L . Dennison Reed, Psy.D NSU CPS

1. THE DISCLOSURE PROCESS AMONG VICTIMS OF CHILD SEXUAL ABUSEand IMPLICATIONS FOR FORENSIC INTERVIEWERS, INVESTIGATORS, AND THERAPISTS . L. Dennison Reed, Psy.D NSU CPS

2. Questions to be addressedin this presentation: • Why are some CSA victims reluctant or unwilling to disclose their abuse? • Which CSA victims are least likely to disclose their abuse during a forensic interview? • Which CSA victims are most likely to disclose their abuse during a forensic interview? • What can forensic interviewers and therapists do to encourage reluctant children who have been abused to disclose their abuse? • What can forensic interviewers and therapists do to help protect abused children that deny their abuse, delay reporting, or recant their allegations?

3. Due to limitations in our knowledge about the disclosure of CSA, it is impossible to know what proportion of victims disclose • Our information about the disclosure process is limited to samples of identified victims • Unidentified victims are excluded: • Children who never disclosed their abuse to anyone • Children who disclosed to ‘someone’ but whose abuse was never reported to the authorities • Children whose abuse was reported, but was erroneously classified as “unsubstantiated” • Adults who were sexually abused as children but who deny their abuse during retrospective surveys

4. Although the exact rates of non-disclosure of CSA cannot be determined, data from known and likely victims suggest that non-disclosure rates are quite substantial

5. Information about the Disclosure Process Is Drawn From Two Sources • Adults who reported (to researchers) that they were sexually abused as children • Children who are “confirmed victims” of CSA

6. Retrospective studies of Adults have found that NON-DISCLOSURE during childhood is very common • Approximately TWO-THIRDS [60-70%] of adults who reported (during retrospective studies) that they were molested as children say they did not disclose their abuse to anyone during childhood (not even to a friend or a parent) London, et al (2007)

7. Even ‘severe’ child sexual abuse is rarely reported to the authorities • A nationally representative retrospective survey of over 4000 American women, found that only 12%of childhood “rapes” were reported to the authorities • “Rapes” were defined as nonconsensual sexual penetration of the victim’s vagina, anus or mouth by the perpetrator’s penis, finger, tongue or an object that involved the use of force or the threat of force or coercion. Rochelle F. Hanson et al (1999). Factors Related to the Reporting of Childhood Rape, Child Abuse & Neglect, 23, 559- 569

8. Which children were most likely to disclose their abuse to “someone” during childhood? • Retrospective studies have found that adults who experienced CSA during adolescence were more likely to have disclosed their abuse to someone than those who were abused at a younger age. • They most commonly disclosed to a peer. (Bruck, et al, 2007)

9. DISCLOSURE DATA FROM CHILD SAMPLES IN HIGH CERTAINTY CASES • Diagnostic medical evidence of CSA (e.g., STDs) • Audiovisual evidence (e.g., videotapes of the abuse)

10. Even When There Is Diagnostic Medical Evidence of Sexual Abuse, Many Children Still Fail To Disclose Their Abuse • Across 21 studies examining gonorrhea in children, the average disclosure rate was only 43% • Having an unsupportive parent was a strong predictor of non-disclosure • Thus, when screened for sexual abuse, MOST children with gonorrhea denied they were abused Lyon (2007)

11. A substantial proportion of sexually abused children failed to disclose their abuse even though there were VIDEOTAPES of the abuse • Videotapes were discovered depicting a man sexually abusing 10 different children (9 boys, 1 girl) • None of the children disclosed their sexual abuse to anyone prior to being interviewed by the police • Half denied the abuse when interviewed by the police. Those who did disclose minimized the extent of the abuse

12. What do children’s denials of abuse mean about the likelihood of abuse? • “. . . to the extent that denial rates are surprisingly high, an expert can justifiably testify that that denials are surprisingly weak evidence that abuse did not occur Lyon, T. (2007). False denials: Overcoming methodological biases in abuse disclosure research. In Child Sexual Abuse: Disclosure, Delay and Denial. Pipe, et al. Ed.

13. Delayed disclosure is common bothin retrospective studies of adults and in child samples • Disclosure is often a ‘process’ that occurs over time rather than being a single ‘event’ • Multiple interviews may be necessary with some children; however, this also increases the risk of leading some non-abused children to make false allegations IF the interviews are suggestive

14. Why Are Many Victims of Child Sexual Abuse Reluctant to Disclose their Abuse?

15. SEXUAL NAIVETÉ -Youngand sexually naïve children may not even realize that they have been abused. Molesters who target younger children often misrepresent the abuse as something innocent: Game or playful activity, i.e., tickling, wrestling display of affection hygiene practice Massage Drum lessons

16. SEXUAL MODESTY Children receive “modesty training” about sexual topics early on. “Private” Parts

17. NON-ABUSED CHILDREN’S REPORTS OF VAGINAL AND ANAL TOUCHING DURING A MEDICAL EXAM5 and 7 year old girls(Saywitz, Goodman, Nicholas & Moan, 1991)

18. SampleN = 72 females5 & 7 year-olds Half (36) of the children received a routine medical exam, including a vaginal and anal exam. The other half received a routine medical exam, but with a scoliosis (spinal) exam instead of a vaginal and anal exam.

19. STAGE 1OPEN-ENDED QUESTIONINGNO ANATOMICAL DOLLS“Tell me everything you remember about your visit to the doctor.” • 22% Disclosed Vaginal touching • 11% Disclosed Anal touching

20. STAGE 2OPEN-ENDED QUESTIONING WITH ANATOMICAL DOLLS“Show and tell me what happened when you went to the doctor’s” (using anatomical dolls and medical props) • 17% Disclosed Vaginal touching • 11% Disclosed Anal touching • Note: Lower rate of disclosure of vaginal touching when anatomical dolls were used (22% vs. 17%)

21. STAGE 3‘YES/NO’ (Option-posing) QUESTIONSWITH ANATOMICAL DOLLS“Did the doctor touch you there?” (pointing to various body parts on anatomical dolls) • 86% Disclosed Vaginal touching • 69% Disclosed Anal touching

22. False Reports of Genital and Anal Touching by 5 & 7 year olds(Scoliosis Condition) Anatomical dolls + option-posing questions • One of the 36 children (< 3%) erroneously answered “yes” when asked if doctor touched the vaginal area. • Two (< 6%) erroneously answered “yes” when asked if doctor touched the anal area. • Only one of these three children were able to provide any detail about the alleged touching.

23. MISPLACED GUILT • Many sexually abused children feel at least partially responsible for their own abuse • “It was my fault” (e.g., It was because I dressed that way; It was because I didn’t lock my door; It was because I was too pretty) • “I should have stopped him/her” • “I should have told the very first time” • Many sexually abused children feel guilty for having become sexually aroused during their abuse

24. For many sexually abused children, disclosing their abuse feels more like confessing a sin, than reporting a crime Their misplaced sense of guilt is a powerful motivator for keeping their abuse a secret

25. STIGMA and SHAMEPre-teen and teenaged BOYS are often extremely reluctant to disclose abuse by a MALE • “Homophobia” is rampant among boys this age • This sense of shame can be reinforced by the victim experiencing an erection during the abuse

26. Secrecy Pacts • Child molesters sometimes directly ask or entice the child to keep the abuse a secret • This is our little secret so don’t tell anyone else, ok? • Here’s a new video game because you’ve been doing really good at keeping our secret

27. FEARS OF SEPARATION & REJECTION • Victims may fear that if they tell they will be separated from loved ones--including the perpetrator who is oftentimes a beloved relative or friend. The child may be confused or repulsed by the abuse, but still love or care for the abuser • The victim may fear that if she discloses the abuse, loved ones will be angry with her and will blame her for : • Lying/making false allegations • Not telling earlier; “seducing” the perpetrator • Causing family hardships by disclosing the abuse

28. NOT WANTING TO GET THE OFFENDER IN TROUBLE • The child may be confused or even repulsed by the abuse but still have loving feelings for the abuser • “I hate what he did to me, but he’s still my father” • Male molesters who target boys are especially masterful at befriending their victims and ensuring that they remain ‘loyal’

29. THREATS OF PHYSICAL HARM • To the victim • To the victim’s loved ones, i.e., parents, siblings, pets • BUT, threats of physical harm are rarely needed to maintain secrecy

30. Dissociation and PTSD-related Amnesia This is far more likely when the abuse is terrifying, painful, repetitive and emotionally or physically intolerable for the child. “Whenever he did that, I went to the pink forest.” “I left my body and hid in a crack in the wall.” “I watched Mickey Mouse cartoons in my head when it started to hurt real bad.” “I think I was sleeping.” PTSD and Dissociative amnesia can give rise to delayed memories and flashbacks

31. Factors that Inhibit Disclosure • Sexual Naiveté • Sexual Modesty • Misplaced Guilt • Stigma and Shame • Fears of Separation and Rejection • Secrecy Pacts • Affectionate feelings for the offender • Threats of Physical Harm • Dissociation and PTSD-related amnesia

32. Which kids are most likely to disclose during a forensic interview? • Kids who made a prior disclosure to someone, e.g., parent, teacher, therapist • Older children • Kids who are not related to the perpetrator • Kids whose parents are supportive of them and are willing to consider the possibility that their child was sexually abused

33. The best predictor of disclosure during a forensic interview is the child having made a prior disclosure to someone

34. Which kids are least likely to disclose during a forensic interview? • Kids who have not made a prior disclosure (e.g., to a parent) • Kids ages 3-6 • Kids abused by a relative • Kids whose parents are not supportive • Children’s reluctance and guardedness is typically obvious very early in the forensic interview—even before abuse-related (substantive) questioning begins

35. The Power of Parental Support • Children with STDs (e.g., gonorrhea) were questioned about possible abuse during a forensic interview • When their parents rejected the possibility that they were sexually abused, only 17% disclosed • 67% of children whose parents were open to the possibility that their child had been sexually abused disclosed their sexual abuse Lawson, L. & Chaffin, M. (1992).

36. What Can Forensic Interviewers Do to Encourage Reluctant Victims to Disclose their Abuse?

37. DEVELOP RAPPORT WITH THE CHILD Sexually abused children’s embarrassment and shame, misplaced guilt, fears about disclosing to an unfamiliar adult, and lack of trust in the interviewer are barriers to disclosure. Developing rapport with children enhances their sense safety and their belief that the interviewer genuinely cares about them, is interested in them, and is a safe person to talk about distressing topics like sexual abuse.

38. Rapport building is not a ‘stage’ in the forensic interview process • Rapport building should begin when you first introduce yourself to the child and should continue throughout the entire interview.

39. Rapport Building TechniquesNon-verbal Communication Smile! Victor Borges, a Danish comedian, said, “A smile is the shortest distance between two people.” Use a warm and friendly tone of voice Speak s-l-o-w-l-y, and maintain a calm appearance Maintain appropriate eye contact Use gestures that convey interest, patience and caring

40. Rapport Building TechniquesIntroductory Phase and beyond Address the child by name: “Hello Cindy. My name is _____. I’m so glad to meet you!” Provide appropriate compliments: “Those sure are cool shoes you have on today.”

41. Rapport Building TechniquesDiscuss something ‘fun’ at the outset At the outset (before ‘ground rules,’ abuse Qs), ask in a friendly and interested manner about something the child likes to do for fun, or a recent event that the child enjoyed: “What do you like to do for fun?” “Tell me all about that.” “You said you had lots of fun at your birthday party. Tell me all about your birthday party.” Follow-up with non-leading, open-ended questions; and thank the child for ‘telling you all about it.’ This ‘practice narrative’ also prepares the child to provide detailed responses when you inquire about abuse later on. (‘Revised’ NICHD Protocol) la

42. Rapport Building TechniquesConvey concern about the child’s comfort Show concern about the child’s comfort at the outset (and throughout the interview) “How are you doing today?” “It’s real important to me that you are as comfortable as you can be while we are together today. So be sure to let me know if you need to go to the bathroom or to get a drink, or if I can do anything to make you more comfortable, okay?”

43. Rapport Building TechniquesConvey ‘interest’ throughout • Show an interest in things the child is interested in, even if it is not “forensically relevant.”

44. Rapport Building TechniquesReassure the child that YOU are comfortable with the interview process • Convey your experience with kids: • “I talk to lot’s of kids about things that have happened to them. And they tell me about all kinds of things.” • ‘Normalize’ the process; avoid showing signs of shock, distress, or disapproval: • “It’s okay to talk about ‘anything’ with me.” • “It’s okay to say those (bad) words here.” • “I can’t believe he did that. How disgusting!”

45. Rapport Building TechniquesMinimize the child’s guilt & embarrassment • When the child reports abuse but seems to feel guilty or embarrassed about it, provide encouragement and reassurance: • “I’ve talked to lots of kids who have had things like this happen to them. You can trust me and tell me about the things that have happened to you.” • “When grown-ups do things like this to a child, it’s not the child’s fault.”

46. Rapport Building TechniquesGive permission to disclose secrets • To address secrecy: • “Many kids have secrets that they do not talk about. If you have a secret, I am someone you can trust to tell secrets to.”

47. Rapport Building TechniquesProvide positive reinforcement for ‘effort’ Provide thanks, appreciation, and positive reinforcement for the child’s efforts (not for specific content, e.g., abuse allegations) “Thank you for telling me all about that.” “You’re really helping me understand.” “You’re paying such good attention to my questions.”

48. Rapport Building TechniquesConvey empathy for the child’s distress • Show empathy for the child’s feelings and difficulties regarding the interview process and provide encouragement and offer help when appropriate (but be cautious about focusing on the abuse experience): • “I know it’s hard answering so many questions. And you’ve been doing a really good job.” • “If its hard for you to talk about, is there something I can do to make it easier?”

49. Rapport Building TechniquesOffer alternative means of communication • If the child simply won’t or can’t talk about it despite your best efforts, offer an alternative: • “Would it be easier for you to write it down? • “Would it be easier for you to draw a picture of what happened?” • “Would it be easier for you to say what happened if I leave the room?”

50. Other Strategies for Overcoming ReluctanceConsider changing interviewers • Gendercan be a factor, i.e., child might be more comfortable speaking to a female than to a male. In this case, it might also be helpful have any male investigators to leave the room • Race or ethnicity can be a factor. Children sometimes are more willing to disclose to those of the same race/ethnicity.