Substantiation of Sexual Abuse Charges When Parents Dispute Custody or Visitation

(1)

Substantiation

of Sexual

Abuse

Charges

When

Parents

Dispute Custody

or Visitation

Jan

E. Paradise,

MD,

Anthony

L. Rostain,

MD,

and

Madelaine

Nathanson,

PhD

From the Division of General Pediatrics, The Children ‘s Hospital of Philadelphia,

Philadelphia Child Guidance Clinic, and the Departments of Pediatrics and

Psychiatry, University of Pennsylvania School of Medicine, Philadelphia

ABSTRACT. Recent news reports have implied that charges of sexual child abuse during parental separa-tion or divorce are often deliberately falsified. Such a conclusion could be harmful if it biased practitioners faced with such allegations in clinical practice. To in-vestigate this concern, sexual abuse cases in a hospital-based consecutive series and in one author’s clinical practice were reviewed. Abuse allegations with and without a concomitant custody or visitation dispute were compared. A custody or visitation dispute oc-curred in 12 (39%) of3l sexual abuse complaints lodged against a parent. Allegedly abused children whose par-ents contested custody or visitation were significantly younger than those for whom custody or visitation was not an issue (5.4 v 7.8 years, P = .02). Sexual abuse

allegations were substantiated less frequently when there was concomitant parental conflict (67% v 95%,

nonsignificant) but were nevertheless substantiated more than halfofthe time. Pediatrics 1988;81:835-839;

sexual child abuse, divorce, parents.

Sexual abuse allegations that arise in the con-text of a dispute about child custody or visitation have the potential to produce a particularly ac-rimonious conflict. These cases can prove excep-tionally difficult and time-consuming for

physi-cians asked to examine the children involved or

to render opinions about the likelihood that

sex-ual abuse has occurred. Cases have been noted

recently in both the medical and lay press, with

emphasis on the occurrence of false sexual abuse charges made by some parents in their efforts to

obtain custody or visitation rights (Pediatric

News, April 1986, p 26, Dec 1986, pp 40-41; The

Received for publication May 11, 1987; accepted Aug 6, 1987. Reprint requests to (J.E.P.) The Children’s Hospital Medical Center, 300 Longwood Aye, Boston, MA 02115.

Philadelphialnquirer, May 20, 1986, p 1; The New

York Times, Oct 22, 1986, p 24, Jan 19, 1987, p

14; New York, Jan 11, 1988, p 42). A recent article on the subject in The Boston Globe stated, “Hostile divorce proceedings and battles for the children of a marriage have always been a breeding ground for the imaginative parent willing to do anything to gain custody” (April 5, 1987, p 33).

Because these news reports have generally been anecdotal, and because their implications could be harmful if they wrongfully biased practitioners faced with sexual abuse allegations in clinical

practice, we reviewed our experience at The

Chil-dren’s Hospital of Philadelphia to obtain a more

complete understanding of the relationship

be-tween sexual abuse allegations and parental

con-flicts about child custody. To discover the relative

rates of substantiated charges and to identify

im-portant characteristics of the disputed cases, we

compared cases of sexual abuse allegations

against parents in which a custody or visitation

dispute was present with cases against parents in

which such a dispute was absent.

METHODS

Cases were selected from two sources for this

comparison. The first source was the data base of

an ongoing prospective study ofthe functional

sta-tus of sexually abused children. This data base

includes all children between 4 and 12 years of

age seen at The Children’s Hospital of

Philadel-phia between June 1985 and March 1986 for a

medical examination because of alleged sexual

abuse. The second source of cases was the clinical

practice of one of the authors (J.E.P.) during the

year before prospective data collection was begun.

These two sources are referred to as the

(2)

From these two sources, cases were selected if

the alleged perpetrator ofthe abuse was a biologic

or adoptive parent of the index child. Cases that

involved a custody or visitation dispute were

corn-pared with those that did not involve such

paren-tal conflict.

As defined by the Pennsylvania Department of

Human Services, substantiation of a child abuse

report occurs if, after investigation, the report is

deemed either indicated or founded. A report is

indicated if substantial evidence of the alleged

abuse exists based on one ofthe following: (1) med-ical evidence, (2) the child protective services

in-vestigation, or (3) the perpetrator’s admission of

the acts of abuse. A report is founded if there is

a courtroom adjudication that the child was

abused.

The data were analyzed with

x2

tests using the

Yates correction, when appropriate, and with

un-paired t tests using the Statistical Package for the Social Sciences.

RESULTS

In the consecutive series, there were 25 cases

ofalleged sexual abuse by a parent. These 25 cases

comprised 15% of 162 consecutive new cases of

alleged sexual abuse evaluated at the hospital

during the 10-month interval from June 1985

through March 1986. The mean age ofthe 25

chil-dren was 7.5 ± 2.6 years; 84% were girls. In seven

TABLE I. Characteristics of 31 Cases of Alleged

Sex-ual Abuse by a Parent*

Characteristics of Child Custody or Visitation Dispute

Present Absent

P Value

No. 12 19

Mean age (yr) 5.4 7.8 .02

Sex (female) 11 14 NS

Race NS

White 8 7

Black 4 12

Other 0 0

Source of allegation NS

Mother 10 12

Father 1 1

Other 1 6

Sexually transmitted it 3 NS

disease present

Allegation substantiated 8 18 NS

* Comparing cases with and without a concomitant dis-pute regarding child custody or visitation.

t Chiamydial vaginitis.

1:One each with chiamydial cervicitis, genital herpes infection, and trichomonal vaginitis.

TABLE 2. Characteristics of 25 Consecutive Cases of Alleged Sexual Abuse by a Parent*

Characteristics of Child Custody or P Value

Visitation Dispute

Present Absent

No. 7 18

Mean age (yr) 6.6 7.8 NS

Sex (female) 7 14 NS

Race NS

White 3 6

Black 4 12

Other 0 0

Source of allegation NS

Mother 6 12

Father 1 1

Other 0 5

Sexually transmitted 0 3t NS

disease present

Allegation substantiated 4 17 NS

* Comparing cases with and without a concomitant dis-pute regarding child custody or visitation.

t One each with chlamydial cervicitis, genital herpes infection, and trichomonal vaginitis.

(28%)

of these cases, a child custody or visitation

dispute was present during the follow-up period.

Six cases from the author’s clinical practice

made up a separate study sample. The children

from the clinical practice series had a mean age

of 4.4 ± 2.0 years; four of the six were girls. Five of the six cases involved a custody or visitation dispute. These clinical practice cases are included in the results when noted.

Follow-up information was available for 28 of

the 31 cases (including 23 of the 25 consecutive

cases) with a median follow-up duration of 8

months (range 3 to 21 months). Characteristics of

all 31 cases are tabulated according to the

pres-ence or absence of an associated custody or

vis-itation dispute in Table 1. Characteristics of cases

in the consecutive series only are compared in

Table 2.

A total of 30 of the 31 cases were reported to

child protective services for investigation. One

case in the clinical practice sample was not

re-ported to child protective services because the

physician judged the abuse allegation to be

with-out foundation. Of the reported cases, 26 (87%)

were substantiated following the investigation.

The cases involving a dispute between the parents

were substantiated less frequently (eight of 11)

than were those without a dispute (18 of 19), but

the difference (73% v 95%) was not statistically

significant. If the unreported case is included in

this analysis as an unsubstantiated case, the

(3)

dis-puted and undisputed cases approaches but does not reach statistical significance (67% v 95%,

P

= .12).

The following three accounts illustrate some of

the difficulties in interpretation and management that can arise when a sexual abuse allegation complicates parental conflict.

CASE REPORTS

Case 1. Not Substantiated

J. was a 5-year-old girl referred for examination by a psychotherapist. Her parents had been separated fre-quently and were divorced during the preceding year. They had no formal custody arrangement for their three children, who resided with their mother and vis-ited their father for one day every 2 to 4 weeks. J.’s mother became suspicious of sexual abuse when

day-time enuresis developed in J.’s younger brother and both children started having nightmares. After one nightmare, the brother told the mother that his father had grabbed him in the bathroom. The mother reported that after she questioned J. persistently, J. stated that her father sexually abused her. According to the mother, the father also had a history of alcoholism and spousal abuse.

During the medical interview, J. did not describe any sexual contact with her father. She had no physical signs of abuse and results of screening tests were neg-ative for gonorrhea, chlamydial infection, and syphilis.

The child protective services investigator deter-mined that the abuse complaint was unsubstantiated after noting that, during the course ofthe investigation, J. described sexual abuse only when in the presence of her mother or when the mother had known in advance about a planned interview. The father accused the mother offabricating the sexual abuse charge but made no further attempts to visit the children. No criminal charges were brought against the father. The mother discontinued J.’s psychotherapy after being informed that the therapist would not testify in court.

Case 2. Substantiated

K. was an 8-year-old girl referred for examination by a child protective services worker. Her parents had never married but had lived together intermittently since her birth. After her parents separated 3 months before she was examined, K. lived with her mother. However, her father cared for her during her mother’s recent nine-day hospitalization for a neck injury and at other times when her mother was absent.

Soon after her mother’s return from the hospital, K. saw an abuse prevention movie in school. She then told her mother that her father had fondled her and forced her to perform fellatio on several occasions while the mother was away. He had threatened to take her away if she told anyone about the abuse. The mother did not

believe the accusation at first but later reported it to child protective services. The child protective services investigation substantiated the allegation. K. had no physical signs of abuse and results of tests for sexually transmitted diseases were all normal.

After the police report was filed, the father visited K. at school and threatened to injure K. and her mother if they did not drop the charges brought against him. Three months later he was arrested and charged with several offenses including involuntary deviate sexual intercourse, indecent assault, and making terroristic

threats. At the preliminary hearing, after K. testified that nothing had happened to her, all charges against

the father were dropped.

Case 3. Substantiated

L. was a 4-year-old girl whose parents had separated 18 months previously. The parents had agreed to share custody and L. visited her father regularly. Three months before the office visit, L. started talking about

secrets she had with her father and labial irritation developed. After some questioning, she told her mother that she and her father had touched each other’s gen-italia. L. was taken th see a therapist who interviewed her further and reported the situation to child protec-tive services. Although the father denied the accusa-tion, the child protective services report was substan. tiated. The mother did not intend to press criminal charges.

L. had no physical signs ofabuse, but a vaginal rapid immunofluorescent slide test for Chiamydia tracho-matis was positive, showing 25 to 30 characteristic par-tides. Other test results for sexually transmitted dis-eases, including a vaginal culture for

C

trachomatis,

were negative. After L. was given a seven-day course of oral erythromycin, a second rapid slide test was neg-ative for

C

trachomatis.

At a subsequent custody hearing, the judge ordered L.’s father, mother, and mother’s boyfriend to be tested for

C

trachomatis. All received both rapid slide tests and cultures. Only one rapid slide test, the father’s, was positive. Since the abuse allegation was first raised more than 1 year ago, L. has resided with her mother, but the custody issue remains in court and unresolved.

DISCUSSION

Recent reports of sexual abuse allegations

dur-ing parental separation and divorce contests

em-phasize the potential for such allegations to be

false. Estimates of the frequency of fictitious sex-ual abuse claims in custody or visitation disputes range from 8% to 30%, with claims as high as 55%

reported by one author.’ However, the

general-izability of these reports is limited.2 Many are an-ecdotal accounts ofsingle cases3 or small, selected series.” Some observers have been attorneys, fo-rensic child psychiatrists appointed by family

(4)

loads are likely to contain a particularly high

pro-portion of conflicted cases

(The

Boston Globe,

April 5, 1987, p 33).

False allegations of sexual abuse when child

custody is not an issue are considered uncommon

in general, but their exact frequency is not well

documented. Estimates vary depending on the

population studied and the context in which the

complaints of abuse have been raised. Peters5

found four fictitious claims (6%) among 64 cases

of suspected sexual abuse registered at a hospital

emergency room. Reviewing their experience

with 46 families referred to a child abuse agency,

Goodwin et al6 found three cases (7%) in which

molestation had been falsely charged; in an

ad-ditional two cases (4%), it had been falsely denied.

None of these cases involved divorce. In a review

of 287 sexual abuse reports made in Denver, 26

(9%) were deemed unfounded after investigation

by the department of social services.7 Of these 26,

two reports were fabricated by adolescents, 12

were fabricated by adults involved in custody

dis-putes, and 12 allegations were made by seriously

mentally ill caretakers.

It must be pointed out that failure to

substan-tiate a case of alleged sexual abuse does not

nec-essarily mean abuse did not occur or that a

false-hood was involved. Some cases of abuse that did

occur are unsubstantiated because a perpetrator

cannot be identified, because the perpetrator is

not a caretaker, or because a child recants. Other

cases cannot be established with certainty

be-cause the young age of the involved child makes

a consistent or detailed history difficult to obtain.

Still other cases, not substantiated because of a

lack of historical evidence, are reported by

par-ents whose motivations range from honest

con-cern about a specific, worrisome event or

state-ment to generalized anxiety, vengefulness, and

paranoia. The current high level of attention to

sexual abuse in the news media causes anxiety on

the part of some parents that may in turn lead to

a lowered threshold for reporting situations to

child protective services agencies and, perhaps

inevitably, to a higher rate of unsubstantiated cases.

This report is less likely than earlier ones to be biased in favor ofdiscovering a nonrepresentative proportion of either conflicted or fabricated cases

because most ofthe cases were taken from a large

consecutive series seen at a children’s hospital, a

relatively nonadversarial site for case

ascertain-ment. In this setting, we found that a child

cus-tody or visitation dispute was present in seven of

25 sexual abuse allegations made against a

par-ent. These seven cases represented 4% of 162

con-secutive sexual abuse cases seen during a

10-month interval. In this more general, consecutive sample, disputed cases tended to be substantiated less frequently than those without coexisting

pa-rental conflict but were nevertheless

substanti-ated more than half of the time.

The disputed cases in our two series involved

significantly younger children than did the

un-disputed cases. (The two series are properly

con-sidered together for this comparison because

chil-dren less than 4 years of age were specifically

excluded from the consecutive series.) This age

difference may reflect the greater likelihood that

a child will become a focus of contention if he or

she is younger and therefore perhaps more easily

influenced or less able to provide a detailed and

consistent history. This association between

pa-rental conflict and young age ofthe involved child

parallels the finding that children 5 years of age

and younger are the focus of the conflict in 44%

of mediated child custody disputes.8

Our observation that disputed cases were

some-what more frequently unsubstantiated than

un-disputed cases supports the concern of others that

underlying conflict between parents may be the

cause of some unsubstantiated cases, as was

pre-sumably true in case 1. However, the difference

was not statistically significant, and more than

half of the disputed cases were ultimately

sub-stantiated, a finding that should be kept in mind

by physicians asked to evaluate children in

sim-ilar circumstances. The younger age of the

chil-dren in our disputed cases may have contributed

to the higher rate of unsubstantiation, because histories of sexual abuse are more difficult to

ob-tam from younger than from older children. Other

aspects ofthe question considered in this

report-the nature of the relationship between parental

conflict and sexual abuse allegations-could be

explored in subsequent research ifelements of the

relationships between parents were characterized and analyzed systematically.

ACKNOWLEDGMENTS

This work was supported, in part, by a grant from the Robert Wood Johnson Foundation Research and De-velopment Program to Improve Patient Functional Sta-tus. The views and opinions expressed in this paper are those of the authors and may not reflect those of the Robert Wood Johnson Foundation.

We thank the families described for providing infor-mation and Jill Johansen for preparing the manuscript.

REFERENCES

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Benedek EP (eds): Emerging Issues in Child Psychiatry and the Law. New York, Brunner/Mazel, mc, 1985, pp 145-156

2. Corwin DL, Berliner L, Goodman G, et al: Child sexual abuse and custody disputes: No easy answers. J Interpers Violence 1987;2:91-105

3. Kaplan SL, Kaplan SJ: The child’s accusation of sexual abuse during a divorce and custody struggle. Hillside J

Clin Psychiatry 1981;3:81-95

4. Green AH: True and false allegations of sexual abuse in child custody disputes. J Am Acad Child Psychiatry

1986;25:449-456

5. Peters J: Children who are victims of sexual assault and the psychology of offenders. Am J Psychother 1976;30:

398-421

6. Goodwin J, Sahd D, Rada RT: Incest hoax: False accusa-tions, false denials. Bull Am Acad Psychiatry Law,

1979;6:269-276

7. Cantwell HB: Sexual abuse of children in Denver, 1979: Reviewed with implications for pediatric intervention and possible prevention. Child Abuse Neglect 1981;5:75-85 8. Wallerstein JS: Children ofdivorce: Emerging trends.

Psy-chiatr Clin North Am 1985;8:837-855

NOTHING

HAS CHANGED

At a recent . . . visit to a London medical school, the students were invited

to comment on their course. They said that the teachers seemed more inter-ested in their research than their teaching. The balance between these two

activities in medical schools has never been easy.

There have always been university staff who prefer teaching to research,

sometimes exclusively so. Presumably they prefer the respect and affection

of their students to the different satisfactions of scientific achievement. In

medicine they also know that they provide, anonymously, inestimable benefit

to the future patients of those students. It seems that such people can no

longer be afforded, since the basic financing, indeed survival, of a school

depends overwhelmingly on the ability to compete for funds in the scientific

arena. The result is simple-patients first; research second; teaching third.

The students were right.

From Research conflict with teaching, editorial. Lancet 1987;2:1128.

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1988;81;835

Pediatrics

Jan E. Paradise, Anthony L. Rostain and Madelaine Nathanson