HOUSTON -- Sexual abuse allegations in a child custody case are not always true, and even professionals who work with these children can have trouble distinguishing fact from fantasy in the children's stories, Joseph Kenan, M.D., said at the annual meeting of the American Society for Adolescent Psychiatry.
When a forensic psychiatrist evaluates potential sexual abuse of a child in a custody case, he or she considers a host of factors, including the child's age, any physical or mental disabilities, and a child's feelings of alienation toward one parent or history of siding with one parent during arguments, he said at the meeting cosponsored by the University of Texas South-western Medical Center at Dallas.
Although psychiatrists use careful questioning and information-gathering skills to evaluate children's allegations, a study of 12 professionals showed that none of them could tell the difference between true and false stories after viewing videotapes of 10 different child testimonies, said Dr. Kenan, chief forensic psychiatrist at the Psychological Trauma Center, a nonprofit organization affiliated with Cedars-Sinai Medical Center in Los Angeles.
That said, keeping some statistics and general points in mind helps interviewers evaluate children or adolescents and their allegations.
The definition of child or adolescent sexual abuse covers a range of activities: intercourse, attempted intercourse, oralgenital contact, fondling of the genitals directly or through clothing, exhibitionism, exposing children to adult sexual activity or pornography, and exploiting a child for prostitution or pornography.
The prevalence of child or adolescent sexual abuse varies as a function of its definition, but in general, 12%-35% of women and 4%-9% of men report unwanted sexual experiences by age 18 years, Dr. Kenan said at the meeting. Data from the U.S. Department of Health and Human Services show that approximately 40% of childhood sexual abuse victims are adolescents aged 12-18 years, which means that the majority of victims are younger than 12 years.
In addition, people of higher socioeconomic status may be better able to hide incidents of abuse. Race and ethnicity, however, do not appear to be risk factors for sexual abuse in parental custody cases.
Having a stepfather at home doubles the risk of sexual abuse for a girl. "That does not mean that the stepfather is the abuser. Sometimes the mother's past boyfriends abuse the girls," Dr. Kenan said. Having a mother with mental illness or alcohol or substance abuse problems also increases a child's risk of sexual abuse.
Few studies have examined the incidence of sexual abuse in custody cases. In a 1990 study of 12 family law courts across the country, investigators asked the courts to report all sexual abuse cases during a 6-month period and found that less than 2% of all custody disputes in eight of the courts involved allegations of child sexual abuse. Although small, the incidence of child sexual abuse in the custody cases was six times higher than the incidence of sexual abuse in the general population (Child Abuse Negl 1990; 14:151-63).
If allegations of child or adolescent sexual abuse arise in custody cases, the court usually orders an evaluation. If the allegation is later found to be false, the relationship between the child and the accused parent can be subjected to unnecessary strain, but if the court does not investigate and remove the child from a dangerous situation or order supervised visits, there is a risk that he or she will be abused again, Dr. Kenan explained.
Remember that a child can make false accusations for different reasons. "I've had cases where Child Protective Services has supported the interviews and got it all wrong, and it later surfaced that no abuse occurred," he said.
Parental alienation--when one parent programs a child against the other …