examiner to defend the reliability and validity of information
obtained in the clinical interview (Haugaard & Reppucci, 1988).
Evaluators were asked to indicate their opinions about when to review records by endorsing
a number on a scale of +3 to - 3 , with +3 representing "review information after the evalua-

L. B. Oberlander

478

Table 1. Mean Ratings and Statistical Values for the Survey Questions
Item

SD

X2

p-Value

1. Rapport:
+ 3 = do s o m e t h i n g different
- 3 = do nothing different
2. R e v i e w of N o n a s s e s s m e n t Data:
+ 3 = review after eval.
- 3 = r e v i e w prior to eval.
3. Structure of Questions:
+ 3 = specific
- 3 = nonspecific
4. Objective Tests:
+ 3 = useful
- 3 = not useful
5. C h i l d r e n ' s Drawings:
+ 3 = useful
- 3 = not useful
6. Standard Projective Tests:
+ 3 = useful
- 3 = not useful
7. Play Sessions:
+ 3 = useful
- 3 = not useful
8. Instruments Specific to Sexual Abuse:
+ 3 = useful
- 3 = not useful
9. A n a t o m i c a l l y Detailed Dolls:
+ 3 = useful
- 3 = not useful
10. Prepare Child for Treatment:
+ 3 = within e v a l u a t o r ' s role
- 3 = outside role
11. A s s e s s m e n t of Consistency with Typical B e h a v i o r and
Symptoms:
+ 3 = possible
- 3 = not possible
12. D i a g n o s e s in Reports:
+ 3 = include
- 3 = do not include
13. PTSD Framework:
+ 3 = useful
- 3 = not useful
14. Evaluation Results:
+ 3 = can establish abuse
- 3 = cannot establish abuse
15. Evaluation Results:
+ 3 = can establish abuser
- 3 = cannot establish abuser
16. Use of Statutory Language:
+ 3 = acceptable
- 3 = not acceptable
17. Expert Opinion on Question of Abuse:
+ 3 = acceptable
- 3 = not acceptable
18. Expert Opinion on Identification of Abuser:
+ 3 = acceptable
- 3 = not acceptable
19. Educate Judge About Psychological Evidence:
+ 3 = within e v a l u a t o r ' s role
- 3 = outside role
20. M i n i m i z e T r a u m a to C h i l d by Legal system:
+ 3 = within evaluator's role
- 3 = outside role

-.194

2.104

5.871

p < .05

-1.613

2.028

23.484

p < .05

-2.452

1.287

45.355

p < .05

-.621

1.860

2.966

1.935

1.181

45.355

p < .05

.584

1.895

6.645

p < .05

1.968

1.402

40.323

p < .05

.000

1.468

3.556

p = .169

.357

2.059

2.214

p = .331

-.357

2.059

1.310

p = .519

.774

1.857

17.290

p < .05

.167

2.335

6.200

p < .05

.967

1.542

18.600

p < .05

.323

2.151

9.742

p = .008

.323

1.851

3.935

p = .140

-.750

1.974

3.500

p = . 174

1.387

2.246

20.194

p < .05

.679

2.465

6.500

p < .05

1.833

2.167

13.333

p < .05

1.241

2.198

17.034

p < .05

p = .227

Psycholegal issues in child sexual abuse evaluations

479

tion," and - 3 representing "review information prior to the evaluation." In this sample,
16.1% said they preferred to review the information after the evaluation, 9.7% said they
preferred to review it as it arrived or that they make a determination on a case by case basis,
and 74.2% said they preferred to review information prior to the evaluation (x-= -1.613, SD
= 2.028, X2 = 23.484, p < .05).

The clinical interview. Obstacles in presenting evidence from the clinical interview to the
Court usually result from the structure of questions asked. One option is to conduct the initial
interview by beginning with open-ended, nonspecific questions and then, as the evaluation
demands it, moving to specific questions which elicit greater detail (Krugman & Jones, 1987;
Walker, 1990). However, if specificity is elicited from direct or suggestive questions, the
, evaluation can be contaminated (Walker, 1990). Some argue, though, that direct questions and
continued probing may be defensible interview strategies because often child victims experienced pressure to participate in the sexual activity, they were threatened with extreme consequences for revealing the abuse, and they are ashamed about the abuse and feel responsible
for it (MacFarlane, Waterman, Conerly, Damon, Durfee, & Long, 1986).
Evaluators were asked to indicate their opinions about how interview questions should be
structured by endorsing a number on a scale of +3 to - 3 , with +3 representing "begin with
specific questions," and - 3 representing "begin with nonspecific questions." In this sample,
3.2% said they preferred to begin with specific questions, 6.5% said they were unsure or that
they preferred to make a determination on a case by case basis, and 90.3% said they preferred
to begin with nonspecific questions (~- = -2.452, SD = 1.287, X2 = 45.355, p < .05).
Standardized assessment techniques. Some evaluators rely on normative-based standardized
tests in evaluations of child victims of sexual abuse. For example, personality and intelligence
testing are used for assessing the reliability and validity of the child's statements (Haugaard &
Reppucci, 1988). In addition, measures and books have been produced, which are specific to
the assessment of children who allegedly have been sexually abused. Specific tests structure
the interview; however, they also limit the scope of questions asked. Such measures generally
lack a research base supporting their selectivity and sensitivity in measuring the psychological
aftermath of child sexual abuse. They also have been criticized as "programmed learning
texts" (Wakefield & Underwager, 1989).
Evaluators were asked to indicate their opinions about the utility of standardized tests by
endorsing a number on a scale of +3 to - 3 , with +3 corresponding to "useful," and - 3
corresponding to "not useful." In this sample, 27.6% said they believed standardized tests
were useful, 24.1% said they were unsure or that they preferred to make a determination on
a case by case basis, and 48.3% said they believed standardized tests were not useful in
evaluations of children where there was a question of sexual abuse (X- = -.621, SD = 1.860,
X2 = 2.966, p = .23).
Evaluators also were asked to indicate their opinions about the utility of instruments specifically designed to assess sexual abuse by endorsing a number on a scale of +3 to - 3 , with
+3 corresponding to "useful," and - 3 corresponding to "not useful." In this sample, 33.3%
said they believed specific tests were useful, 48.2% said they were unsure or unfamiliar with
such tests, and 18.5% said they believed specific tests were not useful (x-= .000, SD = 1.468,
X2 = 3.556, p = .17).
Projective assessment techniques. Evaluators were asked to indicate their opinions about the
utility of standard projective techniques by endorsing a number on a scale of +3 to - 3 , with
+3 representing "useful," and - 3 representing " n o t useful." In this sample, 54.8% said they
believed standard projective tests were useful, 25.8% said they were unsure or unfamiliar with

480

L.B. Oberlander

such tests, and 19.4% said they believed they were not useful (~ = .584, SD = 1.895, X2 =
6.645, p < .05).
Children's drawings are used as a projective test to facilitate communication between the
child and the examiner. Examiners who use drawings believe that they often clarify the details
of the abuse, including who was present, where the abuse occurred, what took place, what
clothing was present, and so forth, and they cite evidence that the drawings of sexually abused
children differ from nonabused children in that they tend to contain sexually relevant body
parts (Miller, Veltkamp, & Janson, 1987). In addition, if a child can draw an abuse scene, the
drawing can be used to allay doubts that the child merely has memorized a description suggested
by a parent. The child's emotional response to drawing the perpetrator or the abuse scene also
may be diagnostic (Haugaard & Reppucci, 1988). Drawings provide a permanent record, which
later can be used in testimony (Miller et al., 1987). Those who argue against the use of
children's drawings state they have questionable diagnostic validity or reliability.
Evaluators were asked to indicate their opinions about the utility of children's drawings by
endorsing a number on a scale of +3 to - 3 , with +3 representing "useful," and - 3 representing "not useful." In this sample, 90.3% said they believed they were useful, 6.5% said they
were unsure or that they made a determination on a case by case basis, and 3.2% said they
believed they were not useful (:t- = 1.935, SD = 1.181, X2 = 45.355, p < .05).
Play sessions frequently are used as a projective assessment tool and are believed by many
to reflect the child's reality. Observations of play sessions are used as a source of assessment
and diagnostic data. Some examiners, however, believe that play sessions are invalid for
forensic purposes, especially when they involve evaluators who are active, initiating, probing,
guiding, directing, and controlling. They also call into question the assumption that the child's
play is a valid representation of reality (Wakefield & Underwager, 1989).
Evaluators were asked to indicate their opinions about the utility of play sessions by endorsing a number on a scale of +3 to - 3 , with +3 representing "useful," and - 3 representing
"not useful." In this sample, 87.0% said they believed they were useful, 6.5% said they were
unsure or that they made a determination on a case by case basis, and 6.5% said they believed
they were not useful (:r = 1.986, SD = 1.402, X2 = 40.323, p < .05).

Anatomically detailed dolls. The use of anatomically detailed dolls is widespread and controversial. There are those who believe that when examiners are appropriately trained in the use of
standardized questions and procedures, the dolls can be of assistance in aiding children to
express the details of what happened (Becker & Shah, 1986; Walker, 1990; Yates & Terr,
1988). Some evaluators reserve the use of the dolls only for children who cannot relate their
account of abuse through words or other modes of assessment (Krugman & Jones, 1987).
Some caution that the dolls should be viewed only as a means for children to clarify their
verbalizations through demonstration and not as a " t e s t " for sexual abuse (Melton & Limber,
1989).
Those who advise against the use of anatomically detailed dolls believe their use can
contaminate the assessment process by influencing what children say and do (Haugaard &
Reppucci, 1988; Yates & Terr, 1988). They assert that: (a) no methodologically sound studies
demonstrate differential responses of sexually abused and nonabused children to the dolls; (b)
the sample of children used in existing studies are those whose cases are alleged but not
substantiated; (c) there is a high false positive rate among 3-year-olds (one of the groups for
whom the dolls primarily are geared); (d) the dolls easily are misused by untrained examiners;
(e) chronically abused children might reject the dolls resulting in false negative conclusions
(Yates & Terr, 1988); and (f) the sexual play of an alleged victim may be in response to the
sexual nature of the dolls and not to previous abuse (Haugaard & Reppucci, 1988; Yates &
Terr, 1988). Goodman and Aman (1987), for example, compared the responses of 3- and 5-

Psycholegal issues in child sexual abuse evaluations

481

year-old children to (a) no dolls, (b) regular dolls, and (c) anatomically detailed dolls, and
found that the anatomically detailed dolls did not facilitate communication, and, in fact,
adversely affected the 3-year-olds' ability to respond to interview questions (the dolls did not,
however, increase children's suggestibility or false positive responses).
Evaluators were asked to indicate their opinions about the utility of anatomically detailed
dolls in cases where there is a question of child sexual abuse by endorsing a number on a
scale of +3 to - 3 , with +3 representing "useful," and - 3 representing "not useful." In this
sample, 46.4% said they believed they were useful, 28.6% said they were unsure or that they
made a determination on a case by case basis, and 25.0% said they believed they were not
useful (~ -- .357, SD = 2.059, X 2 = 2.214, p = .33).

Data Interpretation
Syndrome data. Professionals disagree over whether existing clinical and empirical evidence
is strong or substantial enough to support the validity of "syndrome profiles" (a delineation
or depiction of the characteristics of sexually abuse children), either of a general nature or
specific to sexual abuse, to: (a) explain the impact of sexual abuse on child victims; and (b)
compare the consistency of the child's response with what might be considered a "typical"
response. Such testimony often is excluded in court (Bulkley, 1987), although judicial opinions
concerning the admissibility of such evidence is far from unanimous (Bulkley, 1987; Melton &
Limber, 1989).
A constellation of cognitive, emotional, and behavioral reactions to sexual abuse is identified
in the literature. Recent reviews suggest the most common initial effects of sexual abuse are
sleep problems, school problems, distractedness, withdrawal, psychosomatic problems, fear,
anxiety, guilt, depression, anger, aggression, and sexually inappropriate behavior (Becker &
Shah, 1986; Browne & Finkelhor, 1986; Finkelhor, 1990). The most common long-term effects
are depression, self-destructive behavior, anxiety, feelings of isolation and stigma, poor self
esteem, difficulty trusting others, a tendency toward revictimization, substance abuse, and
sexual maladjustment (Browne & Finkelhor, 1986; Finkelhor, 1990). The psychological sequelae of sexual abuse appear to be similar for boys and girls (Browne & Finkelhor, 1986).
The foregoing studies suggest it may be reasonable to rely upon syndrome profiles as a
conceptual basis for assessing child victims for psychological symptoms, discerning whether
the child's symptoms are of the type and pattern typically found in sexual abuse victims, and
rendering opinions about whether a particular child's cognitive, emotional, and behavioral
state is consistent with a syndrome profile (cf. Walker, 1990). Those who support the use of
syndrome profiles contend that a reliable body of knowledge exists describing the sequelae of
sexual abuse, derived from both clinical consensus and scientifically sound data (cf. Myers et
al., 1989).
Some researchers have attempted to construct a syndrome or framework specific to the
effects of sexual abuse (Browne & Finkelhor, 1986). Such frameworks show promise in
increasing the sensitivity and selectivity of assessment of child victims of sexual abuse. Examples of behaviors that have greater specificity for sexual abuse include age-inappropriate sexual
knowledge, and sexualized play and behavior (Myers et al., 1989). In general, however, it has
been difficult to isolate pathognomonic psychological reactions to sexual abuse (McCord,
1986; Myers et al., 1989).
In the absence of a syndrome profile specific to sexual abuse, some evaluators rely upon
post-traumatic stress disorder (PTSD) to explain the aftermath of child sexual abuse. Many
evaluators find that patterns of symptoms associated with PTSD, (e.g., cognitive disturbances,
avoidance symptoms, and symptoms of heightened arousal) are consistent with children's
reactions to sexual abuse (Walker, 1990). PTSD has been criticized, however, as being too

482

L.B. Oberlander

narrow in scope, and as having a misplaced emphasis; that is, the theory behind PTSD explains
reactions to trauma in which there is danger, threat, and violence, but it requires more breadth
to explain reactions to sexual abuse (Finkelhor, 1990; Walker, 1990).
Those who contend that syndrome profiles are prejudicial and misleading to the fact finder cite
several problems. Profile symptoms (e.g., sleep problems, distractedness, anxiety, etc.) may simply
represent global and generic stress responses (Finkelhor, 1990). Evidence that a child feels abused
does not prove that the legal offense of child abuse has been committed (nor does the absence of
such feelings prove that there was no offense). A determination that a child was abused does not
speak to who committed the abuse (Melton & Limber, 1989).
Syndrome profiles do not account for victims who are asymptomatic, they do not discriminate
among various clinical populations, and they do not discriminate between clinical and normal populations (Haugaard & Reppucci, 1988; McCord, 1986; Melton & Limber, 1989). Reactions to sexual
abuse vary with factors such as the duration and frequency of the abuse, the relationship to and
gender of the offender, the type of sexual act, the use of force and aggression, the child's prior
emotional health, the child's discernment of the life-threatening nature of the incident, the victim's
age and developmental maturity at onset, whether the abuse is disclosed, and parental reactions and
institutional responses to the disclosure (Browne & Finkelhor, 1986; Haugaard & Reppucci, 1988;
Walker, 1990). Lastly, reliance upon syndrome data ultimately puts the victim "on trial," and often
is intrusive for the victim because it requires evaluations, testimony, and arguments about the victim's
reliability (Melton & Limber, 1989).
Evaluators were asked in this survey to indicate their opinions about whether it was possible to
determine whether a child's behavior and symptoms were consistent with typical responses to sexual
abuse by endorsing a number on a scale of +3 to - 3 , with +3 corresponding to "possible," and
- 3 corresponding to "not possible." In this sample, 67.7% said they believed it was possible to
make such a determination, 9.7% said they were unsure or that it depends on the case, and 22.6%
said they believed it was not possible to make such a determination (x-= .774, SD = 1.857, X2 =
17.290, p < .05).
In addition, evaluators were asked to indicate their opinions about the utility of posttraumatic
stress reaction or disorder as a framework for evaluations by endorsing a number on a scale of +3
to - 3 , with +3 corresponding to "useful," and - 3 corresponding to "not useful." In this sample,
70.0% said they believed it was useful, 20.0% said they were unsure or that it depends on the case,
and 10.0% said they believed it was not useful (~ = .967, SD = 1.542, X2 = 18.600, p < .05).

Diagnoses. In their reports, many evaluators include diagnoses because they believe that a diagnostic
conclusion slrengthens the report and appropriately answers the question posed by the legal system
concerning clinical evidence of trauma (Walker, 1990). However, others believe diagnoses connote
more certainty than is merited, and they are concerned over the tendency for some examiners to
diagnose "sexual abuse" (implying it is a disorder and not an event) (Myers et al., 1989). There
are those who assert that a diagnosis of trauma or sexual abuse essentially is a legal conclusion that
a crime has occurred. Use of such a diagnosis usurps the function of the judge and/or jury (Melton,
Petrila, Poythress, & Slobogin, 1987).
Evaluators were asked to indicate their opinions about whether diagnoses should be included in
reports and testimony by endorsing a number on a scale of +3 to - 3 , with +3 representing "include
diagnoses," and - 3 representing "do not include diagnoses." In this sample, 50.0% said they
preferred to include diagnoses, 13.3% said they were unsure or that it depends on the case, and
36.7% said they preferred not to include diagnoses (,r = .167, SD = 2.335, X2 = 6.200, p < .05).
Reaching conclusions. No particular test or result can support an affirmative conclusion of
whether the abuse occurred or who committed the abuse. There are no pathognomonic signs
of sexual abuse (Krugman & Jones, 1987), nor is there evidence that a certain type of response

Psycholegal issues in child sexual abuse evaluations

483

tO objective or projective tests establishes that a child has been sexually abused (Haugaard &
Reppucci, 1988). Neither sexual abuse nor the identification of the perpetrator can be confirmed
or disconfirmed solely by the presence or absence of psychological symptoms (Walker, 1990).
Nevertheless, evaluators sometimes interpret elements of clinical or assessment data as though
they are "dispositive." The temptation to interpret data in this manner may be related to role
confusion over whether the evaluator is concerned with psychological symptoms of trauma,
or with the establishment of the occurrence of sexual abuse (Haugaard & Reppucci, 1988).
Evaluators were asked to indicate their opinions about whether evaluation results could
establish that a child was sexually abused by endorsing a number on a scale of +3 to - 3 ,
with +3 corresponding to "can establish abuse," and - 3 corresponding to "cannot establish
abuse." In this sample, 58.1% said they believed evaluation results could establish abuse,
12.9% said they were unsure or that it depends on the case, and 29.0% said they believed
evaluation results could not establish abuse (x- = .323, SD = 2.151, X2 = 9.742, p < .05).
(Most evaluators drew a distinction between "establish" and "prove," suggesting that their
opinions are probabilistic.)
Additionally, evaluators were asked to indicate their opinions about whether evaluation
results can establish who abused the child by endorsing a number on a scale of +3 to - 3 ,
with +3 corresponding to "can establish abuser," and - 3 corresponding to "cannot establish
abuser." In this sample, 19.4% said they believed evaluation results could establish the identity
of the abuser, 32.2% said they were unsure or that it depends on the case, and 48.4% said
they believed evaluation results could not establish abuser identity (~-= .323, SD = 1.851, X2
: 3.935, p = .14).

Opinions and Testimony

The language of opinions. Some evaluators find it acceptable to use statutory language, or the
language of the court in their opinions and testimony (Myers et al., 1989). Others argue that
legal and psychiatric constructs differ sufficiently that use of legal language in opinions lends
itself to misunderstanding and misinterpretation. In addition, some legal scholars maintain that
the use of legal language too closely embraces the ultimate issue before the court and therefore
is objectionable (Melton et al., 1987).
Evaluators were asked to indicate their opinions about the acceptability of using statutory
language in their reports and opinions by endorsing a number on a scale of +3 to - 3 , with
+3 representing "acceptable," and - 3 representing "unacceptable." In this sample, 17.9%
said they believed use of such language was acceptable, 35.7% said they were unsure or that
they were unfamiliar with statutory language, and 46.4% said they believed use of such
language was not acceptable (~-= -.750, SD = 1.974, X2 = 3.500, p = .17).
Rendering opinions. Opinions can take many forms, but the most controversial opinion, as
already alluded to, is that which speaks to the "ultimate issue" before the court. There is
debate over exactly what constitutes the ultimate issue in cases involving allegations of child
sexual abuse. Many (though not all) experts agree that opinions about criminal responsibility
are impermissible (Bonnie & Slobogin, 1980; Haugaard & Reppucci, 1988; Melton et al.,
1987; Myers et al., 1989). However, they disagree over whether opinions about (a) whether
a child was abused and (b) who committed the abuse embrace the ultimate issue (Bonnie &
Slobogin, 1980; Melton & Limber, 1989; Melton et al., 1987; Myers et al., 1989).
Many legal and mental health professionals contend that under no circumstances should a
court admit the opinion of an expert about whether a child has been abused, or who committed
the abuse (Bonnie & Slobogin, 1980; Melton & Limber, 1989; Melton et al., 1987). Some
suggest the evaluator should outline the data, suggest what the data indicate clinically, identify

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L.B. Oberlander

the validity and strength of the data, and then rely on the judge or jury to make the final
determination (Haugaard & Reppucci, 1988). The rationale provided for avoiding ultimate
issue opinions is that such opinions move beyond the specialized knowledge of mental health
professions, into legal and moral determinations, thereby usurping the role of the fact finder
(Bonnie & Slobogin, 1980; Haugaard & Reppucci, 1988; Melton & Limber, 1989; Melton et
al., 1987).
Others (Myers et al., 1989) assert that opinions and testimony concerning whether a child
was abused and who committed the abuse are appropriate because they are permitted by the
Federal Rules of Evidence, viz. Rule 704(a), and that the Court will limit or exclude such
testimony if the dangers of jury confusion or unfair prejudice outweigh the probative value
of the opinion. They distinguish questions of whether the abuse occurred and who committed
the abuse ("ultimate facts") from the ultimate legal issue of defendant guilt. They contend
that experts possessing helpful facts should be permitted to testify regardless of whether their
testimony embraces "ultimate facts."
With respect to ultimate issue opinions and testimony, evaluators were asked two questions.
First, they were asked to indicate their opinions about the acceptability of rendering an opinion
that a child had been sexually abused by endorsing a number on a scale of +3 to - 3 , with
+3 representing "acceptable," and - 3 representing "unacceptable." In this sample, 71.0%
said they believed rendering such opinions was acceptable, 9.6% said they were unsure or that
they were unfamiliar with this issue, and 19.4% said they believed rendering such opinions
was not acceptable (x- = 1.387, SD = 2.246, X2 = 20.194, p < .05).
Second, evaluators were asked to indicate their opinions about the acceptability of rendering
an opinion concerning the question of who committed the abuse by endorsing a number on a
scale of +3 to - 3 , with +3 representing "acceptable," and - 3 representing "unacceptable."
In this sample, 53.6% said they believed rendering such opinions was acceptable, 14.3% said
they were unsure or that they were unfamiliar with this issue, and 32.1% said they believed
rendering such opinions was not acceptable (x = .679, SD = 2.465, X2 = 6.500, p < .05).
Education and Advocacy
The appropriate role of examiners with respect to advocacy for the child often is ambiguous.
In many cases, examiners believe evaluations of children should include preparation for treatment (Walker, 1990). Some suggest that in cases of child sexual abuse, the evaluation process
in itself is traumatic and requires follow up therapy (Krugman & Jones, 1987). Others believe
that in order to avoid bias, assessment and treatment roles should not be mixed in forensic
cases (Walker, 1990).
Evaluators were asked to indicate their opinions about whether it was within their role to
prepare the child for treatment by endorsing a number on a scale of +3 to - 3 , with +3
corresponding to "within role," and - 3 corresponding to "outside role." In this sample,
24.1% said they believed preparation for treatment was within their role, 34.5% said they were
unsure or that they preferred to make a case by case determination, and 41.4% said they
believed this lies outside their role ( = -.357, SD = 2.059, X2 = 1.310, p = .52).
With respect to educating the court about social sciences evidence, some professionals
believe their role is limited to answering questions posed by the Court. Others take a proactive
role, educating the Court about the relevance of social sciences evidence on the general topic
of child sexual abuse, and about specific clinical evidence relevant to the questions being
asked in the extant case (Walker, 1990). Some expand their role further in order to convey to
the attorneys, jurors, and the Court, the impact of the abuse from the child's perspective
(Green, 1986).
Evaluators were asked to indicate their opinions about whether it was within their role to

Psycholegal issues in child sexual abuse evaluations

485

educate the judge about specific psychological evidence by endorsing a number on a scale of
+3 to - 3 , with +3 corresponding to "within role," and - 3 corresponding to "outside role."
In this sample, 83.3% said they believed education was within their role, and 16.7% said they
believed it lies outside their role (~- = 1.833, SD = 2.167, X2 = 13.333, p < .05).
Many evaluators take on the role of minimizing traumatization of the child by the legal
system (Becker & Shah, 1986; Summit, 1983). This form of advocacy involves: (a) ensuring
that the child is adequately prepared for court appearances, (b) educating the child about the
legal process and what to expect in terms of time lines, bureaucracy and delays (Becker &
Shah, 1986), (c) reducing the impact and frequency of interrogations by police and district
attorneys, (d) making custody and visitation recommendations that protect the child from
further abuse, (e) making crisis intervention and treatment recommendations, and (f) ensuring
that intervention strategies are implemented (Green, 1986). Others assert the role of that
advocacy introduces bias into the evaluation process and should be reserved for the guardian
ad litem.
Evaluators were asked to indicate their opinions about whether it was within their role to
protect the child from further traumatization as a participant in the legal proceedings by
endorsing a number on a scale of +3 to - 3 , with +3 corresponding to "within role," and
- 3 corresponding to "outside role." In this sample, 69.0% said they believed such protection
of the child was within their role, 10.3% said they were unsure or that they prefer to make a
case by case determination, and 20.7% said it lies outside their role (~--- 1.241, SD = 2.198,
X2 = 17.034, p < .05).

DISCUSSION

The Consistency of Evaluation Practices with Existing Guidelines

Results of the survey questions suggest that, for many psycholegal issues, evaluators had
mixed opinions concerning how to proceed in evaluations of children in cases involving
allegations of sexual abuse, and concerning standards of practice for evaluation, courtroom
testimony, and advocacy issues. Examiners opinions were divergent with respect to the following issues: (a) whether rapport building strategies should be modified; (b) the utility of standardized (objective) tests; (c) the utility of assessment instruments designed specifically for the
r.ssessment of abuse or trauma associated with child sexual abuse; (d) the usefulness of anatomically detailed dolls; (e) whether evaluators should prepare the child for treatment; (f) the
reliability and validity of evaluation results in establishing the identity of the perpetrator; and
(g) the appropriateness of using penultimate language (e.g., statutory language) in reports and
testimony.
Evaluators were in relative agreement with respect to other issues. For example, most
evaluators preferred to review case facts prior to the evaluation. Virtually all evaluators preferred to begin the evaluation with nonspecific, open-ended questions, and then move toward
more direct questions as needed. The majority of evaluators indicated they find children's
drawings (e.g., drawings of self, kinetic family drawings), play sessions, and standard projective
instruments useful.
The results of this survey highlight the preference of evaluators for projective assessment
procedures. Based on comments from respondents, evaluators often turn to projective assessment tools because they provide a basis for understanding the child's phenomenological experiences, for understanding the child's inner world and inner turmoil, and for understanding the
child's predominant emotions and thoughts relevant to the alleged abuse. From a forensic
perspective, the preference for projective assessment tools is problematic in several ways.

486

L.B. Obedander

First, the guidelines published by the American Professional Society on the Abuse of Children
(1990) discourage psychological assessment unless a full battery assessment is conducted.
Second, the general validity and reliability of projective assessment results is less easy to
demonstrate than that of "objective" assessment results. The ambiguity involved in clinical
judgment with respect to coding and interpreting responses to projective assessments, coupled
with the many and varied ways of interpreting projective assessment results, lends an air of
scientific uncertainty which may or may not be acknowledged by evaluators when the speak
to the strengths and weaknesses of their evaluation techniques.
The majority of evaluators believed that it was possible to determine whether a child's
behavior and symptoms were consistent with "typical" responses to sexual abuse. Most said
they use diagnoses in their reports and testimony, and they found PTSD to be a useful
framework for child sexual abuse evaluations. It was the opinion of many evaluators that
evaluation results could establish whether a child had been sexually abused. Relatedly, most
evaluators believed ultimate issue testimony regarding whether a particular child was abused
and regarding who committed the abuse was acceptable. With respect to advocacy issues, most
evaluators believed it was within their role to educate the judge about specific psychological
evidence in child sexual abuse cases and to minimize the child's further traumatization by the
legal system.
The reasons evaluators provided to support their opinions in some cases mirrored those
found in the literature. Psycholegal debate cited in the literature was evident in participant's
divergent opinions. Participants reasons for choosing a particular strategy or method, or for
taking on a particular role often were defensible to the extent that the literature is inconclusive
concerning professional consensus about how to proceed or what role is appropriate. In other
cases, participants appeared to have idiographic reasons for their evaluation practices. Finally,
some of the reasons cited for various opinions were suggestive of the fact that evaluators
either are unfamiliar with or disagree with the importance of various psycholegal issues in
evaluations of children in sexual abuse cases.
The results suggest that evaluators typically had experience and training directly relevant
to clinical evaluations of children where there is a question of sexual abuse. It was unusual,
however, for evaluators to have specialized training relevant to applying their clinical skills
to the forensic arena. Results and comments from evaluators suggest evaluators in this sample
typically: (a) reviewed records, police reports, etc., prior to the evaluation; (b) spent an average
of 5 hours on the evaluation and l 1 hours on other activities (e.g., collateral interview, report
writing); (c) used an interviewing format that began with nonspecific questions with a gradual
shift to direct questions where indicated (some indicated direct questions were used as a "last
resort" when other methods had yielded no information about sexual abuse); (d) used children's
drawings as a means of reducing denial and perceived threat in discussing sensitive issues,
enhancing communication and enriching the detail that was elicited in the evaluation, assessing
the quality and dynamics of the child's relationships with significant adults and the alleged
perpetrator(s), and tapping specific and detailed knowledge about anatomy that might not be
expected given the child's educational and developmental level; (e) used standard projective
tests as an additional means of reducing denial and perceived threat in discussing sensitive
issues, as a source of data regarding the child's cognitive and emotional functioning, and as
a source of data about thematic expression of worries and fears; and (f) used play sessions as
a developmentally appropriate means of tapping information suggested above. There was less
consistency among evaluators in the use of objective tests and anatomically detailed dolls.
Evaluators generally appeared to be unfamiliar with tests specific to child sexual abuse.
With respect to the appropriateness of various levels of inference in interpreting the data
gathered in evaluations, most clinicians said they believed there was a basis for stating whether
the child's behavior and symptoms were consistent with a typical response to abuse. Clinicians

Psycholegal issues in child sexual abuse evaluations

487

indicated they found syndrome profiles useful as a framework for interpreting data and explaining responses to sexual abuse to others. As the level of inference moved toward more
specificity (diagnoses rather than syndromes), some evaluators became more skeptical about
the utility of systems of classification. Although there was less agreement regarding the use
of diagnoses, most evaluators said they use them. Those who did not use them appeared to
be more concerned with the consequences of labelling young children than with questions
about the reliability and validity of extant systems of classification. The absence of shared
reasons for skepticism between clinicians and researchers about the use of diagnoses in reports
and testimony was most apparent in the comments of evaluators who appeared to be mystified
as to why the use of diagnoses was even at issue.
Moving up the ladder of levels of inference, most evaluators agreed that the results of
evaluations could establish abuse. Many pointed out that their inferences on these issues were
probabilistic and that the results never proved abuse. Evaluators were skeptical about the use
of evaluation results to establish the identity of the abuser, and their comments suggested that
were they to report or testify on this issue, it would only occur in the presence of a well
documented and detailed statement from a child for whom there was no question of credibility.
If these results are generalizable, they continue to raise the question of whether an evaluator
is needed as a spokesperson for children when they name a perpetrator, or whether the child's
testimony itself is sufficient.
With respect to addressing penultimate issues, some saw no problem in using the language
of the court, especially where it was supplemented with descriptive data to support conclusory
statements. Others indicated they preferred to use lay language in any evaluation not written
for other clinicians. Finally, some evaluators simply were unfamiliar with statutory language
and evidentiary requirements specific to mental health evaluations for a finding of the act of
child sexual abuse.
With respect to reporting the results of the highest level of inference, that is whether
evaluators find it acceptable to testify to the ultimate issue, participants in this sample agreed
that such testimony was appropriate both with respect to whether the act occurred, and to the
identity of the abuser. The comments of a few evaluators, however, mirrored the rationale
espoused by some in the literature proscribing such testimony on ethical and moral grounds.
Interestingly, evaluators appeared to see an ethical and moral responsibility juxtaposed to that
of going beyond specialized knowledge and usurping the role of the fact finder. That is, in
the face of positive findings in the evaluation, they viewed protection of the child and of
society (and, therefore, the provision of ultimate issue testimony) as a responsibility and an
obligation.
Lastly, in their opinions about advocacy issues, some evaluators viewed the evaluation
process and preparation for treatment (and sometimes treatment itself) as inherently fused.
Others viewed their role as relatively limited. There was consensus about the appropriateness
of assuming an educative role in court and minimizing the potential trauma to the child as a
result of participating in the legal process. Finally, as indicated above, some evaluators said
they adopted a liberal advocacy role, which extends to protecting children and society through
the provision of ultimate issue testimony.

THE NEED FOR INFORMED PSYCHOLEGAL DEBATE IN CHILD FORENSIC

MENTAL HEALTH SERVICES
Issues about which many evaluators were relatively uninformed include the utility of various
assessment techniques in evaluations. Many evaluators stated their unfamiliarity with the use
of objective and standard projective techniques, and thus a tendency not to make referrals for

488

L.B. Oberlander

psychological testing. Although not overt, many opinions about how to proceed seemed to
turn on (a) whether participants view their role as investigative, evaluative, treatment oriented,
or some combination; and (b) whether the admixture of evaluation and treatment roles is
viewed as an inherent and unavoidable aspect of clinical services for children.
Many evaluators appeared to be unfamiliar with the hierarchical depiction of levels of
inference in evaluations in the legal arena. Some expressed curiosity as to why diagnosis was
at issue. Others hinted that there was pressure to make a diagnosis and form an opinion even
in the face of inconclusive or ambiguous evaluation results. Evaluators' reasons for their
opinions about penultimate language and ultimate issue conclusions and testimony did not
reflect debate in the psycholegal literature concerning ethical and moral stances about such
conclusions and testimony; however, their opinions were not uninformed from an experiential
perspective. That is, evaluators' opinions appeared to emanate from clinical and courtroom
testimony experiences rather than conclusions of psycholegal scholars, theoreticians and researchers about the limits of opinions and testimony. The appropriate clinical, ethical, and
legal parameters of opinions and testimony about the occurrence of a legal act and about
criminal responsibility are areas in which healthy skepticism and debate would be enriched
were clinicians and researchers in the child forensic subspecialty to engage in more dialogue
about each other's views and experiences.
Given what we know from this sample about evaluation practices, most evaluators take a
reasoned approach to their evaluations; however, their approach was not consistent with the
guidelines published by the American Professional Society on the Abuse of Children (1990),
nor were they informed by other guidelines or protocols. It is recommended that guidelines
for practice be supplemented with analyses concerning (a) the fine line between assessing
consistency and" assessing truthfulness in children; (b) facilitating justice through the duty to
protect the child and society from further harm versus the civil rights of defendants (e.g.,
privacy, personal liberty, due process); and (c) the duty to report the strengths and weaknesses
of assessment data versus moving beyond specialized knowledge in opinions and testimony.
Further research is indicated to test whether evaluations should be limited to descriptive
information, or whether systems of classification should be refined and broadened to account
for the variety of responses of children to abuse and to delineate responses to a variety of
patterns of abuse. Research on alternative and more sophisticated interviewing procedures (the
mainstay in this sample of clinical evidence in abuse cases) is needed. Research is indicated
to inform the question many evaluators have about the impact of repeated interviews on the
reliability and on the psychological health of children.
Theory and data driven determinations of the most appropriate legal and therapeutic interventions would enhance the ability of evaluators to conduct assessments that contemplate a broader
variety of dispositions and resolutions and thus would likely be more efficacious (Haugaard,
1988). More sophisticated knowledge about children's understanding of traumatic experiences,
their ability to share their experiences, the strategies they use to cope with abusive experiences,
and their patterns of concealing information would heighten the ability of clinicians to inform
and educate the court about variations on "typical" responses and accommodations to child
sexual abuse (Maddock, 1988; Pipe & Goodman, 1991). Reforms in legal proceedings (e.g.,
taking victim and family guilt into account in child sexual abuse evaluations by using mediational rather than adversarial approaches to resolution, conducting proceedings in family court,
closing proceedings to the public, and using a relaxed standard of proof) might serve to more
evenly balance concern for child and societal protection with concerns for family privacy and
due process (Bulkley, 1988).
Other questions raised by this study include how specialized child training and specialized
forensic training influence: (a) evaluators' perceptions of how best to proceed; (b) evaluators
perceptions of their role; (c) the correspondence of evaluators' opinions with legal adjudication

Psycholegal issues in child sexual abuse evaluations

489

of the case; (d) evaluators' views of what an optimal child forensic system might look like;
and (e) evaluators' prioritization and resolutions of competing ethical and moral interests in
cases involving allegations of child sexual abuse.

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R~sum~----Les professionnels de la sant6 mentale jonent un r61e significatif dans l'6valuation de cas impliquant des
abus sexuels it 1'6gard des enfants, rendant des opinions h titre d'expert et effectuant des recommandations sur les
mesures h prendre. Bien, qu'il y ait eu r6cemment des efforts pour d6velopper des lignes de conduite ~ suivre dans
la pratique, peu de choses sont connues sur les proc6dures les plus utilis6es par les 6valuateurs iors des mises au
point ou sur l'existence d'un consensus sur ia fa~on de proc6der. Cette 6rude concerne un 6chantillon de professionnels
m6dico-16gaux de la Sant6 Mentale Infantile du Massachusetts, sp6cialis6s dans la conduite d'6valuation d'enfants
dans des cas impliquant des accusations d'abus sexuel. On a observ6 leur pratique d'6valuation onrmative et leur
pratique concernant les t6moignages d'enfants par rapport aux informations recueillies au cours des interviews cliniques
et des 6valuations psychosociales. L'6tude h analys6 (a) ies opinions, (b) les motifs des opinions, (c) les pratiques
typiques des 6valuateurs en ce qui concerne les mati6res psychol6gales associ6es aux abus sexuels des enfants. Les
questions de l'6tude ont couvert trois domaines (a) la proc6dure d'6valuation et ses m6thodes, (b) les limites des
opinions des experts et des t6moignages et (c) la d6fense des enfants. Les r6sultats de l'6tude sont pr6sent6s et les
implications pour la pratique m6dico-16gale sont discut6es.
R e s u m e n ~ L o s profesionales de la salud mental juegan un papel significativo en la valoraci6n, en la provisi6n de
opiniones expertas, y en la propuesta de recomendaciones respecto alas medidas a adoptar, en los casos de alegaciones
de abuso sexual infantil. Aunque se han realizado esfuerzos recientes por desarrollar qufas para la prictica profesional,
se conoce poco acerca de c6mo los evaluadores prefieren proceder realmente en dichas evaluaciones, o si existe un
consenso con respecto a c6mo actuar. En este estudio, se encuest6 auna muestra de profesionales forenses de la salud
mental infantil de Massachusetts especializados en evaluaci6n de nifios/as en casos de alegaciones de abuso sexual.
Se analizaron sus normas en la practica de la evaluacion y la testificaci6n con respecto a la informaci6n a recoger en
las entrevistas cl/nicas y e n la evaluaci6n psicosocial del nifio/a. La encuesta valor6: (a) las opiniones de los evaluadores,
(b) las razones de sus opiniones, y (c) las pricticas mils habituales relativas a l a s cuestiones psicolegales asociadas a
la evaluacion de los casos de abuso sexual infantil. Las preguntas de la encuesta abarcaban tres temas: (a) el proceso
y m6todos de evaluaci6n; (b) los l/mites de las opiniones y del testimonio de los expertos; y (c) la defensa del nifio/
a en el proceso legal. Se presentan los resultados del estudio, y se comentan sus implicaciones para la prictica forense
infantil.