Book Review

True and False Allegations of Child Sexual Abuse: Assessment and case management

N Engl J Med 1995; 333:1573-1574December 7, 1995

Article

True and False Allegations of Child Sexual Abuse: Assessment and case management
Edited by Tara Ney. 371 pp. New York, Brunner/Mazel, 1995. $45.95. ISBN: 0-87630-758-6

This scholarly and generally balanced book provides a comprehensive review of developing knowledge about the clinical assessment and management of suspected sexual abuse of children. It includes contributions by 35 authors from five countries. The reader will find no cookbook recipes for discriminating true cases of alleged child sexual abuse from false ones here. Instead, there are chapters addressing children's sexual behavior, memory, language development, and understanding of truths, lies, and false beliefs. Special considerations in the evaluation of very young children, sexual abuse of adolescents, allegations by separated parents, ritual-abuse cases, and the abuse of children with disabilities are the subjects of other chapters. Current research on medical findings, the assessment of the sexual preferences of men accused of sexual abuse, and the family dynamics of incestuous families is discussed, and appropriate warnings are given regarding their limitations in identifying sexually abused children or abusers.

Statement assessment, a technique used in Germany and other European countries where experts can testify about the credibility of child witnesses, and cognitive interviewing, a promising technique for increasing the amount of accurate information a witness provides without increasing errors, are also covered. Unfortunately, the chapter on statement assessment does not inform readers that U.S. courts do not usually allow experts to offer opinions on the truthfulness of witnesses. A chapter on the recovery of repressed memories during psychotherapy with adults serves to caution child therapists against contaminating and distorting the recollections of the children and adolescents they see.

My strongest reservation about this book is its failure to present both sides of the argument about the admissibility of behavioral-science testimony on whether or not a child was sexually abused. Both Ney and Limber espouse the view that psychologist Gary B. Melton originally articulated in 1987. They believe that such testimony should not be allowed and that, even when a court wishes to hear this kind of testimony, it is unethical for an expert to give it. A more complete and balanced discussion of the issue is contained in an article by Myers et al. on expert testimony in child sexual abuse litigation (Nebraska Law Review 1989;68:1-145). Both the American Academy of Child and Adolescent Psychiatry and the American Professional Society on the Abuse of Children have issued practice guidelines that specifically endorse the appropriateness of this kind of expert opinion. The opposing view lacks such endorsement, and in the United States, appellate court decisions have been divided for and against. Indeed, if experts should not present their conclusions on whether a child has been sexually abused, there is less reason for us to continue pursuing scientific knowledge and seeking the best clinical methods for discriminating sexually abused from nonabused children. There would also be less need for clinicians to read this book. Judges and jurors would be the appropriate readership. Sadly, most judges are probably too busy to read it and most jurors will not realize their need for it until seated on a jury in a child sexual-abuse trial, and then it will be prohibited.

Nevertheless, physicians concerned about child sexual abuse will find this book a valuable resource, with many reasonable recommendations for practice succinctly listed at the end of each chapter.

David L. Corwin, M.D.
Children's Hospital Medical Center, Cincinnati, OH 45267-0539