Working with Avoidant Children: A Clinical Challenge.

Clinicians have become increasingly aware of the difficulty inherent in interviewing avoidant children for possible maltreatment. Evaluations of avoidant children in cases involving multiple risk factors for maltreatment are often the most complex. The dilemma lies in balancing forensic standards while ensuring that every effort is made to enable children to relate their experiences. It is incumbent upon the evaluator to be aware of the reasons children may resist sharing their experiences. Initial stages of the interview process are discussed, including techniques for dealing with avoidant children. Children referred to the Program on Childhood Trauma and Maltreatment, a specialty clinic in the Division of Child Psychiatry at the University of North Carolina at Chapel Hill,* have often been interviewed by a number of professionals. During the evaluation process, children are generally seen three to six times, depending on their age and ability to share their experience. Due to the complexity of these evaluations, many of the children are highly avoidant and have difficulty discussing even nonthreatening events. The strategies discussed in this article were developed to assist these children. The subgroup of children who display high levels of avoidance and resistance pose a uniquely complex challenge to the evaluator to maintain forensic standards while ensuring that every effort is made to enable the children to relate their experiences. Avoidance is best defined as the effort a child puts forth to avoid revealing overwhelming or frightening experiences. Behaviors commonly associated with avoidance include hyperactivity, distractibility, aggressiveness, dissociation, denial, or refusal to answer questions [Davies & Montegna 1990]. Although several protocols have been developed to aid professionals in conducting forensic interviews, none of these provide techniques for working with the avoidant child [American Professional Society on the Abuse of Children 1990; Yuille et al. 1993]. It is incumbent upon the evaluator to be aware of the reasons why a child may be resistant during the disclosure process. These include, but are not limited to, fear of consequences, overt or covert threats or coaching, inability to trust, and the therapist's failure to establish and maintain rapport. An active role must be taken to set the framework for a thorough evaluation. The evaluator must also know appropriate techniques to empower the child and enhance the communication process. Factors Inhibiting Disclosure Disclosure is best viewed as a process for the child, rather than a single event [Sorenson & Snow 1991]. Summit has described the process as the "window of disclosure" [Hollingsworth 1986]. This phrase refers to the sequential and careful way children reveal abusive experiences. More specifically, as the child feels more secure with the environment and the evaluator, the child may move from denial to tentative statements and then to a clear statement of the experience [Sas & Cunningham 1995]. In their frequently cited study of 116 children with confirmed cases of sexual abuse, Sorenson and Snow [1991] found that approximately 75% of the children, when first questioned, denied that abuse had taken place. Over time, 96% of these children eventually gave clear, detailed disclosures. In another study, 57% of a sample of 28 children with sexually transmitted diseases initially denied their abuse experiences [Lawson & Chaffin 1992]. These studies underscore how difficult it is for children to talk about their abuse experiences. Many factors may influence children's willingness to discuss sensitive topics, including possibly traumatic experiences. Parental support is vital for the child to feel able to do so during the interview process [Faller 1990; Lawson & Chaffin 1992]. A parent's ability to demonstrate belief and provide protection for the child are key elements of parental support [Everson et al. …