Opinion ID: 2390226
Heading Depth: 1
Heading Rank: 2

Heading: Types of Expert Testimony in Child-Sexual-Abuse Prosecutions

Text: In recent terms of Court we have had to consider various evidentiary problems in criminal prosecutions of child-sexual-abuse cases. See State v. Crandall, 120 N.J. 649, 577 A. 2d 483 (1990) (finding constitutional N.J.S.A. 2A:84A-32.4, which permits closed-circuit television testimony outside physical presence of alleged abusers); State v. D.R., 109 N.J. 348, 537 A. 2d 667 (1988) (proposing new hearsay exception for child's out-of-court statement concerning acts of sexual abuse); State v. R.W., 104 N.J. 14, 514 A. 2d 1287 (1986) (setting forth standards for use of expert psychological evaluation of child victim witnesses). Whether society has changed or whether society is finally confronting its deepest flaws is something that we cannot answer. Freud mistakenly believed that his female patients' experiences of sexual abuse as children were merely fantasies and attributed their complaints to hysteria. Chandra Lorraine Holmes, Child Sexual Abuse Accommodation Syndrome: Curing the Effects of a Misdiagnosis in the Law of Evidence, 25 Tulsa L.J. 143, 144 (1989) [hereinafter Holmes]. We know now, from the many accounts, that such abuse in the home is regrettably all too real. Since the 1970s   , there has been a growing awareness of child sexual abuse and reports of it have skyrocketed. Diana Younts, Evaluating and Admitting Expert Opinion Testimony in Child Sexual Abuse Prosecutions, 41 Duke L.J. 691, 693 (1991) [hereinafter Younts] (citing L.B. Suski, Child Sexual Abuse: An Increasingly Important Part of Child Protective Service Practice, 3 Protecting Children 3 (1986), which shows an increase to 200,000 reports nationwide in 1986, from 7,559 reports in 1976). At the same time, we know that moving from the child's world into the courtroom presents legal issues of varying dimension. For example, in State v. D.R., supra, 109 N.J. 348, 537 A. 2d 667, we recommended that the Legislature adopt an exception to the hearsay rule for the admission of out-of-court statements by a child witness provided that the child, if available, testify at trial (either through closed-circuit television or in the courtroom) or that there is other corroboration if the child is unavailable. [1] We believed that the availability of the child for questioning would afford the jury the opportunity to assess the child's credibility while safeguarding the defendant's right of confrontation and cross-examination. Id. at 370-71, 537 A. 2d 667. Society must tread a measured path that avoids ignoring the reality of child sexual abuse and avoids as well the possibility of unjust conviction of this most shameful of crimes. In Maryland v. Craig, 497 U.S. 836, 110 S.Ct. 3157, 111 L.Ed. 2d 666 (1990), four members of the Supreme Court cautioned that courts should be particularly insistent in protecting innocent defendants in child-sexual-abuse cases because of the reliability problems created by children's suggestibility in child-sexual-abuse prosecutions. Id., 497 U.S. at 868, 110 S.Ct. at 3175-76, 111 L.Ed. 2d at 693-94 (Scalia, Brennan, Marshall & Stevens, JJ., dissenting). A. At the outset, we must carefully distinguish the issues presented in this case from those that are not presented. There are various categories of expert testimony on child sexual abuse. For purposes of this analysis, we draw on the survey of issues by John E.B. Myers et al., Expert Testimony in Child Sexual Abuse Litigation, 68 Neb.L.Rev. 1 (1989) [hereinafter Myers]. [2] The authors point out that some expert testimony is routinely accepted and presents no genuine evidentiary problem. For example, expert medical testimony plays an important role in child-sexual-abuse litigation. Such testimony is based on a physician's clinical diagnostic examination and the child's medical history. Courts have permitted expert medical witnesses to describe the results of the examination and to offer opinions as to the cause of any injuries, to establish penetration, and to answer questions whether injuries could have been inflicted in a particular way or whether a caretaker's explanation for an injury is reasonable. Myers, supra, 68 Neb.L.Rev. at 48-49. In the behavioral-science field, the authors identify one type of expert testimony that describes behaviors commonly observed in sexually-abused children. Id. at 51-69. By way of background, the authors describe a wealth of literature that documents general patterns of behavioral and emotional reactions found in clinical samples of sexually-abused children, typically victims of incest. Id. at 52-62. The authors' review of the literature, however, leads them to conclude that the effects of sexual abuse vary among children. Id. at 61. Furthermore, children who exhibit symptoms of fear, anxiety, or avoidance are probably suffering the effects of some traumatic experience, of which sexual abuse is only one of many possible causes. Nevertheless, some behaviors, such as age-inappropriate sexualized responses, are more associated with sexual abuse than others. Ibid. Thus, the authors assert that situations in which sexual abuse is likely can be identified. Given the prevalence of sexual abuse, and its documented association with anxiety symptoms, however, abuse should be considered and evaluated through direct inquiry. When symptoms of fear, anxiety, or avoidance accompany a credible report of sexual abuse, sexual abuse must be seriously considered. While no symptom or set of symptoms is conclusive proof of sexual abuse, when symptoms evidencing abuse are present in conjunction with a report that bears indicia of reliability, the clinician is justified in forming a clinical opinion that a child has been sexually abused. [Myers, supra, 68 Neb.L.Rev. at 61-62.] Despite the considerable basis for this behavioral-science evidence, most courts do not approve such testimony as substantive evidence of abuse. Myers, supra, 68 Neb.L.Rev. at 65, 68 (citing People v. Bowker, 203 Cal. App.3d 385, 249 Cal. Rptr. 886, 890-92 (1988), Lantrip v. Commonwealth, 713 S.W. 2d 816, 817 (Ky. 1986), State v. Black, 537 A. 2d 1154, 1156-57 (Me. 1988)). However, this type of testimony has an important nonsubstantive purpose of which the majority of courts approve. It can be used on rebuttal to rehabilitate the victim's testimony when the defense asserts that the child's delay in reporting the abuse and recanting of the story indicate that the child is unworthy of belief. Myers, supra, 68 Neb.L.Rev. at 51, 86-92. Another area of behavioral-science testimony seeks to address the ultimate question of whether a child was in fact sexually abused. Myers, supra, 68 Neb.L.Rev. at 69-86. Such testimony would be based on the clinical observations of a professional trained in the patterns, effects, and dynamics of child sexual abuse. Id. at 73. The authors say that many experts now believe that the study of child sexual abuse has advanced to such a point as to enable qualified professionals to determine whether a child's symptoms and behavior are consistent with sexual abuse. Id. at 73-75. For example, in 1985 the Council on Scientific Affairs of the American Medical Association published a set of guidelines that listed, in particular, physical and behavioral signs identified with child sexual abuse. Id. at 74 (citing AMA Diagnostic and Treatment Guidelines Concerning Child Abuse and Neglect, 254 J.A.M.A. 796 (1985) [hereinafter Guidelines ]). The behavioral signs listed include:  Overt or subtle and indirect disclosures to a relative, friend or teacher  Highly sexualized play  Withdrawal and excessive daydreaming  Low self esteem, feelings of shame or guilt  Falling grades  Pseudomature personality development  Sexual promiscuity  Poor peer relationships  Suicide attempt  Positive relationship exhibited toward the offender  Frightened or phobic, especially towards adults [ Guidelines, supra, 254 J.A.M.A. at 798.] Although the Myers article points to only two instances in which courts have approved the actual use of such testimony at a criminal trial for the purpose of establishing that sexual abuse had occurred, Myers, supra, 68 Neb.L.Rev. at 80-85 (citing Glendening v. State, 536 So. 2d 212 (Fla. 1988), cert. denied, 492 U.S. 907, 109 S.Ct. 3219, 106 L.Ed. 2d 569 (1989), and Townsend v. State, 103 Nev. 113, 734 P. 2d 705 (1987)), we do not rule out the possibility that a qualified behavioral-science expert could demonstrate a sufficiently reliable scientific opinion to aid a jury in determining the ultimate issue that the abuse had occurred. This record does not support the conclusion. The scientific community does not yet exhibit a consensus that the requisite degree of scientific reliability has been shown. Although some argue that `under no circumstances should a court admit the opinion of an expert about whether a particular child has been abused    [,]' [t]he majority of professionals believe qualified mental health professionals can determine whether abuse occurred; not in all cases, but in some. 1 John E.B. Myers, Evidence in Child Abuse and Neglect Cases § 4.31, at 283-84 (2d ed. 1992) [hereinafter Myers, Evidence in Child Abuse and Neglect Cases ] (footnote omitted) (quoting Melton & Limber, Psychologists' Involvement in Cases of Child Maltreatment, 44 Am. Psychol. 1225, 1230 (1989)). In evaluating the qualifications of a witness who seeks to offer substantive evidence of sexual abuse, the trial court may wish to consider the criteria suggested in Myers, supra, Evidence in Child Abuse and Neglect Cases § 4.31, at 284-85. Assessing children for possible sexual abuse is a complex task requiring skill and experience. The expert must possess specialized knowledge of child development, individual and family dynamics, patterns of child sexual abuse, the disclosure process, signs and symptoms of abuse, and the use and limits of psychological tests. The expert is familiar with the literature on child abuse, and understands the significance of developmentally inappropriate sexual knowledge. The expert is able to interpret medical reports and laboratory tests. The expert also is trained in the art of interviewing children, and is aware of the literature on coached and fabricated allegations of abuse. Of tremendous importance is the expert's clinical experience with sexually abused children. [ Ibid. (footnotes omitted).] Obviously, the more limited the purpose for which the evidence is to be used, e.g., were it not for a substantive but for a rehabilitative purpose, the less demanding need be the qualifications of the witness. Still another category of expert testimony, not presented in this case, concerns inferences to be drawn from a child's interaction with anatomically-detailed dolls during the investigative interview. In many child-sexual-abuse trials, the expert's testimony is wholly or partially based on this methodology. Younts, supra, 41 Duke L.J. at 706. However, the social-science literature questions whether proponents of doll use have yet demonstrated that the dolls are a valid assessment tool for diagnosing abuse. Id. at 708-20. Younts suggests that before the reliability of this methodology can be established, researchers must show at least that children can be accurately categorized as abused or nonabused based on their interaction with the dolls. Id. at 719. Obviously, the use of the anatomical dolls may help a child in reciting the history of the event and that demonstration may be of aid to jurors. B. We must examine the scientific premises supporting the expert's testimony and the purpose for which the testimony was used. We note first that testimony on the child sexual abuse accommodation syndrome has been placed within the category of behavioral-science testimony that describes behaviors commonly observed in sexually-abused children. Courts rarely permit the testimony for the purpose of establishing substantive evidence of abuse, but allow it to rehabilitate the victim's testimony. See Myers, supra, 68 Neb.L.Rev. at 51, 66-69, 86-92. Roland C. Summit, M.D., has authored the most concise and seemingly most authoritative statement of CSAAS. Roland C. Summit, The Child Sexual Abuse Accommodation Syndrome, 7 Child Abuse & Neglect 177 (1983) [hereinafter Summit]. [3] Dr. Summit explained in 1983 that although [c]hild sexual abuse has exploded into public awareness during a span of less than five years, the awakening of interest creates new hazards for the child victim because it increases the likelihood of discovery but fails to protect the victim against the secondary assaults of an inconsistent intervention system. Id. at 178 (emphasis omitted). Dr. Summit believed that most adults who hear a distraught child accuse a respectable adult of sexual abuse will fault the child. Ibid. The [d]isbelief and rejection by potential adult caretakers, which in Dr. Summit's view were the too-frequent responses to reports of child sexual abuse, increase the helplessness, hopelessness, isolation and self-blame that make up the most damaging aspects of child sexual victimization. [4] Ibid. To remedy the systemic injury to the child that results from disbelief, Dr. Summit undertook a scientific study of child-sexual-abuse victims. [5] In publishing his results, Dr. Summit hoped to provide a vehicle for a more sensitive, more therapeutic response to legitimate victims of child sexual abuse and to invite more active, more effective clinical advocacy for the child within the family and within the systems of child protection and criminal justice. Summit, supra, 7 Child Abuse & Neglect at 179-80. In other words, the purpose of his study was to improve the health of the child, ensure that children receive adequate treatment for what they had suffered, and guarantee that society's response be not flawed by misperceptions. Dr. Summit's study drew upon correlations and observations that emerged as self-evident within an extended network of child abuse treatment programs and self-help organizations and he tested the validity of his theory over a four-year period of his own practice. Summit, supra, 7 Child Abuse & Neglect at 180. The child sexual abuse accommodation syndrome, or CSAAS, represents a common denominator of the most frequently observed victim behaviors. Ibid. CSAAS includes five categories of behavior, each of which contradicts the most common assumptions of adults. Summit, supra, 7 Child Abuse & Neglect at 181. Of the five categories, he described two as preconditions to the occurrence of sexual abuse and the remaining three as sequential contingencies to the abuse which take on increasing variability and complexity. Ibid. Obviously, the preconditions continue into and characterize the period of abuse. The first of the preconditions is secrecy: child abuse happens only when the child is alone with the offending adult, and the experience must never be disclosed. That secrecy is frequently accompanied by threats: `This is our secret; nobody else will understand.' `Don't tell anybody.' `Nobody will believe you.' `Don't tell your mother; (a) she will hate you,    (c) she will kill you,' and the like. Summit, supra, 7 Child Abuse & Neglect at 181. From the secrecy, the child gets the impression of danger and fearful outcome. Ibid. In this case, Norma and Connie testified that they had not reported the alleged abuse because defendant had told them that if they did, he would hit them and they would get into more trouble than he. The second precondition is helplessness. Dr. Summit explains that the abused child's sense of helplessness is an outgrowth of the child's subordinate role in an authoritarian relationship in which the adult is entrusted with the child's care, such as the parent-child relationship. Summit, supra, 7 Child Abuse & Neglect at 182. The prevailing reality for the most frequent victim of child sexual abuse is a sense of total dependence on this powerful adult in the face of which the child's normal reaction is to play possum. Id. at 182-83. The third aspect of the syndrome, also the first of what Dr. Summit identifies as a sequential contingency, is a combination: the child feels trapped by the situation (entrapment), and that perception results in the behavior of accommodating the abuse (accommodation). Because of the child's helplessness, the only healthy option left is to survive by accepting the situation. There is no way out, no place to run. Summit, supra, 7 Child Abuse & Neglect at 184. Adults find that hard to believe because they lack the child's perspective, but [t]he child cannot safely conceptualize that a parent might be ruthless and self-serving; such a conclusion is tantamount to abandonment and annihilation. Ibid. The roles of parent and child become reversed: it is the child who must protect the family. The abuser warns, `If you ever tell, they could send me to jail and put all you kids in an orphanage.' Summit, supra, 7 Child Abuse & Neglect at 185. The fourth aspect, then, is delayed, conflicted and unconvincing disclosure. Id. at 186. Most victims never disclose the sexual abuse  at least not outside the immediate family. Dr. Summit found that family conflict triggers disclosure, if ever, only after some years of continuing sexual abuse and an eventual breakdown of accommodation mechanisms. Ibid. Allegations of sexual abuse seem so unbelievable to most that the natural reaction is to assume the claim is false, especially because the victim did not complain years ago when the alleged abuse was ongoing. Ibid. Dr. Summit surmises that [u]nless specifically trained and sensitized, average adults, including mothers, relatives, teachers, counselors, doctors, psychotherapists, investigators, prosecutors, defense attorneys, judges and jurors, cannot believe that a normal, truthful child would tolerate incest without immediately reporting or that an apparently normal father could be capable of repeated, unchallenged sexual molestation of his own daughter. [ Ibid. ] There are very few clues to such abuse. Most women (indeed, even this mother) do not believe it possible that a man whom she loved would ever be capable of molesting his or her own children. Summit, supra, 7 Child Abuse & Neglect at 187. The fifth and final aspect is retraction. Although this case does not involve retraction, that [w]hatever a child says about sexual abuse, she is likely to reverse it appears to be a fact. Summit, supra, 7 Child Abuse & Neglect at 188 (emphasis omitted). The post-disclosure family situation tends to confirm the victim's worst fears, which encouraged her secrecy in the first place, i.e., her mother is disbelieving or hysterical, her father threatened with removal from the home, and the blame for this state of affairs placed squarely on the victim. Ibid. Once again, because of the reversed roles, the child feels obligated to preserve the family, even at the expense of his or her own well being. The only good choice, then, is to capitulate and restore a lie for the family's sake. Ibid. Dr. Summit analogizes the gradual acceptance of the reality of child sexual abuse to society's changing attitude towards adult rape with the emergence of the rape trauma syndrome theory (RTS). Summit, supra, 7 Child Abuse & Neglect at 189 (citing Ann W. Burgess & Linda L. Holmstrom, Rape Trauma Syndrome, 131 Am.J. of Psychiatry 981 (1974) [hereinafter Burgess & Holstrom]). Women were assumed to cause rape, in the absence of a consistent clinical understanding of the psychological climate, and reactions to such sexual attacks. Summit, supra, 7 Child Abuse & Neglect at 189. Thus, Those who reported often regretted their decision as they found themselves subjected to repeated attacks on their character and credibility. Ibid. The gradual departure from the mythology of women and rape so recently outlined by our Court in In re M.T.S., 129 N.J. 422, 432-33, 443-45, 609 A. 2d 1266 (1992) (dispelling myth that victim's silence in response to sexual assault equals consent), and State v. Hill, 121 N.J. 150, 157-66, 578 A. 2d 370 (1990) (dispelling myth that victim's failure immediately to report an alleged sexual assault tends to show that she was not assaulted at all), has slowly been extended to child-abuse victims. Hence, the behavioral studies of CSAAS are designed not to provide certain evidence of guilt or innocence but rather to insure that all agencies, including the clinician, the offender, the family, and the criminal justice system, offer the child a right to parity with adults in the struggle for credibility and advocacy. Summit, supra, 7 Child Abuse & Neglect at 191. CSAAS achieves that by providing a common language for analysis and a more recognizable map to the understanding of child abuse. Ibid.