The Application of Images in Child Abuse Investigations

Chapter in Image-Based Research: A Sourcebool for Qualitative Researchers (Jon Prosser, Editor)

Hollida Wakefield and Ralph Underwager

ABSTRACT: Mental health professionals use a variety of image-based techniques when interviewing children about sexual abuse allegations. These include anatomical dolls, books, puppets, drawings, projective cards, play dough, games, and toys. Many of these lack acceptable validity or reliability for the ways they are used; whereas others appear helpful in obtaining forensically-useful information from young children. The history and current status of research concerning the child witness is the background for a discussion of these practices. It is argued that interviewers should only use techniques that can be defended in terms of their reliability and validity.



From ancient cave drawings, to archeological artifacts ranging from royal jewelry to household objects, to thousands of clay Chinese warriors, to today's computer screen, images and symbols show the richness and complexity of human life. Human cognition often depends upon the use of images and symbols to represent or stand for something other than itself. This ability separates us from all other creatures and has enabled humanity to transcend space and time. Science makes great use of models, symbols, and number systems to advance our human capacities.

The use of images and symbols is so much a part of human cognition that adults often completely overlook the fact that children are not born with a capacity to represent one thing by another thing. This is a cognitive capacity that must be learned during the developmental process of the individual from infant to adult (DeLoache, 1995a). A longitudinal study of this process in seven distinct symbol systems (Gardner & Wolf, 1987) shows developmental changes both within and across the seven systems. From ages 5 to 7 the symbolic process begins to develop and notational literacy is acquired in early school years.

Unfortunately, during early developmental stages when children are difficult to communicate with, adults who want to elicit information from children may attempt to use images and symbols in an effort to break through the limitations. But the child may not have the capacity to use one object to represent another. If adults are not familiar with this developmental process, they may miss opportunities to accurately understand children and may then introduce unnecessary error into the interaction.

Mental health professionals use a variety of techniques employing images when interviewing children about sexual abuse allegations. These include anatomical dolls, books, puppets, drawings, projective cards, play dough, games, and toys (Conte, Sorenson, Fogarty, Rosa, 1991; Kendall-Tackett, 1992). Many of these are controversial and do not show acceptable validity or reliability for the ways they are used (Underwager & Wakefield, 1995); others appear valuable for assisting young children to provide forensically useful information. A crucial factor is how the image-based techniques are used by the interviewer. The history and current status of research concerning the child witness is the background for a discussion of these practices.


Brief History of Research on Child Witnesses

In the early part of the 20th century, research on children's memory focused on children as witnesses in court. Most of this research was in Europe, especially Germany and France; there was very little in the United States until the 1920s and even then there were only a few studies on the child witness until the 1980s (Ceci & Bruck 1993, 1995). Although children in Canada, America, and Great Britain were rarely permitted to testify, their testimony was allowed in some other European countries, hence the interest in performing research that dealt directly with children's court testimony. The general conclusion from this research was that young children were suggestible and vulnerable to making serious errors in their court testimony (Ceci & Bruck, 1993, 1995; Goodman, 1994; Wakefield & Underwager, 1988).

Following this early period, little research was done for years and laboratory studies of children as witnesses were rare until the 1970s. But then the increases in reports and allegations of sexual and physical abuse led to changes in the legal system regarding the admissibility of child witnesses' testimony (Ceci & Bruck, 1993, 1995; Goodman, 1984). In most countries the requirement for corroboration of children's statements alleging sexual abuse was dropped. Therefore, children's credibility, their reliability as witnesses, and their susceptibility to leading questions quickly became salient issues. Over the past few years interest in this issue has proliferated and there are now hundreds of articles in the literature addressing these topics.

During the beginning of this recent period, the testimony of young children was often accepted in the justice system as truthful and false allegations were believed to be extremely rare (i.e., Faller, 1984; Summit & Kryso, 1978). A number of unsupported dogmas, such as children cannot lie about sexual abuse and children cannot be "coached" to make erroneous statements about abuse, gained acceptance in the legal and mental health communities. Although some researchers acknowledged that suggestive interviews might cause children to make unimportant errors about peripheral details, it was claimed that children could not be led to make statements about important, central events. Several highly publicized cases during this period involving satanic, ritual abuse allegations resulted in convictions (Nathan & Snedeker, 1995).

To our knowledge, the first time expert opinion on the impact of leading interrogations was given in a court of law was when Dr. Underwager testified in a sex abuse trial in Winner, South Dakota, in the winter of 1983. The next year we were the experts in the first of the highly publicized Scott County cases to go to trial where Dr. Underwager provided similar testimony. In these cases 25 adults were accused of abusing 40 children in two interlocking sex rings. The alleged abuse involved animals, ritual abuse, and murder. This trial resulted in an acquittal and charges were dropped against all but the first defendant, who had confessed. A later state attorney general's report (Humphrey, 1985) concluded that the repeated suggestive interrogations of the children made it impossible to sort out what may have happened.

Following this, a few forensic psychologists and psychiatrists began to report on their analyses of actual real world interrogations (Coleman, 1986; McIver, 1986; Underwager, Wakefield, Legrand, Bartz, & Erickson, 1986). These early reports of actual real world interrogations suggested coercive questioning could produce serious errors in a child's statements. Then, as academic researchers became involved in actual cases and reviewed videotapes of actual interviews, they began conducting studies that more closely approximate what happens in the real world. These studies demonstrated that children who are interviewed suggestively can produce false narratives about fictitious events, including central events (see Ceci & Bruck, 1995 for a review of this research). These erroneous narratives were often coherent and detailed and could not be detected as false by professionals. As a result, the current consensus of scientific opinion has revived the initial caution and concern about children's reliability and suggestibility. The justice system now recognizes these data and several of the highly publicized convictions in the United States and Canada from the 1980s have been overturned.

It is now acknowledged that persistent suggestive questioning can lead children to provide accounts of events that never occurred, even when they first denied them. Sometimes the questioning results in the child developing a subjectively real memory for an event that never happened. (Bruck & Ceci, 1995; Ceci, 1994; Ceci & Bruck, 1993, 1995; Ceci, Loftus, Leichtman, & Bruck, 1994). Several conclusions are now generally accepted in the scientific community (Ceci & Bruck, 1993):

· First and foremost, contrary to the claims made by some . . . there do appear to be significant age differences in suggestibility, with preschool-aged children being disproportionately more vulnerable to suggestion than either school-aged children or adults (p. 431).
· Our review of the literature indicates that children can indeed be led to make false or inaccurate reports about very crucial, personally experienced, central events (p. 432).
· The second major conclusion is that contrary to the claims of some, children sometimes lie when the motivational structure is tilted toward lying (p. 433).
· Third, notwithstanding the aforementioned two points, it is clear that children-even preschoolers-are capable of recalling much that is forensically relevant (p. 433).

It is extremely important to examine the conditions prevalent at the time of the child's original report. The way the child was interviewed, including the use of image-based techniques, must be carefully examined. The conclusions from the current research are clear-when children are interviewed skillfully and appropriately and supported and encouraged to tell their story in their own words, they can provide accurate and forensically useful information. But when interviewers use suggestive, leading, specific, and coercive questioning to get the child to confirm preexisting biases about abuse, they risk eliciting false statements. Therefore, if image-based techniques are used, it must be in a nonsuggestive way that encourages children to provide details and a narrative account from their free recall of events.


The Use of Images in Interviews

Techniques using images vary greatly as to whether they introduce potential error into the investigation or whether they are useful aids to accurate recall. Unfortunately, despite growing knowledge about how interviews should be done to increase the reliability of the information elicited, many interviews in actual cases continue to be suggestive and contaminating (Underwager & Wakefield, 1990; Warren, Woodall, Hunt, & Perry, 1996).


Anatomically-Detailed Dolls

Anatomically-detailed dolls are routinely used in interviewing children suspected of being abused. The dolls are made of plastic or cotton and come dressed with easily-removable clothing. There are several commercial manufacturers who sell the dolls but they are also sometimes hand made. The mature female dolls have representations of breasts that protrude and the boy and mature male dolls have penises. There are holes in the dolls representing the mouth, anus, and vagina. The penis is able to fit into these openings. Often, the dolls have fingers that also fit into the openings. The mature male and female dolls have pubic hair. Although some early versions of the dolls appeared to have genitals that were disproportionately large, a survey of 17 sets of anatomical dolls (Bays, 1991) indicated that the genitals were not exaggerated in size. The design of the dolls is not standardized (see Figure 1).

Anatomical dolls are used by many different types of professionals (Boat & Everson, 1988, 1996; Conte et al., 1991; Kendall-Tackett & Watson, 1992), many of whom may have little or no training in their use. Despite their widespread use, these dolls are extremely controversial and there is disagreement in the professional community as to whether they should be used (e.g., Koocher et al., 1995; Yates & Terr, 1988). However, all agree that they have no demonstrated validity and reliability.

The dolls are sometimes used in ways that can induce serious error into the interview. In one videotape we reviewed, the mother, who was part of the interview, took the dolls, put them in the intercourse position, and then asked the child to do this. In another, the interviewer pointed to and touched the genitals of a doll that had been labeled "daddy" and told the child, "Show me where daddy touched you." Boat and Everson (1996) describe an example of a young child putting the doll's penis in her mouth but not responding when asked about it. Later, the interviewer asked, "You put [the doll's] wienie in your mouth. Whose wienie have you had in your mouth?" Boat and Everson (1996) also note that in 28% of the interviews with 2- to 5-year-olds and 9% of the interviews with 6- to 12-year-olds, the terms "play" or "pretend" were used as part of the doll interview. To invite a young child to play or pretend as a part of an interview about real events can be very confusing. This is compounded if the adult then assumes the pretend behavior reflects actual events.

We believe the dolls should not be used. There are no accepted standards for their or normative data on them (APA Council of Representatives, 1991; Koocher et al., 1995; Levy, Markovic, Kalinowski, Ahart, & Torres, 1995). The dolls, in the way they are often used, may become learning experiences for a child (Wakefield & Underwager, 1988; Underwager & Wakefield, 1990). Interviewers may model handling the dolls, undress them, or name them for the child. They may ask the child to show with the dolls what the accused person did. They may place the dolls in sexually explicit positions. Although some researchers claim the dolls are not necessarily suggestive (e.g., Everson & Boat, 1994), some nonabused children engage the dolls in representations of sexual play (Dawson & Geddie, 1991; Dawson, Vaughan, & Wagner, 1992; Everson & Boat, 1990; Gabriel, 1985; Glaser & Collins, 1989; McIver, Wakefield, Underwager, 1989).

Studies that claim to show differences between the doll play of sexually abused and nonabused children have major methodological shortcomings which limit any conclusions that can be drawn from them (Ceci & Bruck, 1993; Skinner & Berry 1993; Underwager & Wakefield, 1990, Wakefield & Underwager, 1988, 1989, 1994; Wolfner, Faust, & Dawes, 1993). DeLoache (1995b) notes that the basic reason for using anatomical dolls is the belief that the dolls will elicit information from children who are unable or unwilling to verbally describe the abuse. She observes, however, that not only is there no good evidence that dolls help in interviews with young children, but the presence of the dolls might result in the youngest children providing less information. Younger children cannot understand the basic self-doll relation assumed by interviewers. They cannot use dolls as symbols or representations for themselves and therefore cannot use the dolls to enact their own experiences. DeLoache concludes that the presence of an anatomical doll might even interfere with the memory reports of younger children.

Wolfner et al. (1993) point out that the necessary research to determine whether the dolls provide any incremental validity in establishing abuse would involve a group of children who were all suspected of being abused who, based on subsequent evidence, could be definitely divided into those who have and have not been abused. The doll interviews would have to take place prior to the children undergoing the standard procedures for investigating sexual abuse, since the process of being questioned about abuse could affect their reactions to the dolls. Such research has not been done-the studies that are claimed to support the use of the dolls only compare children suspected of abuse to those who are not suspected.

In summary, anatomical dolls are controversial, with some professionals claiming they are useful and others contending that they are too suggestive. Their use is especially problematical if the child's interaction with the dolls forms the basis for a conclusion about sexual abuse. Some professionals maintain that the dolls can be used if great care is taken not to be suggestive, if the child's interaction with the dolls is not the basis for an opinion about sexual abuse, and if they are not be used with very young children (e.g., Boat & Everson, 1996; Koocher, et al., 1995; Simkins & Renier, 1996).
Others believe the dolls should not be used, even with great care (e.g., Fisher & Whiting, in press; Underwager & Wakefield, 1995; Wolfner et al., 1993). They are unnecessary for older children and risk introducing error into the accounts of younger children. There is no empirical evidence that doll interviews are a valid and reliable method for getting accurate information. The use of the dolls as an assessment or investigatory technique is not generally accepted within the scientific community, rather, their use remains highly controversial.


Puppets

Although puppets are used as interview aids (Kendall-Tackett, 1992), we found no research concerning them. The way they are used in videotapes we have seen is highly suggestive. When a child is not responding to questions or is saying, "I don't remember," the interviewer may give the child one puppet, place another on her own hand, and have the puppets talk to each other. The child sometimes interprets this a pretend game and begins saying all sorts of things. The interviewer, however, fails to recognize this and responds to the child-puppet's statements as though the child were telling about actual, real-life events. In our opinion, puppets have no place in an investigatory interview.


Books

Books for younger children can provide cues for eliciting spontaneous information or they can be suggestive and potentially contaminating, depending upon the book and how it is used. We often read books to very young children, both as an ice breaker and rapport builder and as a possible cue for children to provide spontaneous information about their families and their concerns. The books, which can be bought at the children's department at any bookstore, are on topics such as bathing, nap time, parents who are divorcing, bedtime, dreams, the birth of a new brother or sister, etc. These are environments in which abuse may occur and reading about them may permit a child to naturally and spontaneously speak about events in these circumstances. Such books, although providing possible cues for spontaneous information, are not suggestive in terms of sexual abuse.

Other books directly deal with sexual abuse. Children may be taught about "good" and "bad" touches and told that they can tell others not to touch them if they don't want it. For example, Red Flag Green Flag People (Rape and Crisis Abuse Center, 1985) leads children through a series of pages that present good touch and bad touch and instructs them to color portions of a figure where they were touched. My Feelings (Morgan, 1984) tells children to "trust your feelings" and tell an adult when a touch makes them feel "creepy and icky and such." No More Secrets for Me (Wachter, 1983) contains short stories about children who are touched "in a way you don't like." A Very Special Person (Nelson, 1985) informs children that they can choose who can touch them and that they should tell "yucky secrets" to someone they trust. The research evidence on prevention programs using the same concepts as these books suggests they are both ineffective and may increase false accusations (Krivacska, 1990). Since such books deal directly with sexual abuse, the use of them in an investigatory interview is suggestive.

One of the better books is A Touching Book by Hindman (1985), who uses "secret touching" to refer to sexual abuse. This book, which contains many humorous cartoon-type drawings and clever examples, treats bodies and adult sexuality positively and lacks the antisexuality found in many of the books. But all books of this type are suggestive if used as part of an assessment for suspected sexual abuse.

A completely inappropriate book is Don't Make Me Go Back Mommy: A Child's Book About Satanic Ritual Abuse (Sanford, 1990). This book contains explicit full-color pictures illustrating satanic rituals and is used to encourage the child to describe ritual abuse. One of the illustrations contains naked children in a ritual circle, black-robed figures, and a noose. This book presumes the reality of widespread satanic ritual abuse, despite the fact that there is no evidence suggesting organized satanic, ritual abuse actually occurs (Bottoms, Shaver, & Goodman, 1996). Using it to get information from children cannot produce reliable statements.

Drawings

Children's drawings drawings may be interpreted in a variety of ways. Tests such as the Bender-Gestalt and the House-Tree-Person provide information about perceptual-motor abilities and developmental level and can be useful for this purpose. But children's drawings are also used to assess possible sexual abuse (Conte et al., 1991; Kendall-Tackett, 1992). This latter use lacks empirical support.

The assumption underlying this use is that, since emotionally disturbed children are believed to reflect their problems in their drawings (e.g., Di Leo, 1973; 1996; Handler, 1996; Koppitz, 1968; Myers, 1978; Yates, Beutler, & Crago, 1985), the drawings of children who have been abused will differ from those of nonabused children. Free drawings, as well as the as the House-Tree-Person, Draw-A-Person, and Kinetic Family Drawings are used and qualitative features of the drawings, such as the colors used, the size and detail of body parts, and the shape of the figures may be interpreted in terms of the presence or absence of sexual abuse.

Burgess, McCausland and Wolbert (1981) claim that drawings in which a child exhibits a shift from age-appropriate figures to more disorganized objects or drawings with repeated stylized, sexualized figures indicate suspected sexual abuse. Sahd (1980) recommends using drawings as part of the evaluative interview of the sexual abuse victims and gives several examples of drawings that reflect abuse histories. Kelley (1984, 1985) believes that human figure drawings can be analyzed for "emotional indicators" (signs) in young children who are unable to verbalize their trauma.
Cantlay (1996) claims that distress and trauma, including sexual abuse, is reflected in drawings that include such signs as large heads, large, empty eyes, abundant hair, shaded clouds, knotholes in trees, large hands, large heads, large pointed teeth, abnormally tiny eyes, eyes without pupils, crossed eyes, excessive details, box-shaped bodies, poorly integrated body parts, lack of gender differentiation, hair that is long at the sides or thinning at the crown, wedge-shaped windows, extraneous circles, and large smoke trails coming out of the chimney. She cautions, however, that trauma can only be determined from a series of drawings which contain a number of these signs and that a single characteristic is not enough to indicate abuse.

The presence of genitalia is often considered a sign of sexual abuse because it is considered rare for normal, nonabused children to include genitals in their drawings (Di Leo, 1973, 1996). Cantlay (1996), Hibbard, Roghmann, and Hoekelman (1987), and Kelley (1984, 1985) claim that the presence of genitalia in drawings means possible sexual abuse, Yates et al. (1985) believe that incest victims either exaggerate or minimize sexual features in their drawings and Miller, Veltkamp, and Janson (1987) state that sexualized drawings indicate sexual knowledge beyond a child's years.
Empirical support for all these claims is extremely weak. In addition, a major difficulty with these assumptions is that sexually abused children are likely to have been interviewed about sexual abuse, have perhaps undergone a distressing genital examination, and/or have been placed into sexual abuse therapy. They are likely to have been shown undressed anatomical dolls where their attention is focused on the genitals. They may have been asked repeatedly to describe the details of the abuse. Therefore, genitalia may well become salient and it is not surprising that some of these children will include genitals in their drawings. In addition, other factors, such as family nudity, the birth of a sibling, or viewing an X-rated video may affect the tendency of a child to include sexual details in a drawing.

We have seen many examples of drawings by children that are erroneously interpreted as bolstering a conclusion of sexual abuse: For instance:
· A 4-year-old girl drew nothing but circles which she called "caves." One of the drawings looked to the psychologist like male genitalia-when asked what it was, the child said it was "a ball rolling into a lion's cave." The psychologist said this meant the child has been subjected to some type of traumatic experience. But when we saw evaluated the child, now age 5, we found that she was of borderline intelligence and could not do any kind of drawing task. All she could do was make scribbled circles.
· The child, when asked to draw a tree, also drew a cactus (Figure 2). This was interpreted in terms of "unconscious expression of danger and fearfulness." However, the child was not asked if she had a cactus in her yard (this was in Texas).
· The 7-year-old girl drew a picture of herself and her sister with their hands up in the air with the father standing next to them and smiling (Figure 3). She told the psychologist that she and her sister were "cheering at a show." But the psychologist claimed that this really signified a "helpless posture." She saw it as significant that there were no fingers drawn on the hands and that the hands were large on the father-she claimed that abused children put large hands on the drawings of their perpetrators. She also said that the thick lines in the crotch in the picture of the father meant an emphasis on genitals, was probably a penis, and showed anxiety about the father. She concluded that the girl, who continued to deny allegations of sexual abuse by the father, had, in fact, been sexually abused by the him.
· Hundreds of drawings over two years were interpreted by a psychologist who saw two girls in a day care case with allegations of ritualistic satanic abuse complete with costumes, masks, dead animals, sacrificed babies, blood, feces, skeletons, and monsters. These allegations only surfaced during therapy. The psychologist depended heavily upon the children's drawings in forming conclusions about satanic ritual abuse. But all of the drawings were typical of the types of scribbles and rudimentary figures drawn by 3- and 4-year-olds. In her deposition the psychologist said that what she believed was significant included practically every characteristic she believed she saw in the drawings:

Shapes that are untypical for 3- and 4-year-old children
Shapes that are phallic symbols.
Jiggly lines that indicate anxiety
Straight mouths that mean people can't say anything.
Jagged mouths that mean anxiety.
A mouth that is open and oval shaped
Darkened eyes
Eyeballs that are scribbled around
Eyes that are two different colors
Drawing something and then covering it up
Drawings something and not talking about it
Colors are very important and significant:
Black means the child is frightened or distressed; black is a morbid down color
Red means angry, unless the child is drawing a pretty red flower, when it is healthy
If everything is the picture is red or red and black, this is very suspicious.
Blue, brown, and orange mean fear, anger, and depression
Pink, red, and green are healthy colors

There are no empirical data to support these types of interpretations. Despite their frequent use in child abuse investigations, drawings are subject to the same criticisms as the anatomical dolls (Underwager & Wakefield, 1990; Wakefield & Underwager, 1988, 1989, 1994). Interpretations of drawings lack validity and reliability as projective assessment devices. In a review of the Draw-A-Person test in the Seventh Mental Measurements Yearbook, Harris (1972) states that there is little evidence for the use of "signs" as valid indicators of personality characteristics. In fact, there is so much variability from drawing to drawing that particular features of any one drawing are too unreliable to say anything about them. Reviews by Cundick (1989) and Weinberg (1989) in the Tenth Mental Measurements Yearbook note that there are no normative data establishing reliability and validity of the Kinetic Drawing System. Smith and Dumont (1995) state that four decades of research have failed to support the validity of human figure drawings in assessing personality, behavior, or intelligence. They observe that the confirmatory biases expressed in anchoring errors predispose clinicians to find support for their initial opinions in whatever material the client provides.

There are serious methodological problems with the few studies that claim to find differences between sexually abused and nonabused children. As with the anatomical dolls, studies with drawings with children suspected of being abused would have to take place before children underwent physical examinations, interviews, or therapy since these could affect their drawings. The persons who rated the drawings would have to be blind concerning the child's status regarding abuse. Ideally, a study would involve children who were all suspected of being abused who, based on subsequent evidence, could be divided into those who have and have not been abused. None of the studies meet these criteria.

Another common drawing technique is an outline of the back and the front of a naked male or a female. These cards are ostensibly used to enable the interviewer to learn what terms the child uses for body parts. However, this suggests that the purpose of the interview is to talk about sexual matters. The interviewer also may also tell the child to put an X where he or she was touched, which gives the message, "You were touched, now show me where." A recent New Zealand research report questions whether this constitutes a prompt or priming technique and states that drawings increased errors and confabulation in children's accounts (Rawls, 1996).

Nevertheless, drawings may be useful evaluation aids. They can provide information about possible perceptual-motor difficulties and developmental delays. They can help build rapport and encourage narrative accounts. Goodwin (1982) had children complete the Draw-A-Person task and the Kinetic Family Drawing and also asked them to draw whatever they wanted, to draw the whole family doing something together, and then to draw a picture of the alleged perpetrator. She reports that drawings were helpful in understanding the child's fears and anxieties, her view of the family, and her self-image, and in opening up a workable line of communication between the evaluator and the child. She cautions, however, that by themselves drawings are not sufficient to form diagnostic conclusions. Miller et al. (1987) report that, once a child has drawn a picture, he or she becomes highly verbal regarding the contents of the drawing. They believe that drawings are less threatening to a child who is hesitant to talk.

But drawings must not be used suggestively or the child's description of the drawing selectively reinforced. It inappropriate to tell a child who has not mentioned anything about abuse to "draw me a picture of what daddy did to you." Any useful information about possible abuse will come from the child's explanations of the drawing and spontaneous narratives that this elicits. Details and signs in the drawings itself cannot be projectively interpreted. Drawings may be valuable in building rapport and in facilitating communication but they cannot be used in the absence of a description from the child to draw conclusions about abuse.


Other Projective Techniques

Other image-based projective techniques are often used in child abuse assessment. The Rorschach Ink Blot Test, which can be used with children as young as 5, consists of 10 inkblots on white backgrounds (Rorschach, 1921). The child is asked what the ink blot "looks like" and asked to explain the response. Although the responses are believed to reflect personality characteristics, there are serious doubts about the Rorschach's validity, and hence usefulness, as a diagnostic technique (Dawes, 1994; Wakefield & Underwager, 1993; Ziskin, 1995).

Another well-known projective test is the Thematic Apperception Test (TAT). The TAT consists of 31 ambiguous pictures depicting a variety of situations or dramatic events and the person is asked to tell a story about the characters (Murray, 1943). Although scoring systems have been developed for analyzing the responses, none have received widespread acceptance. Practitioners are likely to use different systems, idiosyncratic systems, or no systems at all; therefore, despite its popularity, the TAT lacks reliability and validity (Ryan, 1985). A similar test intended for children ages 3 to 10 is the Children's Apperception Test (CAT) (Bellak & Bellak, 1980). The CAT, which consists of 10 pictures depicting anthropomorphic animals in a variety of situations, also lacks norms and data on reliability and validity.

The Storytelling Card Game (Gardner, 1988) consists of 24 different scene cards and 15 figurines, ranging in age from infancy to old age. The child is asked to select one or more figurines, place them on the card, and tell a story. This technique is not suggestive in terms of sexual abuse and may be used as a rapport builder or interview aid. There are no data on its reliability or validity and it cannot be considered a psychological test.

The Projective Story Telling Cards (Caruso, 1990) consist of a series of cards with drawings on them depicting a wide variety of situations. There are no standard instructions for administration and the evaluator is instructed to select cares that represent particular concerns. The manual gives the example of choosing cards that may represent circumstances of sexual abuse when evaluating a child where child protection believes the child may have been abused by a live-in boyfriend.
Many of the cards are relatively neutral or ambiguous, and may serve the same function as does a carefully-chosen book. But other cards are highly suggestive. Some depict adults and children in bed wearing only underwear with cameras prominently displayed. One depicts a young child with his mouth open standing a few inches in front of the open fly of an adult male. Several show graphic satanic ritual abuse scenes, including one in a graveyard with robed adults standing around a fire, holding a baby with its head cut off. Although the publisher claims that these cards represent "a relevant, meaningful, and useful tool" for assessment, there are no data concerning reliability and validity.


Play Therapy Toys

In play therapy, the assumption is that the child expresses and works out conflicts and problems through play. There are many different toys to choose from and the toy chosen along with the child's play with these may be interpreted in terms of suspected sexual abuse. For example, in one case, the child made long rolls out of play dough, which were interpreted as penises by the therapist. When the child then cut the play dough into pieces, this was interpreted as reflecting anger at the alleged perpetrator (the father).

The symbolic interpretation of play behaviors as images representing something else is a psychoanalytic concept. In 1905 Freud used the case of Little Hans to suggest the play of little children represents conscious and unconscious wishes and fears. Psychoanalytic therapists take for granted that children's behaviors can reveal troubling unconscious factors otherwise not available to either the child or the observer (Slade & Wolf, 1994).

Play therapy for sexual abuse is sometimes called "disclosure-based" and the sessions focus on reenactments in play, expressing feelings, and talking repeatedly about the alleged abuse. Although there is no evidence that play therapy is an effective therapeutic procedure (Campbell, 1992b; Underwager & Wakefield, 1990; Wakefield & Underwager, 1988, 1994; Weisz & Weiss, 1993), children are frequently given therapy for sexual abuse before there has been any legal determination that sexual abuse has occurred.

There is no support, however, for the supposition that specific interactions with toys in play therapy can be used as signs to establish the truth of past events. The same objections raised earlier about the projective "sign" interpretation of drawings are relevant here. Also, disclosure-based play therapy can influence children to accept the beliefs of the therapist and can be a contributing factor in cases of false allegations (Campbell, 1992a).


Image-Based Techniques in The Cognitive Interview

Children's reports of events based on their free recall are quite accurate, but young children provide very limited amounts of information. Therefore, the task of the interviewer is to encourage children to provide more information without asking leading questions which risks increasing error. The cognitive interview involves techniques designed to elicit from a child as complete a narrative report of the event as possible. Although much in the cognitive interview is similar to other suggestions about how to conduct an effective and nonsuggestive interview, the cognitive interview is distinguished by its memory-jogging strategies.

Several research studies on the cognitive interview indicate that it does improve the accuracy and increase the amount of information (Fisher & McCauley, 1995; Powell & Thomson, 1994). Studies with children also suggest that, in comparison with a standard interview, the cognitive interview results in more correct facts recalled without an increase in errors (Fisher, 1995; Fisher & McCauley, 1995; Saywitz, Geiselman, & Bornstein, 1992). There are limitations in generalizing from this research since none of the children were younger than 7 and the events have not involved personally experienced, traumatic events. In addition, the interviews in the research studies took place shortly after the event, but in the real world, investigatory interviews may take place months later.

Nevertheless, several of the image-based suggestions may be useful in interviewing children about alleged abuse. Modifications of the techniques are necessary with young children since some of the specific techniques are not appropriate with children. For example, before a certain age, children do not appear to understand some of the memory strategies (Bekerian & Dennett, 1995).
One memory retrieval technique involves attempts to recreate the original context or circumstances. The witness is instructed to mentally recreate the environmental, cognitive, physiological, and affective states that existed at the time of the original event (Fisher & McCauley, 1995). We have used family photographs, favorite toys, and familiar objects to help young children picture the circumstances, persons, and feelings surrounding the alleged events. We then encourage free narrative recall by asking them to tell everything that happened that they can remember.

For example, a father who had not seen his 4-year-old son in over a year provided a favorite toy that had been left with him. The child remembered the toy with affection and began talking about playing with his father. Another child, who initially recalled very little about life with her father, recalled several relatives and incidents when looking at family photographs. A child was able to talk about when he was in day care after looking at several photographs of the day care center. The value in such objects lies in tapping into the child's free recall. If suggestive and leading questions are asked about the objects, the risk of error in greatly increased.

Another way of reinstating the context is by imaging. The child can be asked to close her eyes and try to picture the event and the circumstances surrounding it. She can be asked to report everything she pictures in her mind about it, no matter how small. With children, however, it is important to stress that they should only describe actual events that have happened.

Children who are old enough to understand the instruction can be asked to describe the incident from a different perspective, that is, as if someone else were watching, what they would have seen. They can be asked what the incident would have looked like from the doorway or from the ceiling. Since the words "imagine" or "pretend" may be perceived as an instruction to fantasize, these terms should be avoided with young children.

For children who are old enough, backward order recall may allow increased information to be produced. The child can be asked to picture the events in backward order beginning with the end, then the middle, and then the beginning. After each response, the child is asked, "What happened right before that?" This technique, however, will be confusing to younger children who have not developed the necessary knowledge about time and sequencing.


Conclusions

Given the lack of demonstrated validity and reliability for many image-based techniques used in obtaining information from children, there are serious questions about the ethical quality of their use. The use of invalid techniques and techniques when there are questions about competency is proscribed by the 1992 American Psychological Association's Ethical Principles and Code of Conduct (Bersoff, 1995; Smith & Dumont, 1995; Dumont & Smith, 1996). Since it is not possible to be competent in doing something that nobody knows how to do to produce outcomes at a better than chance level (Underwager & Wakefield, 1989), until there is sufficient research to show a technique can meet the requirements for validity and reliability, it is best to remain cautious and use only those which can be defended adequately. Knowledge and understanding of the developmental capacities of children to use one object to represent another must also be demonstrated. Whatever techniques are used, any limitations or qualifications to any opinion based on the use of images must be clearly stated.

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