Ambiguity, Barriers, and Contradictions: The ABCs of Child Abuse Allegations

James C. Overholser^*

ABSTRACT: Variables that impede the accurate identification and reporting of child sexual abuse include ambiguity, barriers, and contradictions.  Ambiguity refers to the difficulties involved in knowing if a situation should be considered abusive and whether the observer needs to respond to the situation as a crisis.  Barriers come into play once other people know abuse has occurred but their assistance can still be delayed or inhibited by many psychosocial factors.  Barriers to the identification and effective treatment of child abuse include stigma, secrecy, blame, and diffusion of responsibility.  Once the problem has been identified and reported, many factors can obscure the accurate portrayal of the events that happened.  Child abuse allegations are fraught with contradictions arising because of circumstantial evidence, lack of corroboration, and contamination of interviews.  Recommendations are made to help ensure the prompt and accurate identification, reporting, and prosecution of child abuse cases.
  

Sexual abuse of children has become an increasing concern over recent years.  This is partly due to the increased rates of child abuse reports (Russell, 1984).  In addition, a number of societal factors play a role in the increased incidence of child abuse.  Higher rates of divorce and remarriage place a child at risk for abuse by a stepparent (Finkelhor, 1984).  Also, in today's society, many young children spend 30 to 50 hours per week in child care settings, placing them at risk for abuse by a nonrelative caretaker.  Finally, the media has played a role in making many cases of child abuse important news topics. S uch media coverage has served to reduce the social hesitations to openly discuss the taboo topic of child abuse.

It has been estimated that only 20% of actual cases of child abuse ever come to the attention of professionals (Finkelhor, 1984).  Thus, the majority of cases are never detected or reported.  Besides the substantiated cases of abuse, an additional number of complaints arise but cannot be substantiated.  Estimates of false accusations have ranged from 3% to 65%.  Quinn (1988) argues that 3% to 8% of child abuse allegations are completely false.  Jones and McGraw (1987) found 22% of cases to be unsubstantiated and another 8% to be completely fictitious.  Richardson (1990) argues that 65% of all reported cases of abuse are unsubstantiated.  One recent study (Eckenrode et al., 1988) found 61% of sexual abuse reports were unsubstantiated.  It should be remembered that unsubstantiated complaints do not necessarily mean false accusations (Quinn, 1988).  Even when an allegation is false, young children may believe they have been telling the truth (Yates & Musty, 1988).  Because of the disagreement described above, professionals involved in potential cases of child abuse must be prepared to distinguish true from false accusations.

An important distinction to be made in any assessment situation involves identifying errors of prediction.  The two main prediction errors are false positives and false negatives.  False positives refer to cases where abuse is said to occur when it actually did not.  False negatives refer to cases in which no abuse is noticed even though it has actually occurred.  These two prediction errors are based on the notions of specificity and sensitivity.  Specificity refers to the ability of information to help identify people who are not abusive, i.e., true negatives (Schneider, Helfer, & Hoffmeister, 1980).  Sensitivity refers to the ability of the information to help identify people who actually have become abusive, i.e., true positives (Schneider et al., 1980).  For example, the use of anatomical dolls has been questioned because they are sensitive but lack specificity of the information obtained (Realmuto, Jensen, & Wescoe, 1990).  Anatomical dolls are likely to elicit sexual reenactments in older children even if they have never been abused (Everson & Boat, 1990).  This could lead to false positive accusations of abuse.  Because of the limited amount of research done on child abuse risk assessment instruments, high rates of false positives are likely (Wald & Woolverton, 1990).

Different sources of information have different utility.  Most symptoms of child abuse are nonspecific in focus.  Such nonspecific symptoms include anxiety, depression, social withdrawal, somatic complaints, substance abuse, and a sudden reduction in school performance (Benedek & Schetky, 1987b).  The use of nonspecific symptoms can lead to high rates of false positive diagnoses (Quinn, 1988).  For example, many sexually abused adolescents cope with the abuse by attempting suicide or running away from home (Goodwin & Owen, 1982).  However, this does not mean that all adolescent suicide attempters or runaways have been sexually abused.  Thus, professionals must be cautious in the behaviors that are assumed to indicate child abuse has occurred.  More specific indicators of child sexual abuse include overt sexual acting out, simulation of sexual activity, fear of being left alone with a particular adult, and tissue damage around the genital area (James & Nasjleti, 1983).

Professionals must resist the tendency to decide quickly whether abuse has occurred (Ross & Blush, 1990).  The possibility of a false positive diagnosis is increased when the professional ignores or fails to examine disconfirming evidence (Wakefield & Underwager, 1988).  A professional who enters the interview holding preconceived ideas about what did or did not happen will structure the interview so as to get the information needed to support these ideas (Quinn, 1988).  It is essential for all professionals to keep an open mind during the data collection stage of the investigation process (Jones & McGraw, 1987).  Alternative explanations should be examined before reaching a decision (Wakefield & Underwager, 1988).  Professionals may need to focus less on what the child says happened, and more on possible motivating factors in the child or accusing parent (Schuman, 1986).  Also, nonsexual stressors should be identified that could be causing the emotional reactions in the child (DeYoung, 1986).  Most symptoms of abuse are nonspecific and could arise for many different reasons.  Other stressors capable of causing symptoms of emotional distress in the child include the pressure to lie about abuse that did not really occur (DeYoung, 1986).

The present review will focus on variables that impede the accurate identification of child sexual abuse.  First, variables will be examined that make it difficult for observers to know whether abuse has occurred.  Second, barriers will be examined that inhibit the accurate reporting of known cases of abuse.  Finally, the many contradictions inherent in cases of suspected abuse will be discussed.
  

Ambiguity

Ambiguity refers to the difficulties involved in knowing if a situation should be considered abusive and whether the observer needs to respond to the situation as a crisis.  It can be surprisingly difficult to know if and when to respond to a possible case of child abuse.  The literature on bystander intervention (Latane & Darley, 1970) can shed some light on these issues.  The bystander intervention research examines variables capable of promoting or inhibiting the tendency of an observer to help another person during an emergency.  An important factor causing a reduction in bystander intervention involves ambiguity.  Most emergencies begin ambiguously and can be interpreted in a variety of ways.  Some people admit to not reporting suspected child abuse because they couldn't be sure that abuse was really taking place (Finkelhor, 1984).  It can be difficult to ascertain what factors define a situation as an emergency.  People often take their cues from the environment, the victim, and other bystanders.

Cues from the environment may be weak and inadequate.  Previous research has shown that child sexual abuse is more likely to occur in broken homes, with a stepfather being a frequent perpetrator (Swanson & Biaggio, 1985).  Also, child sexual abuse is more likely to occur when children share a bed with their parents.  Such environmental factors may increase the risk for abuse, but are not strong enough to clearly indicate an abusive situation is present.

Another "environmental" factor is divorce.  Many cases of false accusations arise during divorce and child custody proceedings (Paradise, Rostain, & Nathanson, 1988).  It can be important to examine revenge or manipulation as possible motives underlying the accusations.  The underlying conflict between the parents may be a motivating factor behind an unsubstantiated accusation (Paradise et al., 1988).  A falsely accusing parent may appear vindictive, attempting to hurt the other parent without regard for the impact on the child (Wakefield Underwager, 1988, 1990).  Thus, child abuse accusations arising as part of a divorce or custody battle may suggest a tendency for false positive accusations.  However, the couple may seek a divorce when one parent finds the other parent sexually abusing their children.  Thus, divorce may be common in both true and false cases of abuse, causing the situation to remain ambiguous.

Cues from the victim may be quite ambiguous.  For example, if a four-year-old girl says she hates going to preschool, dislikes being left with a babysitter, or hates spending the weekend with the divorced father, it can be difficult to ascertain whether it is due to child abuse, separation anxiety, or other factors.  Situations like these often involve separation anxiety and are a natural part of development.  However, several authors (e.g., James & Nasjleti, 1983) warn that fears about going to certain places or spending time alone with specific people may be a warning sign that child abuse is occurring.  This may be the child's way of indirectly communicating about the abuse.  Even when abused children attempt to report the abuse, they often speak in riddles or provide indirect clues about the abuse.  Therefore, it takes skill, patience, and experience to accurately decipher the cryptic comments often made by sexually abused children (Ortiz y Pino & Goodwin, 1982).

Emotional reactions to the abuse can provide an important clue.  The child's emotional state should be consistent with the disclosure of abuse (Wehrspann, Steinhauer, & Klajner-Diamond, 1987).  Abused children typically feel nervous and reluctant to discuss the abuse (Wakefield & Underwager, 1988).  However, emotional reactions are less likely to occur in boys (Faller, 1988) and may be a consequence of the pressure to lie instead of due to any actual abuse (Bresee, Stearns, Bess, & Packer, 1986).  Also, severe abuse may lead to emotional blunting in the child (Jones & McGraw, 1987).  The child may begin to withdraw and display constricted emotional responses.  Thus, the situation remains ambiguous.  Both abused and nonabused children may fail to display the expected emotional reactions.

Cues from other bystanders may be counter-productive and can inhibit the urge to help.  If an observer is involved in a possible emergency but sees no one else responding, the inactivity of the other bystanders may suppress the urge to help (Latane & Darley, 1970).  However, the other bystanders may be temporarily frozen by confusion or fear and thus give the mistaken belief that they are not concerned.  In cases of physical abuse of children, it has been found that abusive mothers often admit to the abuse when talking with friends or family members (Korbin, 1989).  However, these friends and family members may minimize the seriousness of the abuse, perhaps describing it as appropriate disciplinary tactics.  This can result in a continuation and escalation of the abuse and the eventual death of the child (Korbin, 1989).  Also, the situation can be similar to cases of spouse abuse where friends may minimize the problem and push the victim back into the abusive relationship (Overholser & Moll, 1990).  It can be a very difficult decision for the nonabusing parent to discriminate when her spouse is just having a bad day versus when it becomes a pattern of abuse.

In false positive cases of abuse, the complaining parent may be affected less by pure fabrication and more by a tendency to overreact to minor pieces of evidence (Bresee et al., 1986, Wakefield & Underwager, 1990).  Many cases of alleged sexual abuse involve incidental sexual contact, such as that which occurs while bathing a young child or sharing a bed with a child (Summit & Kryso, 1978).  It can be important to distinguish between abusive and hygienic touching (Quinn, 1988).  Although physical contact is a necessary and important part of parenting, it is unclear when it becomes abusive.  There are no clear standards to distinguish nurturant from sexual behavior (DeJong, 1985).  Simple misunderstandings occur when the child or accusing parent misinterprets physical displays of affection (Mantell, 1988).  It can be difficult to distinguish between normal affection and eroticized contact.  Likewise, it can be extremely difficult to identify the line separating normal discipline from physical abuse.  Corporal punishment is still accepted by many parents.  Anxious parents may read too much into borderline situations (Benedek & Schetky, 1987b).  Thus, a large part of ambiguity lies in the difficulty separating normal from abnormal behavior.

Ambiguity reduces the likelihood that observers will perceive the abusive situation as abusive and respond in a prompt manner.  This is likely to increase the rate of false negative and reduce the rate of false positive cases of abuse.  Because of the ambiguous nature of most cases of abuse, many true cases of abuse are likely to go unnoticed.
  

Barriers

There are numerous barriers to the identification and effective treatment of child abuse.  The barriers come into play once other people are aware of the abuse and they know they need to respond, but their assistance can still be delayed or inhibited by many psychosocial factors.  Many parents fail to respond to the abuse in a prompt manner, often letting the abuse continue for an extended period of time (Adams-Tucker, 1982).  When under pressure to make important decisions, people often postpone and procrastinate (Janis & Mann, 1977).  The decision to report a spouse is a no-win situation for accusing parents.  Either they report the abuse and completely destroy their marital relationship, or they do not report it and allow the abuse to continue.  Barriers to reporting the abuse include stigma, secrecy, blame, and diffusion of responsibility.

There is a terrible stigma associated with being a victim of sexual assault (Finkelhor & Browne, 1985).  The stigma implies the abused child is bad or guilty.  Many victims feel marked or branded by the sexual victimization (Browne & Finkelhor, 1986).  The stigma may result in feelings of depression, despair, and low self-esteem in the child.  Even false accusations may result in negative consequences for the child and the parents (Richardson, 1990).  Both valid and false accusations may result in similar problems, including marital separation, divorce, loss of friends, loss of job, and loss of home (Richardson, 1990).  Parents falsely accused of incest are likely to be abandoned by friends and colleagues (Benedek & Schetky, 1987b).  Because of the stigma surrounding child abuse accusations, many adults may be reluctant to report suspected cases of abuse.

Because of the stigma, secrecy develops.  Incestuous families are known to become extremely secretive (Swanson & Biaggio, 1985).  The secrecy can make it difficult for others to know and understand the family dynamics that are involved.  The secrecy and collusion within the family serves as a barrier for any family member to report the abuse.  There are strong norms against informing on one's family members (Finkelhor, 1984).  Incestuous uncles are often able to pressure the child's mother to not file charges against them (Browning & Boatman, 1977).  This makes sense in light of the literature on bystander intervention.  The likelihood to intervene may be reduced if the bystander knows the offender (Latane & Darley, 1970).  Thus, child abuse reporting may be impeded by the relationship between the abusive adult and the bystanders.  Bystander intervention is reduced when there are other observers around because of diffusion of responsibility.  The bystanders assume someone else can report the abuse.  This may be related to a fear of retaliation.  Some people report being unwilling to report suspected child abuse due to a fear of retaliation by the offender (Finkelhor, 1984).

Tendencies for blame disrupt the reporting process.  Some individuals are capable of blaming the offending adult.  However, it is fairly common for nonabusive parents to blame themselves.  They may feel they should have known about the abuse earlier and should have prevented it.  This self-blame can cause depression and low self-esteem, and may result in a reduced tendency to report the abuse.

Some uninformed people blame the child.  They may see erotic tendencies in the sexually abused child as a precipitant of the abuse instead of the consequence of coercive sexual activity (Yates, 1982).  There is a direct relationship between the duration and intensity of sexual abuse and the subsequent eroticization of the child (Yates, 1982).  Even professionals may be affected by the blaming process.  One professional (Virkkunen, 1981) has defined a subgroup of child victims as "participating victims," stating "Without doubt, the child victim's own behavior often plays a considerable part in initiating and maintaining a pedophiliac crime" (p. 130-131).  Apparently, this author has relied more on reports from the offending adults than from objective evidence.  Similar to spouse abuse (Overholser & Moll, 1990) incestuous parents tend to externalize the problem by attributing the cause to other people including the victim.

Tendencies for victim self-blame cause another barrier.  Victims of abuse often tend to blame themselves.  Abused children often refrain from reporting the abuse out of fear of harming the abusive parent or breaking up the family (Ortiz y Pino & Goodwin, 1982).  The abusive adult may have warned the child that if the "secret" gets out, the adult will go to jail, the child's parents will get divorced, and the child may be placed in a foster home.  Because of the realistic nature of these threats, the child may protect the secret.  Young children typically feel protective of parents, even if the parent has been abusive (Benedek & Schetky, 1987a).  Thus, abused children may see themselves as the cause of the abuse.  After the initial episode of abuse, attributional patterns have been formed and tend to stabilize (Overholser & Moll, 1990).

Barriers reduce the speed or likelihood that abuse will he reported to the authorities.  Because the barriers inhibit reporting tendencies, barriers are likely to reduce the rate of false positive and increase the rate of false negative cases of abuse.  Similar to the effects of ambiguity, barriers are likely to result in more cases of actual abuse that go unreported.
  

Contradictions

Child abuse allegations are fraught with contradictions.  Once the problem has been identified and reported, many factors can obscure the accurate portrayal of events that happened.  Such contradictions reduce the likelihood that true cases of abuse will be justly prosecuted.  In order to reduce some of the contradictions, corroborating information from multiple sources is required.  Unfortunately, current practices have relied heavily on the child's report.  Because many developmental factors reduce the clarity of a child's report, it should not be used as the sole indicator of abuse (DeYoung, 1986).  The child's statement is affected by many distorting factors, including social pressure, guilt, shame, and fear (Green, 1986).  The child's stage of development can have a tremendous impact on language and memory abilities.  Child witnesses tend to be quite suggestible, perhaps because young children do not pay much attention to details (Cohen & Harnick, 1980).  Young children tend to be concrete and egocentric, which can obscure an allegation (DeYoung, 1986).  Children can be overly compliant and follow the lead of the interviewer.  Evidence from a child can be easily contaminated by the child's parents, police, or attorneys.  Even well meaning parents may contaminate the interview data.  Thus, the initial interview is very important in order to collect useful and uncontaminated data (Blush & Ross, 1990).

Consistency is the key to the accurate assessment of child abuse allegations.  It is best to have corroborating evidence from two or more independent sources.  Valid allegations require consistency over time, across people, and across methods of communication.  Although consistency of data is preferred, most evidence is usually filled with contradictions.  In cases of false accusations, the child may use verbal expressions that mimic the accusing adult (Ross & Blush, 1990).  The child's words and sentence structure should be congruent with the child's developmental level (Jones & McGraw, 1987).  Also, details of the abuse may be inconsistent with sexual physiology (Rogers, 1990) or extremely unlikely to occur (Wakefield & Underwager, 1988).

Consistency over time means the witness tells the same story on several different occasions.  In order to evaluate the consistency of a child's report, a minimum of two interviews are required (Quinn, 1988).  It can be a sign of falsification if the child's story vanes over time, especially when the details become increasingly abusive over time (Wakefield & Underwager, 1988).  Alternatively, consistency over time may reflect the repetition involved when numerous interviews are conducted with the child (Wakefield & Underwager, 1988).  Furthermore, some children need time away from the abusive situation before they feel secure enough to discuss the abuse (Sink, 1988).  Thus, the child's story may remain consistent for two reasons: (1) the events actually happened, or (2) the child has created and rehearsed a strong story line.  The story may change over time because of two reasons: (1) the child is making up the story, or (2) the child is gradually becoming able to discuss the details of the abuse.  Thus, the contradictions continue to obscure the accurate portrayal of events that happened.

Consistency across people refers to telling the same story to more than one person (Wehrspann, Steinhauer, & Klajner-Diamond, 1987).  Collateral reports are necessary to validate any child abuse allegation.  Definite conclusions regarding the abuse are not possible without corroboration (Jones & McGraw, 1987).  It is recommended that both parents be interviewed to evaluate the consistency between their responses and the allegations (Bresee et al., 1986).  Also, it has been recommended that all family members be interviewed individually (Goodwin et al., 1978).  This may allow the professional to identify abuse or deceit in the child's siblings.  Finally, the child's friends, teachers, and neighbors may provide useful information.  The truly abused child often complains of the abuse (or its effects) to someone other than the accusing parent (Bresee et al., 1986).  Thus, consistency of reports across different people can help reduce contradictions in child abuse accusations.

Consistency across methods of communication refers to corroborating data from the child's play or drawings (Wehrspann et al., 1987).  Abused children often display their distress and/or abuse through various modes of communication.  There should be agreement between the child's statement and other test data or play behavior (Bresee et al., 1986).  The possibility of a false allegation should be closely examined if the child fails to show any behavioral evidence of abuse.

Several authors have noted an interesting paradox in the child abuse literature.  Sheridan (1990) notes that both consistency and inconsistency have been used to indicate that abuse has actually occurred.  Consistencies in the child's report may suggest the abuse actually occurred, while inconsistencies in the child's report have been used to imply the child was too emotionally disturbed over the abuse to report it accurately.  Abused children are typically reluctant to discuss the details of the abuse.  However, in order to identify and prosecute cases of abuse, the child must describe what happened.  When a child spontaneously and easily provides details of sexual abuse, it may be a sign of fabrication (Green, 1986).  Thus, a contradiction exists: both a child that reports abuse and a child that never speaks of abuse may not have been abused.  In a similar way, the child may maintain or recant his story, and both situations may be used as support that abuse has occurred (Sheridan, 1990).  Retractions made by the child have been used to imply the abuse has actually occurred but the child is now afraid of the consequences to himself or to the offending adult (Goodwin, Sahd, & Rada, 1978).  Thus, both positive and negative evidence can be used to support or refute claims of abuse.

A cause of many problems can be found in the biased search strategies used by many professionals.  Selective attention to certain information or minimizing the importance of other information causes biases in the professional's judgment.  Professionals often tend to search for information that supports their initial impressions and disregard information that conflicts with their views (Nezu & Nezu, 1989).  Also, different professionals may hold different preconceptions.  Female therapists tend to identify with the victim while male therapists identify with the offender (Swanson & Biaggio, 1985).  In either case, such identification can reduce the professional's objectivity and detachment.  This can lead to problems when attempting to clarify the contradictory nature of most child abuse allegations.

Contradictions interfere with the prosecution of alleged abuse.  Because of the various contradictions, fewer cases of actual abuse will be prosecuted and more cases of falsified abuse may be prosecuted.  Thus, in contrast to the effects of ambiguity and barriers, contradictions are likely to increase the rate of false positive and reduce the rate of false negative cases of abuse.
  

Recommendations

There are numerous factors that impede the prompt and accurate assessment of child abuse accusations.  In general, all parties should remain cautiously aware.  Adults should be sensitive to the situations where abuse may be occurring, and respond in a prompt and caring manner.  Professionals must recognize and manage the ambiguity, barriers, and contradictions inherent in most cases of alleged child abuse.  Only by supporting factors that promote the prompt and accurate identification, reporting, and prosecution of child abuse can we hope to bring this serious problem under control.  Despite the current emphasis on false positive cases of abuse, the biggest problem continues to lie in cases of false negative allegations.  Despite the fact that diagnostic errors are influenced by the population base rate (Wakefield & Underwager, 1988), we still lack an accurate estimate of the prevalence of child abuse (James, Womack, & Stauss, 1978).

Factors causing ambiguity of the abusive situation should be reduced so as to facilitate the detection of true cases and minimize the reporting of false cases of abuse.  If adults have any reason to suspect child abuse has occurred, they must take prompt action to investigate.  It is not productive to assume someone else will protect the child.  Also, it is not wise to tolerate the ambiguity and assume nothing abusive has occurred.  However, it does not mean making accusations based on conflicting or circumstantial evidence.  Ambiguity can only be reduced by taking responsibility for investigating the situation in an objective manner.

A variety of barriers must be confronted in order to help people report suspected cases of abuse.  The stigma surrounding abuse must be reduced and collusion within families should be curtailed.  Only the offending adult should be blamed for the abuse.  Even though all parties play some role in the onset or continuation of the abuse, the offending adult is the only party that deserves blame.

The many contradictions inherent in child abuse accusations must be managed in order to prosecute the true cases of abuse.  Care must be taken to collect reliable and valid evidence in order to recreate an accurate portrayal of the events that occurred.  It will be important for professionals involved in possible cases of child abuse to reduce the confusion which follows when circumstantial evidence is used.  Also, it is essential to get corroborating evidence from other people and multiple assessment modalities.  In this way, it may be possible to improve society's ability to manage cases of suspected child abuse.
  

References

Adams-Tucker, C. (1982). Proximate effects of sexual abuse in childhood: A report on 28 children. American Journal of Psychiatry, 139, 1252-1256.

Benedek, E., & Schetky, D. (1987a). Problems in validating allegations of sexual abuse. Part 1: Factors affecting perception and recall of events. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 912-915.

Benedek, E., & Schetky, D. (1987b). Problems in validating allegations of sexual abuse. Part 2: Clinical evaluation. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 916-921.

Blush, G., & Ross, K. (1990). Investigation and Case Management Issues and Strategies. Issues in Child Abuse Accusations, 2(3), 152-160.

Bresee, P., Stearns, G., Bess, B., & Packer, L. (1986). Allegations of child sexual abuse in child custody disputes: A therapeutic assessment model. American Journal of Orthopsychiatry, 56, 560-569.

Browne, A., & Finkelhor, D. (1986). Impact of child sexual abuse: A review of the research. Psychological Bulletin, 99, 66-77.

Browning, D., & Boatman, B. (1977). Incest: Children at risk. American Journal of Psychiatry, 134, 69-72.

Cohen, R., & Harnick, M. (1980). The susceptibility of the child witness to suggestion. Law and Human Behavior, 4, 201-210.

DeJong, A. (1985). The medical evaluation of child sexual abuse. Hospital and Community Psychiatry, 36, 509-512.

DeYoung, M. (1986). A conceptual model for judging the truthfulness of a young child's allegation of sexual abuse. American Journal of Orthopsychiatry, 56, 550-559.

Eckenrode, J., Powers, J., Doris, J., Munsch, J., & Bolger, N. (1988). Substantiation of child abuse and neglect reports. Journal of Consulting and Clinical Psychology, 56, 9-16.

Everson, M. & Boat, B. (1990). Sexualized doll play among young children: Implications for the use of anatomical dolls in sexual abuse evaluations. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 736-742.

Faller, K. (1988). Criteria for judging the credibility of children's statements about their sexual abuse. Child Welfare, 67, 389-401.

Finkelhor, D. (1984). Child Sexual Abuse: New Theory and Research (). New York: Free Press.

Finkelhor, D., & Browne, A. (1985). The traumatic impact of child sexual abuse: A conceptualization. American Journal of Orthopsychiatry, 55, 530-541.

Goodwin, J., & Owen, J. (1982). Incest from infancy to adulthood: A developmental approach to victims and families. In J. Goodwin (Ed.), Sexual Abuse: Incest Victims and Their Families ()() (pp. 77-91). Boston: John Wright.

Goodwin, J., Sand, D., & Rada, R. (1978). Incest hoax: False accusations, false denials. Bulletin of the American Academy of Psychiatry and the Law, 6, 269-276.

Green, A. (1986). True and false allegations of sexual abuse in child custody disputes. Journal of the American Academy of Child and Adolescent Psychiatry, 25, 449-457.

James, B., & Nasjleti, M. (1983). Treating Sexually Abused Children and Their Families (). Palo Alto, CA: Consulting Psychologists Press.

James, J., Womack, W., & Stauss, F. (1978). Physician reporting of sexual abuse of children. Journal of the American Medical Association, 240, 1145-1146.

Janis, I., & Mann, L. (1977). Decision Making: A Psychological Analysis of Conflict, Choice, and Commitment. New York: Free Press.

Jones, D., & McGraw, J. (1987). Reliable and fictitious accounts of sexual abuse to children. Journal of Interpersonal Violence, 2, 27-45.

Korbin, J. (1989). Fatal maltreatment by mothers: A proposed framework: Child Abuse & Neglect, 13, 481-489.

Latane, B., & Darley, J. (1970). The Unresponsive Bystander: Why Doesn't He Help? ()() New York: Appleton-Century-Crofts.

Mantell, D. (1988). Clarifying erroneous child sexual abuse allegations. American Journal of Orthopsychiatry, 58, 618-621.

Nezu, A., & Nezu, C. (1989). Clinical Decision Making in Behavior Therapy: A Problem-Solving Perspective (). Champaign, IL: Research Press.

Ortiz y Pino, J. & Goodwin, J. (1982). What families say: The dialogue of incest: In J. Goodwin (Ed.), Sexual Abuse: Incest Victims and Their Families ()() (pp. 57-75). Boston: John Wright.

Overholser, J., & Moll, S. (1990). Who's to blame: Attributions regarding causality in spouse abuse. Behavioral Sciences and the Law, 8, 107-120.

Paradise, J., Rostain, A., & Nathanson, M. (1988). Substantiation of sexual abuse charges when parents dispute custody or visitation. Pediatrics, 81, 835-839.

Quinn, K. (1988). The credibility of children's allegations of sexual abuse. Behavioral Sciences and the Law, 6, 181-199.

Realmuto, G., Jensen, J., & Wescoe, S. (1990). Specificity and sensitivity of sexually anatomically correct dolls in substantiating abuse: A pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 743-746.

Richardson, D. (1990). The effects of a false allegation of child sexual abuse on an intact middle class family. Issues in Child Abuse Accusations, 2(4), 226-238.

Rogers, M. (1990). Coping with alleged false sexual molestation: Examination and statement analysis procedures. Issues in Child Abuse Accusations, 2(2), 57-68.

Ross, K. & Blush, G. (1990). Sexual abuse validity discriminators in the divorced or divorcing family. Issues in Child Abuse Accusations, 2(1), 1-6.

Russell, D. (1984). Sexual Exploitation: Rape, Child Sexual Abuse, and Workplace Harassment (). Beverly Hills: Sage.

Schneider, C., Helfer, R., & Hoffmeister, J. (1980). Screening for the potential to abuse: A review. In C. Kempe & R. Helfer (Eds.), The Battered Child, 3rd Ed. ()() (pp. 420-430). Chicago: University of Chicago Press.

Schuman, D. (1986). False allegations of physical and sexual abuse. Bulletin of the American Academy of Psychiatry and the Law, 14, 5-21.

Sheridan, R. (1990). The false child molestation outbreak of the 1980s: An explanation of the cases arising in the divorce court: Issues in Child Abuse Accusations, 2(3), 146-151.

Sink, F. (1988). A hierarchical model for evaluation of child sexual abuse. American Journal of Orthopsychiatry, 58, 129-135.

Summit, R. & Kryso, J. (1978). Sexual abuse of children: A clinical spectrum. American Journal of Orthopsychiatry, 48, 237-251.

Swanson, L., & Biaggio, M. K. (1985). Therapeutic perspectives on father-daughter incest. American Journal of Psychiatry, 142, 667-674.

Virkkunen, M. (1981). The child as participating victim. In M. Cook & K. Howells (Eds.) Adult Sexual Interest in Children () (pp.121-134). New York: Academic Press.

Wakefield, H. & Underwager, R. (1988). Accusations of Child Sexual Abuse ()(). Springfield, IL: Charles Thomas.

Wakefield, H., & Underwager, R. (1990). Personality characteristics of parents making false accusations of sexual abuse in custody disputes. Issues in Child Abuse Accusations, 2(3), 121-136.

Wald, M., & Woolverton, M. (1990). Risk assessment: The Emperor's new clothes? Child Welfare, 49, 483-511.

Wehrspann, W., Steinhauer, P., & Klajner-Diamond, H. (1987). Criteria and methodology for assessing credibility of sexual abuse allegation. Canadian Journal of Psychiatry, 32, 615-623

Yates, A. (1982). Children eroticized by incest: American Journal of Psychiatry, 139, 482-485.

Yates, A., & Musty, T. (1988). Preschool children's erroneous allegations of sexual molestation. American Journal of Psychiatry, 145, 989-992.
  

Acknowledgements

The author would like to thank Patti Watson for helpful comments made on an earlier version of this manuscript.