Disclosure of Child Sexual Abuse: A Review of the Contemporary Empirical Literature

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Review of the contemporary literature on how children
report sexual abuse to others: Findings, methodological
issues, and implications for forensic interviewers
Kamala London
University of Toledo, OH, USA
Maggie Bruck
Johns Hopkins University, Baltimore, MD, USA
Daniel B. Wright
University of Sussex, UK
Stephen J. Ceci
Cornell University
Methods used during forensic interviews with children are driven by beliefs about how children recall
and report child sexual abuse (CSA) to others. Summit (1983) proposed a theory (Child Sexual Abuse
Accommodation Syndrome) contending that, due to the specific traumatic characteristics of CSA,
children will often delay disclosing abuse or altogether fail to disclose during childhood, deny abuse when
asked, and often recant abuse allegations. His theory has had a tremendous impact on the field of CSA
forensic evaluations, despite its dearth of empirical support. In this paper, we review and critique the
contemporary literature from two main sources: retrospective accounts from adults reporting CSA
experiences and studies of children undergoing forensic evaluation for CSA. We conclude that data
support the notion that children often delay abuse disclosure, but that among valid abuse cases
undergoing forensic evaluation, denial and recantation are not common. Methodological issues and
implications for forensic interviewers are discussed.
Child sexual abuse (CSA) is a major societal
problem that presents an array of difficult deci-
sions for those involved in its investigation and
substantiation. In cases that come before autho-
rities, investigative interviewers face the weighty
task of evaluating the veracity of children’s
allegations. Errors in judgement either allow
perpetrators to be free to commit further abuse
or, at the other extreme, lead to the break-up of
families or imprisonment of innocent people. In
the absence of reliable medical evidence or
corroborative eyewitness testimony, the diagnosis
of CSA is complicated because psychological and
medical profiles do not reliably differentiate
abused and non-abused children. Psychological
findings are inconclusive because many beha-
viours that might result from abuse (e.g., anxiety,
bedwetting, sexual play) are also present in many
non-abused children (Kendall-Tacket, Williams,
& Finkelhor, 1993; see Poole & Lindsay, 1998;
#2007 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business
Address correspondence to: Kamala London, Department of Psychology/ MS948, University of Toledo, Toledo, OH 43606, USA.
E-mail: kamala.london@utoledo.edu
MEMORY, 2008, 16 (1), 2947
http://www.psypress.com/memory DOI:10.1080/09658210701725732
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J. Wood & Wright, 1995). Medical findings are
often inconclusive or simply not present because
many types of sexual abuse, such as fondling, do
not leave physical evidence. Even when there is
some medical evidence it is most often incon-
clusive of abuse in that many non-abused children
show similar findings (e.g., Berenson et al., 2000;
Heger, Ticson, Velasquez, & Bernier, 2002;
McCann, Wells, Simon, & Voris, 1990). Thus, in
most cases the child’s statement is the sole
evidence by which fact-finders can evaluate the
validity or likelihood of the allegations.
This reliance on children’s statements has
raised concerns due to two related factors. First,
there is a general belief that a majority of CSA
victims do not disclose abuse even in formal
interviews. Consequently, when suspicion is
high, investigators often feel it necessary to use
an array of techniques to elicit the allegations.
This leads to the second concern that the use of
such techniques is suggestive and associated with
a risk of eliciting false disclosures and false
memories (see Bruck, Ceci, & Principe, 2006).
The critical issue thus focuses on the need to use
such suggestive techniques given the risk of false
reports. In order to address this issue, however,
one must first examine the validity of the belief
that CSA victims do not disclose abuse, as well as
the characteristics of victim, perpetrator, and
crime that are associated with nondisclosure.
This paper focuses on these issues.
CHILD SEXUAL ABUSE
ACCOMMODATION SYNDROME
The major influence in formulating the issues
concerning nondisclosure in CSA victims was
Roland Summit’s Child Sexual Abuse Accommo-
dation Syndrome (CSAAS; Summit, 1983). Sum-
mit stated that, due to the nature of child sexual
abuse, certain psychological factors (shame, em-
barrassment, sense of responsibility, allegiance to
the perpetrator) often result in the behavioural
sequelae of delayed disclosure, denial of abuse,
and recantation of abuse. Summit’s 1983 paper
has exerted a tremendous influence on forensic
interview practices.
However, models such as CSAAS were theo-
retical in nature and were not based on systematic
observations or scientific studies. Due to concerns
about the misuse of CSAAS as a CSA diagnostic
tool, Summit (1992) later emphasised that his
1983 theory ‘‘. . . is a clinical opinion, not a
scientific instrument’’ (p. 156). However, his
plea for caution seems to have been less influen-
tial than his original paper. A citation count from
PSYCHINFO (1 November 2006) reveals that
1983 paper was cited 139 times in other articles in
the PSYCHINFO database; whereas the 1992
cautionary paper was only cited 9 times.
Given the non-empirical basis of the assump-
tions of CSAAS, London and colleagues
(London, Bruck, Ceci, & Shuman, 2005, 2007)
reviewed the evidence for CSAAS. They con-
cluded that despite the widespread beliefs among
clinicians and researchers, there was relatively
little scientific examination of the theory, and
either the evidence, such as there was, was
methodologically problematic or the findings
were equivocal. In this paper we update that
review by adding new studies and by focusing on
some major methodological issues that have
posed barriers to the field of research examining
disclosure patterns of sexually abused children
and that must be seriously considered to advance
knowledge in this field.
We focus on the two major sources of data that
provide information about disclosure patterns.
One source comes from studies of adults who
report histories of sexual abuse. In one set of
studies adults with histories of CSA were asked
whether and when they disclosed the abuse to
others; these results have been used to estimate
delays of disclosure of CSA. The results of these
studies are reported in the first major section of
this paper. The second source comes from studies
of children undergoing assessment of abuse.
These studies are typically case reviews of chil-
dren undergoing forensic evaluation or psycholo-
gical/medical treatment; these data have
primarily been used to provide estimates of denial
and of recantation of abuse. The results of these
studies are presented in the second major section.
Within each section we focus on two main
methodological issues that affect interpretation
of the results: the reliability of retrospective recall
of events surrounding CSA, and sampling proce-
dures. We also discuss studies that did not present
childhood disclosure rates, but do shed light on
other important factors related to disclosure
patterns. We limit our review to studies published
since 1990, due to the many changes that have
taken place in educating children about abuse and
to major reforms in best practice guidelines for
forensic interviewers.
30 LONDON ET AL.
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DELAY OF DISCLOSURE: ADULTS’
RETROSPECTIVE REPORTS OF CSA
Retrospective studies of CSA disclosure provide
information on delay of disclosure during child-
hood as reported by adults who indicate they
experienced CSA. We identified 13 studies that
provide relevant information about rates of dis-
closure and delay of disclosure in childhood and
one additional study that only includes data of
disclosure rates to authorities only (see Table 1).
In all these studies adults with childhood histories
of abuse were identified and were asked details of
the abuse, including whether they had told an
adult about the abuse and if so at what time
period relative to the abuse.
Major findings
As can be seen from Table 1, the sampling
techniques and definitions of abuse varied across
studies. Most studies employed convenience sam-
ples (e.g., college students, adults at sexual abuse
support groups, respondents to magazine solicita-
tions). Some studies only included victims of
intrafamilial abuse, and some only included
female participants. Some studies defined
‘‘abuse’’ generally, such as any unwanted sexual
experience before age 18, contact or no contact,
including by peers. Others defined abuse nar-
rowly, such as incidents involving forcible pene-
tration occurring before age 14 by someone at
least 5 years older. There are also differences in
the time windows used to define time of disclo-
sure (e.g., ‘‘within 1 year of the abuse’’ vs ‘‘by age
14’’ or ‘‘by age 18’’).
Despite these methodological variations, some
consistent findings emerge from the retrospective
literature. First, most adults reported they de-
layed disclosure or altogether failed to disclose
the abuse to anyone during childhood. Table 1
shows that, excluding two outliers (Fergusson,
Lynskey, & Horwood, 1996; Fleming, 1997), the
estimate of the frequency of childhood disclosure
ranged from 31% to 45%. Stated another way,
5569% of adults indicated that they never told
anyone about the sexual abuse during childhood.
Considering the range of definitions of abuse,
sampling methods, sampling characteristics, and
age cutoffs for ‘‘childhood disclosure’’ across
these studies, these rates are remarkably consis-
tent. A second consistent finding (see column 9 of
Table 1) was the low frequency of reports to the
authorities; the range was from 5% to 13%.
Finally, a sizable minority of participants reported
that the first and only time they had ever reported
CSA was during the survey (see last column of
Table 1).
These data indicate that, indeed, many child-
hood victims of sexual abuse do not readily report
the abuse, and a fair number of them never report
the abuse. These data are consistent with the
CSAAS position that many CSA victims do not
immediately report abuse.
Although delayed disclosure of abuse seems
common, it is difficult to estimate length of delay
because of between-study differences in measure-
ment of delay (e.g., from the onset versus offset of
abuse; number of months vs number of years) and
because most of the statistics are limited to means
and standard deviations. From a closer examina-
tion of the few studies that do report more
detailed information, it appears that distribution
of delay of reporting is positively skewed; many
children disclosed within a month of abuse and
then many waited 1 year or more to disclose.
Hence, the mean length of disclosure provides a
longer estimated length of delay compared with
the median length to disclosure (e.g., see Kellogg
& Huston, 1995). For example, Smith et al. (2000)
found 34% of women who were victims of child-
hood rape disclosed within 6 months of the abuse;
18% disclosed between 6 months and 60 months;
and 48% waited 60 or more months to disclose.
Similar trends with different time periods were
obtained in Finkelhor, Hotaling, Lewis, and
Smith’s (1990) telephone survey. Of those with
histories of CSA, 42% reported having disclosed
abuse within 1 year of the incident, 20% told
someone of the event later, and 38% never told
anyone of the abuse prior to the telephone
interview.
In sum, many abuse victims fail to report the
abuse in childhood. Even when childhood dis-
closures occur, there often is a considerable time
lag between the abuse and disclosure. Based on
limited data we hypothesise that many children
disclose shortly after the CSA, with many more
waiting a considerable time to disclose. Because
of the right skew of the data the mean length of
delay to disclosure does not provide a fair
measure of central tendency. As a result, re-
searchers should report more information about
the distribution of this variable, including the
median.
DISCLOSING CSA 31
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TABLE 1
Frequency of disclosure of child abuse recalled in retrospective studies
Study
Survey sample
(n)
Survey sample
CSA (%) Sample source
a
Mean age
(yrs) at
abuse
Mean age
(yrs) at
survey Definition of CSA
Childhood
disclosure rates
CSA
reported to
authorities
First disclosure
at survey
1. Fleming (1997) 710 (f) 20% Australia electoral
register
Over-sampled those
with an alcohol
problem
10 39 Contact &
non-contact
abuseBage 17 by
someone]5 years
older
21% in first year
38% in 110
years
5% 10%
2. Arata (1998) 860 (f)
b
24% College sample 8.5 23 Unwanted contact
before 14 yrs
31% (at time of
abuse)
10%
3. Smith et al. (2000) 3220 (f) 9% National probability
sample
10.9 45 Rape 34% (within 6
months of abuse)
12% 28%
4. Roesler & Wind
(1994)
286 (f) 100% CSA hotline callers 6 41 Intra-familial
before 16 yrs
36%
5. Lamb &
Edgar-Smith
(1994)
48(f) 12 (m)
c
100% Newspaper ad 8.15 30 Not specified 36% (by age 13)
6. Mullen et al. (1993) 298 (f)
d
100% Random sample of
women in a New
Zealand town
B16 Ages 1865 Sexual abuse in
some form before
age 16
37% within 1
year of abuse
7.5%
7. Roesler (1994) 168 (f) 20(m) 100% Abuse centre B16 41 Genital contact
before 16 yrs
37%
8. Tang (2002) 1151 (f) 887 (m) 6% Hong Kong Chinese
college students
11 21 Unwanted sexual
experiences before
age 18
38%
9. Finkelhor et al.
(1990)
1481(f) 1145 (m) 27% (f) 16%
(m)
National probability
sample
Median9.7 3039 Before 18 yrs 42% within 1
year of abuse
38%
10. Somer &
Szwarcberg (2001)
41(f) 100% Israeli abuse centre 7.11 32 CSA survivors 45% (by age 17)
11. Ullman & Filipas
(2005)
733 (m & f) 22.8% College students B14 20 Contact &
non-contact
abuseBage 14 by
someone]5 years
older
45%Bage 14
66.5%Bage 21
13%
12. Ussher &
Dewberry 1995)
775 (f) 100% Magazine
survey
8.5 38 Unwanted sexual
attention
54%
d
18% 46%
12. Fergusson et al.
(1996)
1019 (m&f) 10% New Zealand
longitudinal study
B16 18 Unwanted
experience before
16 yrs
87% (by age 18)
13. Hanson et al.
(1999)
4008(f) 8.5% National probability
sample
B18 37.5 Non-consensual
penetration assaults
before age 18
13%
Studies are listed in ascending order by rates of disclosure in childhood.
a
Unless noted, all studies were conducted in the United States.
b
Female.
c
Male.
d
The age by which disclosures were made in this sample was unclear but reactions to disclosing participants implies during childhood (see Ussher & Dewberry, 1995, p. 183).
32 LONDON ET AL.
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Characteristics of disclosers versus
non-disclosers
Some of the retrospective studies examined
whether certain characteristics associated with
abuse predicted delay of disclosure. We focus
our review on analyses that test some of the
assumptions of the CSAAS theory concerning the
potential causes of children’s silence. These
include the childperpetrator relationship, the
use of threats, and the severity of abuse.
Relationship to perpetrator. The CSAAS was
initially formulated to explain children’s silence
concerning intrafamilial abuse (Summit, 1983)
although later it was extended to include abuse
from a variety of perpetrators. Children abused
by a family member, according to CSAAS, often
delay disclosure because of feelings of guilt,
loyalty to the perpetrator, fear of not being
believed, and worry of the consequences to the
family of such a disclosure.
The existing studies are equivocal regarding
this hypothesis. Consistent with the hypothesis,
Ussher and Dewberry (1995) and Wyatt and
Newcomb (1990) reported longer delays to dis-
closure among familial versus non-familial abuse.
However, the more common finding is that there
is no significant association between relationship
to perpetrator and CSA disclosure/delay (Arata,
1998; Kellogg & Hoffman, 1995; Kellogg &
Huston, 1995; Lamb & Edgar-Smith, 1994; Roes-
ler, 1994). We urge caution in accepting these null
findings because of the relatively small sample
sizes.
Threats. One explanation for children’s failure
to disclose abuse is that they were threatened by
the perpetrator of the consequences of telling
(e.g., ‘‘Your family will be hurt’’; ‘‘Nobody will
believe you’’). There are few relevant data to test
this explanation and the existing data are contra-
dictory. Ussher and Dewberry (1995) found
decreased disclosure rates among intra-familial
abuse cases that involved violence and threats.
However, others (Hanson, Resnick, Saunders,
Kilpatrick, & Best, 1999; Kellogg & Hoffman,
1995) found the opposite; higher disclosure rates
were associated with incidents that involved
threat of physical injury. One study found no
relationship between the reported presence of
threats and disclosure of CSA (Roesler, 1994).
The major shortcoming of these data concerns
the researchers’ failure to define threats to their
readers and presumably to the participants. Thus,
it is not clear if threats were construed as force
used to engender silence (e.g., ‘‘If you tell, I will
kill your dog’’) or to gain compliance during the
commission of abuse (e.g., ‘‘I have a knife and will
kill you if you fail to comply’’). At this time, there
is insufficient evidence from the retrospective
studies to determine whether the use of threats
to gain compliance or silence affects disclosure
patterns. Of course, the null and contradictory
findings could be masking individual differences
where some children view threat as a reason to
disclose to prevent a possibly violent assault and
others view threat as a reason not to disclose to
avoid such an assault. The present data do not
allow us to differentiate this from simple null
effects.
Severity of abuse. Research to examine severity
of abuse/use of force and disclosure has also
yielded inconsistent results. Two studies (Arata,
1998; Ussher & Dewberry, 1995) reported longer
delays until disclosure among more severe cases.
Most researchers have either found the opposite
pattern*that is, higher disclosure rates are asso-
ciated with incidents that are life threatening and
involve physical injury (Hanson et al., 1999;
Kellogg & Hoffman, 1995), or there is no
significant relationship between severity and
method of coercion with disclosure (Lamb &
Edgar-Smith, 1994; Roesler, 1994; Smith et al.,
2000). However, investigators employ a variety of
definitions for severity of abuse (e.g., use of force
to gain compliance, abuse involving penetration),
which could contribute to these null findings.
We just provided summaries of individual
differences involving only three variables. How-
ever, the general pattern of inconsistency also
holds for a variety of other psychological and
demographic factors (e.g., gender, race), thus
providing no strong evidence to support CSAAS
or any other theory regarding children’s disclo-
sures of CSA. Further, even when adults in these
studies (see Kellogg & Huston, 1995; Lamb &
Edgar-Smith, 1994; Roesler & Wind, 1994; Ussher
& Dewberry, 1995; Wyatt & Newcomb, 1990)
provided CSAAS-consistent explanations of de-
lay or of non-disclosure of abuse (e.g., fear,
shame, embarrassment, guilt, fear of not being
believed), when independently tested, these fac-
tors tend not to significantly predict who discloses
and who delays. As described below, some
methodological shortcomings of retrospective
DISCLOSING CSA 33
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    In this Article, Professors Ceci and Friedman analyze psychological studies on children's suggestibility and find a broad consensus that young children are suggestible to a significant degree. Studies confirm that interviewers commonly we suggestive interviewing techniques that exacerbate this suggestibility, creating a significant risk in some forensic contexts-notably but not exclusively those of suspected child abuse-that children will make false assertions of fact. Professors Ceci and Friedman address the implications of this difficulty for the legal system and respond to Professor Lyon's criticism of this view recently articulated tn the Cornell Law Review. Using Bayesian probability theory, Professors Ceci and Friedman assess the implications of children's suggestibility for fact-finding in adjudication. Based on the constitutionally compelled principle that an inaccurate criminal conviction is a far morse result than a failure to gain an accurate conviction, even a slight risk of false allegations is significant Professors Ceci and Friedman present several policy implications that follow from their analysis. First, interviewers should use leading questions only as a last resort, and they should completely avoid some strongly suggestive techniques that create particularly significant risks of false allegation. Second, except in very limited circumstances the fact that a child has been subjected to suggestive questioning should not preclude her from testifying. Instead in appropriate cases, courts should be receptive to expert evidence on the suggestibility of children. Furthermore, in some extreme cases in which the child's allegation is essential to the prosecution and the child was subjected to very strongly suggestive influences, a criminal conviction should be precluded. To the extent that reliability is a factor in determining the admissibility of hearsay statements, in some circumstances children's statements should be considered unreliable. Finally, absent exigent circumstances, all interviews conducted as part of a criminal abuse investigation should be videotaped, to reduce the uncertainty as to whether interviewers have used suggestive questioning techniques.
  • Article
    Laboratory and autobiographical studies of normal adults' memory for the time of past events are reviewed, and the main phenomena that have been discovered are described. A distinction is introduced among several kinds of information on which this knowledge could be based: information about distances, locations, and relative times of occurrence. The main theories of memory for time are classified in these terms, and each theory is evaluated in light of the available evidence. In spite of the common intuition that chronology is a basic property of autobiographical memory, the research reviewed demonstrates that there is no single, natural temporal code in human memory Instead, a chronological past depends on a process of active, repeated construction.
  • Article
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    This study examined whether sexually abused preschool boys and girls (ages 2–5) differed in terms of abuse characteristics or psychological outcomes. A retrospective chart review of 74 cases of sexually abused children (29 boys and 45 girls) treated at an urban mental health clinic in Maryland was conducted. Information was collected on: (1) demographics; (2) abuse characteristics (victim's age, type of sexual abuse, relationship to perpetrator); (3) abuse discovery pattern (accidental vs. purposeful); (4) children's symptomatology; and (5) child and familial factors. No differences were found between boys and girls in terms of the victim's age at the time of abuse, perpetrator's age, or the identity of the perpetrator. However, boys and girls experienced different forms of abuse; boys were more likely to experience fondling, oral and anal intercourse. The majority of boys and girls were abused by males, typically someone they knew (biological parent/parent figure or relative). No differences were evident in the type of disclosure; however, older children were more likely to self-disclose than younger children. Results indicated that boys exhibited more developmental delays and aggressive symptoms than girls. Clinical implications of these findings are discussed as well as recommendations for future research.
  • Article
    This study attempts to discover if further traumatization occurs to sexually abused children through societal system interventions. The Traumagenic Model, developed by David Finkelhor, which explains the dynamics of trauma in child sexual abuse, was employed as the theoretical framework to understand how societal system interventions can produce or reinforce the previous trauma from sexual abuse. Ninety sexually abused children ages 9 to 19 were selected from three counties that have contrasting societal system interventions. The results of the study indicated that the number of interviews children experienced and a trusting relationship with a professional were statistically significant predictors of trauma scores. Other major system interventions, testifying and removal of the child from the home, were not statistically correlated to trauma scores. The majority of the children found the system a positive support in assisting them with the stress of the intervention and personal loss.
  • Article
    Verbal disclosure of abuse in a specialized interview was studied in a sample of 28 children, ages 3 to menarche, who presented with purely physical complaints later diagnosed as a sexually transmitted disease, in the absence of any known prior disclosure or suspicion of sexual abuse. Only 43% gave any verbal confirmation of sexual contact. Fifty-seven percent were “false negatives.” Disclosure was strongly associated with the attitude taken by the child's caretaker toward the possibility of abuse. Children whose caretakers accepted the possibility that their child might have been sexually abused disclosed at a rate almost 3.5 times as great as those whose caretakers denied any possibility of abuse (63% vs. 17%). The results suggest that caretaker attitude and support is a critical variable in the child's disclosure process and a valuable target for intervention and prevention efforts. In addition, it was found that, aside from their STD, many of these abused children presented as free from any specifically suspicious abuse symptoms, suggesting that reliance on single interviews and identification of “red flags” cannot be expected to identify many hidden victims.