Consistency in children's reports of sexual and physical abuse

Memory Accuracy After 20 Years for Interviews About Child Maltreatment

When adults allege childhood victimization, their long-term memory comes under scrutiny. This scrutiny can extend to the adults' memory of childhood interviews. The concerns raise important theoretical and applied issues regarding memory for long-past discussions of child maltreatment and trauma. In this longitudinal study, 104 adults, who as children (ages 3-15 years) were interviewed in child maltreatment investigations (Time 1), were questioned 20 years later (Time 2) about the Time 1 interviews. Verbatim documentation from Time 1 permitted scoring of memory accuracy. A subset of the participants (36%) reported no memory for the Time 1 interviews. Of the 64% who remembered being interviewed at Time 1, those who had been adolescents at Time 1 remembered the forensic interview discussion about abuse incidents better than discussion about general psychological issues. Adult trauma symptoms were associated with more accurate memory for interview content that directly concerned abuse experiences but not for non-abuse-specific information. Findings indicate that the veracity of adults' long-term memory for clinical/forensic conversations about childhood maltreatment depends on age at interview, interview content, and traumatization factors. Implications are discussed.

An Examination of the Synergy of Age and PTSD on Narrative Coherence in Child Sexual Abuse Testimony

In a criminal proceeding, a witness is considered as reliable if he/she can recall in narrative form the events, chronologically ordered, with salient contextual (place and time) details, and essential evaluations for the definition of meanings. This study aimed to confirm the effects of age and PTSD on narrative coherence and to investigate the moderating role of age on the association between PTSD and narrative coherence. Narrative coherence was analyzed in 92 allegations of children (M = 10.3; range: 4-17), who were victims of sexual abuse. Thirty-five children presented the symptoms for a diagnosis of PTSD. Each deposition has been codified through the Narrative Coherence Coding Scheme, a coding scheme based on the three independent dimensions (context, chronology, and theme). Correlation analysis indicated the positive associations between age and context, chronology, and theme; and the negative associations between PTSD symptoms and context, chronology, and theme. Predictive effect of PTSD became less and less significant with increasing age. This study could underline the importance of age and PTSD (and their synergy) in legal testimony of children who have been sexually abused.

Kompetenzerleben von Psychotherapeut_innen im Umgang mit Kindern und Jugendlichen mit Gewalterfahrungen und Traumafolgestörungen

Zusammenfassung. Theoretischer Hintergrund: Die psychotherapeutische Versorgung von Kindern und Jugendlichen mit psychischen Störungen nach Gewalterfahrungen ist ungenügend. Zu ihrer Verbesserung wird eine routinemäßige Exploration von Gewalterfahrungen und Traumafolgestörungen und eine evidenzbasierte Behandlung empfohlen. Behandelnde berichten jedoch Unsicherheiten und Befürchtungen dahingehend. Fragestellung: Beeinflusst das therapeutische Kompetenzerleben das konfrontative Vorgehen, den Einbezug von Bezugspersonen, die berufliche Belastung und das Interesse an Weiterbildungen? Methode: 323 Psychotherapeut_innen nahmen an der Online-Umfrage teil. Zur Beantwortung der Fragestellung wurde ein Strukturgleichungsmodell spezifiziert und geprüft. Ergebnisse: Ein höheres Kompetenzerleben ist mit einem konfrontativeren Vorgehen, einem häufigeren Einbezug von Bezugspersonen und einer geringeren beruflichen Belastung assoziiert, nicht jedoch mit einem geringeren Weiterbildungsinteresse. Organisatorische Aspekte werden als häufigste Gründe gegen Weiterbildungen genannt. Diskussion und Schlussfolgerung: Es ergeben sich praktische Implikationen für die inhaltliche und organisatorische Gestaltung von Weiterbildungen und Supervisionen.

Increasing maltreated and nonmaltreated children's recall disclosures of a minor transgression: The effects of back-channel utterances, a promise to tell the truth, and a post-recall putative confession

BACKGROUND

Children are often hesitant to disclose transgressions, particularly when they feel implicated, and frequently remain reluctant until confronted with direct questions. Given the risks associated with direct questions, an important issue is how interviewers can encourage honesty through recall questions.

OBJECTIVE

The present study examined the use of three truth induction strategies for increasing the accuracy and productivity of children's reports about a transgression.

PARTICIPANTS

A total of 285 4-to-9-year-old maltreated and nonmaltreated children.

METHODS

Each child took part in a play session with a stranger during which the child appeared to break some toys. A research assistant interviewed the child with narrative practice rapport building and recall questions. The study included manipulations of back-channel utterances (brief expressions used to communicate attention and interest), whether (and when) the child was asked to promise to tell the truth, and the use of a post-recall putative confession.

RESULTS

Back-channel utterances failed to increase disclosure (OR = 0.79 [95% CI: 0.48, 1.31]) but increased the productivity of children's reports about broken (p = 0.04, η_p = 0.02) and unbroken toys (p = 0.004, η_p = 0.03). A promise to tell the truth significantly increased children's disclosures, but only among nonmaltreated children (OR = 3.65 [95% CI: 1.23, 10.90]). The post-recall putative confession elicited new disclosures from about half of children who had failed to disclose.

CONCLUSIONS

The findings highlight the difficulties of eliciting honest responses from children about suspected transgressions and the need for flexible questioning strategies.

[Assessment of Maltreatment in Childhood and Adolescence]

Assessment of Maltreatment in Childhood and Adolescence In view of mounting evidence for substantial prognostic relevance of child maltreatment for the future developmental course, assessment of maltreatment in children and adolescents is increasingly gaining attention. At the same time, maltreatment assessment is replete with difficulties, ranging from the definition of maltreatment and establishment of threshold values determining when events meet prognostically relevant criteria, to poor agreement between sources. The aim of this paper is to provide an overview of instruments for assessing maltreatment in children and adolescents. This overview serves as a point of departure to emphasize the importance of various sources for the purpose of assessing maltreatment and to consider the unique role of the child's or young person's perspective. We conclude with preliminary proposals regarding the role of maltreatment assessment in clinical practice.

Assessing Children's Credibility in Courtroom Investigations of Alleged Child Sexual Abuse: Suggestibility, Plausibility, and Consistency

As children's testimonies of child sexual abuse (CSA) often lack concrete evidence to corroborate a child's claims, attorneys devote a substantial amount of time to establishing a child as credible during the course of a trial. Examining 134 CSA victim testimonies for children aged 5-17 (M = 12.48, SD = 3.34; 90% female), we explored how attorneys assess child credibility through specifically targeting children's suggestibility/honesty, plausibility, and consistency. Results revealed that while prosecutors examine plausibility more often to establish credibility, defense attorneys focus their assessments on suggestibility/honesty and potential inconsistency. However, both attorneys asked many more questions about children's consistency than any other area of potential credibility. Furthermore, while prosecutors ask proportionally more credibility-challenging questions of older children, the defense do not. These results suggest that prosecutors may be missing an opportunity to establish children as honest and consistent and elucidate a need to train attorneys on the implications of children's inconsistencies, suggestibility, and plausible abuse dynamics.

A retrospective approach to examining child abuse disclosure

BACKGROUND

Often times, a child's disclosure is the only forensic evidence available in child abuse cases. Therefore, understanding disclosure patterns of suspected child abuse victims plays a critical role in the forensic investigations of both child physical abuse (CPA) and child sexual abuse (CSA) cases.

OBJECTIVE

To explore adults' retrospective reports about childhood disclosure of CPA and CSA.

PARTICIPANTS AND SETTING

College students (N = 907) were screened for reported histories of CSA (n = 94) or CPA (n = 109).

METHODS

Through an online survey, participants provided anonymous information regarding CSA and CPA experiences along with information about any disclosure events or opportunities that they have encountered since the abuse.

RESULTS

Among the adults reporting CSA histories, 50 % indicated disclosing the abuse during childhood; 80 % indicated any lifetime disclosure. Among the adults indicating CPA histories, 32 % reportedly disclosed the abuse to someone during childhood with 52 % reporting any lifetime disclosure. For both groups, length of delay until disclosure was bimodal with many individuals reporting immediately and many waiting considerable time. Among adults reporting CSA, a minority (16 %) indicated the abuse came to the attention of authorities, with even fewer CPA cases (8%) reporting authorities were aware of their abuse. Denial and recantation in a formal setting was infrequent regardless of abuse type reported.

CONCLUSIONS

Given that participants experiencing CSA and CPA both reported low levels of denial and recantation, forensic investigators and practitioners may benefit from considering consistent interviewing approaches and protocols, regardless of the type of abuse suspected.

Investigating linguistic coherence relations in child sexual abuse: A comparison of PTSD and non-PTSD children

Background

Language is the most common way to communicate internal states and emotions into a narrative form. Studies on the use of language provide a useful understanding of how people process an event and interpret it.

Objective

The aim of this study was to investigate the effects of PTSD on the narrative coherence of children's reports of sexual abuse.

Participants and setting

Narrative coherence was analyzed within a group of 89 allegations of children (M = 10; range: 4–16), who were victims of sexual abuse. Thirty-seven children presented the symptoms for a diagnosis of PTSD.

Method

Linguistic Inquiry Word Count (LIWC) was employed and narrative coherence was analyzed through some linguistic markers (first-person singular pronouns, conjunctions, and cognitive words).

Results

Results illustrated the effects of PTSD on the narrative coherence, in terms of first-person singular pronouns, conjunctions, and cognitive processes. Indeed, compared with traumatic narratives of children without PTSD, traumatic narratives of children with PTSD contained a greater number of first-person singular pronouns (M_PTSD = 1.45 versus M_no-PTSD = 1.12) and a smaller number of conjunctions (M_PTSD = .37 versus M_non-PTSD = .67), cognitive (M_PTSD = 2.93 versus M_non-PTSD = 3.76) and insight words (M_PTSD = 2.29 versus M_non-PTSD = 3.09). Regression analyses were used to examine if age and PTSD were predictors of the narrative coherence, suggesting the effects of PTSD in predicting the use of the first-person singular pronouns and the conjunctions.

Conclusion

This study could underline the importance of considering the PTSD in legal testimony of children who have been sexually abused.

When Is a Child's Forensic Statement Deemed Credible? A Comparison of Physical and Sexual Abuse Cases

A large national sample of 4,775 reports of child physical and sexual abuse made in Israel in 2014 was analyzed in order to examine whether assessments of credibility would vary according to abuse type, physical or sexual, and whether child and event characteristics contributing to the probability that reports of abuse would be determined as credible would be similar or different in child physical abuse (CPA) and child sexual abuse (CSA) cases. Results revealed that CPA reports were less likely to be viewed as credible (41.9%) compared to CSA reports (56.7%). Multigroup path analysis, however, indicated equivalence in predicting factors. In a unified model for both types of abuse, salient predictors of a credible judgment were older age, lack of a cognitive delay, and the alleged abusive event being a onetime less severe act. Over and beyond the effects of these factors, abuse type significantly contributed to the prediction of credibility judgments.

Narrative fragmentation in child sexual abuse: The role of age and post-traumatic stress disorder

The present study aimed to assess the effects of age and PTSD on the narrative fragmentation in memories for child sexual abuse. Lexical complexity, cohesion and coherence were analyzed within a group of 86 allegations of children (M=10years; SD=3.7; range: 4-17) who were victims of sexual abuse. Results illustrated that age played an important role in establishing narrative coherence and predicted the level of orientation, the sequence of events and the level of evaluation of the event. Instead, PTSD was related to narrative coherence and cohesion. Therefore, in children, the narrative fragmentation could be an effective diagnostic tool for understanding the effects of PTSD. Moreover in a legal setting the traumatic effects of PTSD on the narrative coherence and cohesion could be significant indices in the evaluation of child testimony.

Credibility assessment in child sexual abuse investigations: A descriptive analysis

A major challenge in cases of child sexual abuse (CSA) is determining the credibility of children's reports. Consequently cases may be misclassified as false or deemed 'no judgment possible'. Based on a large national sample of reports of CSA made in Israel in 2014, the study examines child and event characteristics contributing to the probability that reports of abuse would be judged credible. National data files of all children aged 3-14, who were referred for investigation following suspected victimization of sexual abuse, and had disclosed sexual abuse, were analyzed. Cases were classified as either 'credible' or 'no judgment possible'. The probability of reaching a 'credible' judgment was examined in relation to characteristics of the child (age, gender, cognitive delay, marital status of the parents,) and of the abusive event (abuse severity, frequency, perpetrator-victim relationship, perpetrator's use of grooming, and perpetrator's use of coercion), controlling for investigator's identity at the cluster level of the analysis. Of 1563 cases analyzed, 57.9% were assessed as credible. The most powerful predictors of a credible judgment were older age and absence of a cognitive delay. Reports of children to married parents, who experienced a single abusive event that involved perpetrator's use of grooming, were also more likely to be judged as credible. Rates of credible judgments found are lower than expected suggesting under-identification of truthful reports of CSA. In particular, those cases of severe and multiple abuse involving younger and cognitively delayed children are the ones with the lowest chances of being assessed as credible.

A Multisource Approach to Assessing Child Maltreatment From Records, Caregivers, and Children

Practitioners and researchers alike face the challenge that different sources report inconsistent information regarding child maltreatment. The present study capitalizes on concordance and discordance between different sources and probes applicability of a multisource approach to data from three perspectives on maltreatment-Child Protection Services (CPS) records, caregivers, and children. The sample comprised 686 participants in early childhood (3- to 8-year-olds; n = 275) or late childhood/adolescence (9- to 16-year-olds; n = 411), 161 from two CPS sites and 525 from the community oversampled for psychosocial risk. We established three components within a factor-analytic approach: the shared variance between sources on presence of maltreatment (convergence), nonshared variance resulting from the child's own perspective, and the caregiver versus CPS perspective. The shared variance between sources was the strongest predictor of caregiver- and self-reported child symptoms. Child perspective and caregiver versus CPS perspective mainly added predictive strength of symptoms in late childhood/adolescence over and above convergence in the case of emotional maltreatment, lack of supervision, and physical abuse. By contrast, convergence almost fully accounted for child symptoms for failure to provide. Our results suggest consistent information from different sources reporting on maltreatment is, on average, the best indicator of child risk.

Developmental changes in consistency of autobiographical memories: adolescents' and young adults' repeated recall of recent and distance events

Autobiographical memories contribute continuity and stability to one's self yet they also are subject to change: they can be forgotten or be inconsistently remembered and reported. In the present research, we compared the consistency of two reports of recent and distant personal events in adolescents (12- to 14-year-olds) and young adults (18- to 23-year-olds). In line with expectations of greater mnemonic consistency among young adults relative to adolescents, adolescents reported the same events 80% of the time compared with 90% consistency among young adults; the significant difference disappeared after taking into consideration narrative characteristics of individual memories. Neither age group showed high levels of content consistency (30% vs. 36%); young adults were more consistent than adolescents even after controlling for other potential predictors of content consistency. Adolescents and young adults did not differ in consistency of estimating when their past experiences occurred. Multilevel modelling indicated that the level of thematic coherence of the initial memory report and ratings of event valence significantly predicted memory consistency at the level of the event. Thematic coherence was a significant negative predictor of content consistency. The findings suggest a developmental progression in the robustness and stability of personal memories between adolescence and young adulthood.

Realizing Relevance: The Influence of Domain-Specific Information on Generation of New Knowledge Through Integration in 4- to 8-Year-Old Children

In accumulating knowledge, direct modes of learning are complemented by productive processes, including self-generation based on integration of separate episodes. Effects of the number of potentially relevant episodes on integration were examined in 4- to 8-year-olds (N = 121; racially/ethnically heterogeneous sample, English speakers, from large metropolitan area). Information was presented along with unrelated or related episodes; the latter challenged children to identify the relevant subset of episodes for integration. In Experiment 1, 4- and 6-year-olds integrated in the unrelated context. Six-year-olds also succeeded in the related context in forced-choice testing. In Experiment 2, 8-year-olds succeeded in open-ended and forced-choice testing. Results illustrate a developmental progression in productive extension of knowledge due in part to age-related increases in identification of relevant information.

Statements from Youth in Legal Contexts: Effects of Consistency, Legal Role, and Age

Jurors are often asked to evaluate statements provided by young victims, witnesses, and suspects. When, over time, youths' statements contain inconsistent information or recantations of prior statements, jurors face a difficult task in evaluating the validity of the initial claim. The underlying reasons for inconsistencies and recantation of young people's statements, particularly in cases of child sexual abuse, have been debated. Of primary interest here is whether inconsistencies (e.g., recantation) are evaluated differently by fact finders depending on the youth's age and role in a legal case. The current study examined effects of consistency of juvenile statements, legal role, and age on perceptions of testimony in a child sexual abuse investigation. Participants (N = 693) read vignettes describing child sexual abuse in which consistency of a follow-up statement (consistent, inconsistent, recanted), legal role (victim, witness, suspect), and age (10 years, 16 years) of the juvenile providing testimony were manipulated. The results revealed that judgments of initial statement quality, blameworthiness, and guilt were dependent on the consistency of follow-up statements and on the interactive effects of a juvenile's legal role and age. The current study has theoretical implications for understanding juror decision-making and practical implications for legal professionals and fact finders evaluating youths' statements. Copyright © 2016 John Wiley & Sons, Ltd.

Are parents reliable in reporting child victimization? Comparison of parental and adolescent reports in a matched Chinese household sample

There is ongoing debate about the reliability of parental reports on child victimization. Some studies have shown that they are useful, whereas some others have provided contrary evidence suggesting that parents are not accurate in reporting child victimization, especially when they are the one who inflicted the violence. This study aimed to (a) examine the reliability of parental reports of adolescents' experiences of victimization, including that inflicted by parents as well as others, by comparing them with self-reports using a parent-child matched sample from China; and (b) explore the possible reasons underlying any disagreement between the parental and adolescent reports. A total of 2,624 parent-adolescent pairs were recruited during 2009 and 2010 in 6 cities in China. Parents were asked to report the victimization experiences of their child using of the Juvenile Victimization Questionnaire, and these reports were matched with the adolescents' self-reports of victimization. Low levels of parent-adolescent agreement in reporting were found (Cohen's kappa=.04-.29). Except for sexual violence, parents were significantly less likely to report all types of victimization. Overall, lower levels of agreement were found in the reporting of (a) less severe types of victimization, (b) victimization outside the family, and (c) victimization involving parents as perpetrators. Intimate partner violence between parents was significantly associated with discrepancies between reports. The findings suggest that parents might not be reliable as a single source of information on certain types of adolescent victimization.

High accuracy but low consistency in children's long-term recall of a real-life stressful event

The accuracy and consistency of children's memories of their removals from their biological families by the Child Protective Services (CPS) was investigated. A researcher was present during the removals and documented what happened. A total of 37 maltreated children, aged 3 to 12 years, were interviewed 1 week and 3 months after the removals. The accuracy of the memory reports was high at both time points, but their consistency was fairly low; in all age groups (3-6, 7-10, and 11-12 years), a high percentage of new accurate information was reported during the second interview and a high percentage of the accurate information reported in the first interview was omitted in the second interview. Older children were significantly more consistent in their memory reports than younger children. The results show that low consistency in memory does not imply memory inaccuracy and has implications for the interpretation of successive interviews of children in forensic contexts.

Disclosure Suspicion Bias and Abuse Disclosure: Comparisons Between Sexual and Physical Abuse

Prior research has found that children disclosing physical abuse appear more reticent and less consistent than children disclosing sexual abuse. Although this has been attributed to differences in reluctance, it may also be due to differences in the process by which abuse is suspected and investigated. Disclosure may play a larger role in arousing suspicions of sexual abuse, while other evidence may play a larger role in arousing suspicions of physical abuse. As a result, children who disclose physical abuse in formal investigations may be doing so for the first time, and they may be more reluctant to provide details of the abuse. We examined abuse disclosure and evidence in comparable samples of court-substantiated physical (n = 33) and sexual (n = 28) abuse. Consistent with predictions, the likelihood that the child had disclosed abuse before an investigation began was lower in physical (27%) than that in sexual (67%) abuse cases, and there was more nondisclosure evidence of abuse in physical abuse cases. These findings have implications for understanding the dynamics and meaning of disclosure in cases involving different types of abuse.

Children's expressed emotions when disclosing maltreatment

OBJECTIVE

Our goal was to examine children's expressed emotions when they disclose maltreatment. Little scientific research exists on this topic, and yet children's emotional expressions at disclosure may inform psychological theory and play a crucial role in legal determinations.

METHOD

One hundred and twenty-four videotaped forensic interviews were coded for children's emotional displays. In addition, children's trauma-related symptoms (depression, dissociation, and PTSD) and global adaptive functioning were assessed, and abuse type and frequency were documented.

RESULTS

Most children in the sample evinced neutral emotion during disclosure. However, stronger negative reactions were linked to indices of psychopathology. Number of abuse experiences was inversely related to negative emotional displays.

CONCLUSION

Fact finders may profit from knowing that maltreated children do not necessarily cry or display strong emotion when disclosing maltreatment experiences. Nevertheless, predictors of greater negative affect at disclosure can be identified: fewer abuse experiences; higher global adaptive functioning; and for sexually abused children, greater dissociative tendencies.

PRACTICE IMPLICATIONS

Although further research is needed, practitioners should consider that children who disclose abuse may display relatively neutral affect despite having experienced maltreatment.

What can subjective forgetting tell us about memory for childhood trauma?

In the present study, we examined the prevalence and predictors of subjective forgetting (i.e., self-reported amnesia) of child sexual abuse (CSA). Adults who, as children, were involved as victims in legal prosecutions were questioned about their CSA experiences, which had been documented in the 1980s, and about lost and recovered memory of those experiences. Males and individuals who experienced more severe abuse were more likely to report forgetting. The majority of individuals attributed their forgetting to active attempts to avoid thinking about the abuse. In contrast, when predictors of subjective forgetting were used to predict objective memory of abuse, more severe abuse and more extended legal involvement were associated with fewer memory errors. The differences between subjective and objective memory underscore the risks of using subjective measures to assess lost memory of abuse.

Inconsistencies in the self-report of traumatic experiences by unaccompanied refugee minors

The authors investigated the consistency with which stressful life events are reported by unaccompanied refugee minors during a 12-month follow-up period and analyzed to what extent demographic and psychopathology variables affected memory consistency. From a population-based sample of 920 unaccompanied refugee minors aged 12 to 18 years old, 63% completed the follow-up measurements. Younger participants and those with lower levels of internalizing behavior and posttraumatic stress at follow-up were more prone to memory inconsistencies. Moreover, younger participants and those with fewer inconsistencies were more likely to have obtained a temporary residence permit. Given the difference between accuracy and consistency, it is not warranted to interpret memory inconsistencies as an indication of lack of credibility when assessing traumatic life events in minors applying for asylum.

Dynamics of verbal interaction between interviewer and child in interviews with alleged victims of child sexual abuse

A number (n = 27) of investigative interviews with children were analyzed with a view to explore the verbal dynamics between interviewer and child. Different types of interviewer utterances and child responses were defined, and the interrelationships between these were explored. The effectiveness of different interviewer utterances in eliciting information from children as well as the type of utterance the interviewer used to follow up an informative answer by the child were investigated. Option-posing and suggestive utterances made up for more than 50% of interviewer utterances, the proportion of invitations being only 2%. Invitations and directive utterances were associated with an increase in informative responses by the child, the adverse being true for option-posing and suggestive utterances. Interestingly, even after the child had provided an informative answer, interviewers continued to rely on focused and leading interviewing methods--in spite of a slight improvement in interviewing behavior.

Relations of parental report and observation of parenting to maltreatment history

Parenting assessments (the Parent-Child Conflict Tactics Scale, CTSPC; and a mother-child observation) were examined for their ability to identify mothers with a history of physically abusing or neglecting their child. Participants were mothers of 139 children (age 3 to 6 years; 58 with a history of maltreatment). Mothers with a history of maltreatment reported higher scores on the Neglect, Nonviolent Discipline, and Psychological Aggression subscales of the CTSPC. These group differences, however, were limited to mothers who acknowledged a history of maltreatment, as mothers who concealed their maltreatment history rated themselves similar to controls. Observation of parental behaviors during a brief, nonstressful task did not discriminate mothers who maltreated from mothers who did not maltreat. The findings suggest that parental report using the CTSPC may be useful in assessing parenting behaviors among mothers with a history of maltreatment, although socially desirable responding is a significant problem.

Reconceptualizing Children's Suggestibility: Bidirectional and Temporal Properties

Forty-one children (3 to 7 years) were exposed to a staged event and later interviewed by 1 of 41 professional interviewers. All interviews were coded with a detailed, mutually exclusive, and exhaustive coding scheme capturing adult behaviors (leading questions vs. neutral) and child behaviors (acquiescence vs. denial) in a temporally organized manner. Overall, interviewers' use of leading questions did not result in increased acquiescence as previously found. However, one specific type of leading question (i.e., inaccurate misleading) was followed by acquiescence. Lagged sequential analyses showed that it was possible to predict directly from child-to-child behavior, effectively skipping the intervening adult behavior. This result raises questions about the current conceptualization that suggestibility is driven by adult behaviors.

Child sexual abuse

Child sexual abuse is a worldwide concern. It is an insidious, persistent, and serious problem that, depending on the population studied and definition used, affects 2-62% of women and 3-16% of men as victims. Pain and tissue injury from child sexual abuse can completely heal in time, but psychological and medical consequences can persist through adulthood. Associated sexually transmitted diseases (such as HIV) and suicide attempts can be fatal. All physicians who treat children should be aware of the manifestations and consequences of child sexual abuse, and should be familiar with normal and abnormal genital and anal anatomy of children. This aim is best accomplished through training and routine examination of the anus and genitalia of children. Because as many as 96% of children assessed for suspected sexual abuse will have normal genital and anal examinations, a forensic interview by a trained professional must be relied on to document suspicion of abuse.