Clinical forensic examination findings and legal outcome in cases of suspected physical child abuse

Clinical forensic examinations performed at the Institute of Legal Medicine of the Hanover Medical School between 1999 and 2008 in cases of suspected physical abuse of children were analyzed retrospectively with special emphasis on the legal consequences. Altogether, 192 children (85 girls, 107 boys) with a median age of 4.4 years were examined. In 47 cases (24.5 %), the clinical forensic examination findings were interpreted as accidental injuries, birth traumas or unspecific findings. 29 victims (20.0 %) had suffered a shaken baby syndrome. Only part of the presented cases ended with conviction, which was more likely if the victims were aged between 7 and 11 years. Prison terms of 2 years and more were imposed only if the child suffered potentially or acute life-threatening injuries or if additional anogenital lesions were diagnosed indicating sexual child abuse.     

Clinical forensic examination findings in assault cases among adolescents

Child and youth criminality has risen markedly over the past 25 years and causes increasing concern to the general public. The clinical forensic examination cases of youth violence victims examined at the Institute of Legal Medicine of the Hanover Medical School and its Oldenburg Branch between 1999 and 2008 were retrospectively analyzed. In all, 55 adolescents (37 females, 18 males; median age 15.5 years) were examined. In most cases the suspect was a close (40.0%) or passing (23.6%) acquaintance. 16 assaults were committed by two or more adolescents jointly. Most of the juveniles were victims of sexual assaults (56.4%). In 15 victims of sexual offences (51.7%) diagnostic findings were obtained on the basis of anogenital injuries and/or the presence of sperm. In summary, the analysis shows that adolescents frequently become victims of sexual assault. In addition, youth violence is often committed in a group.     

Expert testimony in child sexual abuse cases

We presented participants with syndromal, witness credibility, or anatomically detailed doll evidence to determine (a) whether these different types of expert evidence exert differential influence on participants' judgments and (b) whether the influence of this evidence could be better explained by the relative scientific status or the probabilistic qualities of the research presented. Additionally, we investigated whether a strong or weak cross-examination of the expert would be more successful in discrediting the information provided in the expert's testimony. Findings suggest that participants are less influenced by expert testimony based on probability data (i.e., syndromal evidence) than by expert testimony based on case history data (i.e., credibility of anatomically detailed doll evidence). Participant responses did not differ as a function of the strength of the cross-examination of the expert. As expected, women were more likely to respond in a pro-prosecution direction than were men. Implications for the use of expert evidence in child sexual abuse cases are discussed.     

Forensic medical examination in cases of sexual abuse

The article presents the analysis of forensic medical expert practice in the field of sexual abuse. Drawbacks in expert examinations, official decisions on such examinations, low expertise of forensic medical personnel in sexual crime, lack of tools for genital and anal examination are analysed and methods of correction of this situation are proposed.     

Recovered memories of childhood sexual abuse: Current findings and their legal implications

Recent research on recovered memories of childhood sexual abuse has shown that there are at least two types of recovered memory experiences: those that are gradually recovered within the context of suggestive therapy and those that are spontaneously recovered, without extensive prompting or explicit attempts to reconstruct the past. By focusing on well‐known imperfections of human memory, we were able to find differing origins for these recovered memory experiences, with people recovering memories through suggestive therapy being more prone to forming false memories, and with people reporting spontaneously recovered memories being more prone to forgetting prior incidences of remembering. Moreover, the two types of recovered memory reports are associated with differences in corroborative evidence, suggesting that memories recovered spontaneously, outside of suggestive therapy, are more likely to correspond to genuine abuse events. In this paper, we summarize recent research on recovered memories and we argue that these scientific findings should be applied in the justice system, but also in clinical practice.     

25例医疗纠纷的法医临床学鉴定回顾性分析

目的探讨医疗纠纷的法医临床学鉴定及其相关问题。方法对25例医疗纠纷案例资料进行了回顾性整理分析。结果医疗失误16例,其中有不良后果的10例,均发生于手术科室;无医疗失误9例。结论医疗纠纷法医学鉴定过程中认定医疗失误是基础,认定医疗失误与不良后果的关系是关键。     

Undetected and detected child sexual abuse and child pornography offenders

Current knowledge about risk factors for child sexual abuse and child pornography offenses is based on samples of convicted offenders, i.e., detected offenders. Only few studies focus on offenders not detected by the criminal justice system. In this study, a sample of 345 self-referred pedophiles and hebephiles was recruited from the community. All participants met DSM-IV-TR criteria for pedophilia or hebephilia (paraphilia not otherwise specified), were assured of confidentiality, and self-reported lifetime sexual offending against prepubescent and/or pubescent children. Two sets of group comparisons were conducted on self-report data of risk factors for sexual reoffending. Measures of risk factors address the following dimensions identified in samples of convicted offenders: sexual preferences (i.e. co-occurring paraphilias), sexual self-regulation problems, offense-supportive cognitions, diverse socio-affective deficits, and indicators of social functioning (e.g., education, employment). Men who admitted current or previous investigation or conviction by legal authorities (detected offenders) were compared with those who denied any detection for their sexual offenses against children (undetected offenders). Group comparisons (detected vs. undetected) were further conducted for each offense type separately (child pornography only offenders, child sexual abuse only offenders, mixed offenders). Although there were more similarities between undetected and detected offenders, selected measures of sexual-self regulation problems, socio-affective deficits, and social functioning data demonstrated group differences.     

Containing the secret of child sexual abuse

This study reports a grounded theory study of the process of how children tell of their experiences of child sexual abuse from the perspectives of young people and their parents. Individual interviews were conducted with 22 young people aged 8 to 18, and 14 parents. A theoretical model was developed that conceptualises the process of disclosure as one of containing the secret of child sexual abuse. Three key dynamics were identified: the active withholding of the secret on the part of the child, the experience of a 'pressure cooker effect' reflecting a conflict between the wish to tell and the wish to keep the secret, and the confiding itself which often occurs in the context of an intimacy being shared. Children's experiences of disclosure were multidetermined and suggest the need for multifaceted and multisystemic approaches to prevention and intervention. The need for the secret to be contained, individually and interpersonally in appropriate safeguarding and therapeutic contexts needs to be respected in helping children tell.     

The impact of questioning style on the content of investigative interviews with suspected child sexual abuse victims

Abstract

This study explored the influence of question type and interviewer style on the quantity and quality of responses offered by children in interviews for suspected sexual abuse. The analysis covered 36 investigative interviews conducted by polia officers under the Memorandum of Good Practice with children aged 4–7, 8–11 and 12–14 years. The dependent measures were the temporel length of children's answers and the number of criteria derived from Criteria Based Cornent Analysis (CBCA) they contained. Only 2% of all questions were open-ended, but just 3% were judged leading. Open questions were most effective with 12–14 year olds but not with younger children who provided nose information in response to specific yet not leading or closed questions. Longer answers containing move CBCA criteria were associated with interviews containing many affirmative utterances and verbal affirmations and a brief rapport. The implications of these findings for interview theory and practice are briefly discussed.     

National survey of professional practice in child sexual abuse

A sample of 276 professionals described how they spend their professional time, their attitudes and knowledge about etiology and treatment of sexual abuse. Professionals were also asked to respond to a case vignette where varied on two dimensions: age of the child victim and relationship of the offender to the victim. Agencies receiving the questionnaire were randomly assigned to one of the six possible scenario conditions resulting from the two dimensions.     

Influences of an interviewer's behaviors in child sexual abuse investigations

The content of an investigatory interview is one of several factors which may influence the data gathered in the course of a sexual abuse investigation. This article focuses on the impact of an interviewer's behaviors upon the information presented by the alleged victim. Behavioral aspects of the interview which may influence the child's information include inappropriate interactional patterns, emotional reactions of the interviewer, and/or changes in continuity of specific behaviors. Recommendations are made to assist investigators in avoiding these interviewing pitfalls and, thereby, minimizing contamination of the child's data.     

A dangerous direction: legal intervention in sexual abuse survivor therapy

In this Article, Professors Bowman and Mertz question recent popular and academic commentary that disputes the validity of all delayed-recall memories of childhood sexual abuse. They examine one court's decision to allow a father, accused by his daughter of childhood sexual abuse, to recover malpractice damages from his daughter's therapist in connection with therapy during which the daughter recovered memories of the abuse. The authors argue that such third-party liability is unsound in terms of established principles of tort doctrine and in terms of public policy. After a review of the scientific evidence, the authors further conclude that, although some memories may be inaccurate, delayed-recall memory can also accurately reflect that past abuse occurred. Permitting third-party liability against therapists when accurate memories of abuse surface in therapy gives abusers a weapon to use against their victims. Because such suits exclude the party in privity (the client), they effectively erase the victim's voice. Professors Bowman and Mertz argue that such a novel extension of third-party liability is at best a misuse of the courts' resources and ultimately harms abuse survivors, therapists, and the community far more than it helps any wrongfully accused parents.     

Female victims of child sexual abuse: Adult adjustment

A questionnaire administered to a University sample of 245 female victims of sexual child abuse and 750 nonvictims attempted to determine whether abuse is related to poor adult social and psychological adjustment. The instrument consisted of three outcome measures of adjustment, variables directly related to abuse, perceived satisfaction with early family life, and demographic data. Only one of the outcome measures — the Texas Social Behavior Inventory — yielded a statistically significant difference between the samples. There was a steady, significant and progressive increase in maladjustment between the nonabused, the nonincestuously abused and the incest victims. When controls were applied for levels of satisfaction with early family life, differences between the abused and nonabused samples disappeared. Those abused as children who reported good treatment by parents exhibited no ill effects as adults on the TSBI.     

Ambivalence of nonoffending guardians after child sexual abuse disclosure

A concern in the intervention with sexually abused children is the support of their nonoffending guardians after disclosure of the abuse. Approximately a third of nonoffending guardians respond with vacillation in support, and these nonoffending guardians are at greater risk for having their children removed. This article reconceptualizes vacillation in support as an ambivalent response. Drawing on the interdisciplinary literature, this article suggests that ambivalence in support reflects the confluence between the nonoffending guardian's valence toward the child and perpetrator. This article further proposes that ambivalence is normative when the costs of disclosure are high and when the nonoffending guardian is ambivalent/preoccupied in attachment. Ambivalence may also be both a precursor to and an effect of the traumatic experience of the disclosure on the nonoffending guardian. In a study of 30 nonoffending mothers whose partners sexually abused their children, these relationships were supported.     

Drawbacks and new methodological approaches to forensic medical examination of sexual conditions

Drawbacks of forensic-medical examination of sexual conditions are due to problems of management and diagnosis. Updating expertise of sexual conditions means standardization, application of modern examination tools and devices, making more than one examinations, skills in examination of the man in suspected erectile dysfunction, purposeful search for sperma.     

Barriers to successful treatment completion in child sexual abuse survivors

Child sexual abuse (CSA) often requires psychological treatment to address the symptoms of victim trauma. Barriers to entry and completion of counseling services can compromise long-term well-being. An integrated medical and mental health evaluation and treatment model of a child advocacy center (CAC) has the potential to reduce barriers to mental health treatment. Objective: (a) to describe characteristics between CSA patients who engage versus those who do not engage in mental health treatment and (b) to identify factors associated with successful completion of mental health treatment goals. For design/setting, a retrospective cohort study was conducted of CSA patients (ages 3-16 years) referred to mental health services following a CAC assessment. Outcome variables included linkage with treatment and completion of treatment. Independent variables included demographics, abuse characteristics, and therapist characteristics. Data were abstracted from the CAC and billing databases. Results: Four hundred ninety subjects were evaluated. Subjects were as follows: predominately female (74%), White (60%), and more than half received Medicaid (56%). Mean age was 8.4 years. About 52% linked with mental health services and 39% of patients that successfully linked with mental health services completed therapy. Successful linkage was independently associated with referrals to other counseling services (AOR 8.4 [2.5, 27.7]). Successful completion of therapy was independently associated with caregiver participation in therapy (AOR 3.2 [1.8, 6.0]) and if the patient was referred to other counseling services (AOR 4.1 [1.9, 8.5]). There were no differences between subjects that linked and/or completed therapy and those that did not with regard to demographic characteristics or abuse severity. Conclusion: In contrast to previous reports, efforts at our CAC seem to overcome linkage barriers in this population. However, there remain challenges in achieving successful completion of treatment goals in this population. Engaging caregivers' involvement in therapy services had a positive effect with successfully achieving treatment goals.     

Exploring taboos: comparing male- and female-perpetrated child sexual abuse

The objective of this article is to compare male- and female-perpetrated sexual abuse in terms of victim and abuser characteristics, type of abuse, family structure, and worker information. Bivariate tests of significance were performed on the 1998 Canadian Incidence Study of Reported Child Abuse and Neglect, which included 308 male and 37 female abusers. Results show a prevalence rate of 10.7% for female-perpetrated sexual abuse. Girls were more likely to be victimized for both male- and female-perpetrated sexual violence and females tended to abuse younger children. The majority of children came from families with lower socioeconomic status although one in five victims of female-perpetrated sexual abuse came from middle-class homes. Referrals to child welfare agencies were more likely to be made by nonprofessionals when females abused.