PEDIATRICS Vol. 89 No. 3 March 1992 513
The
Child
as a Witness
Committee on Psychosocial Aspects of Child and Family Health
In the last two decades, there has been a dramatic
increase in the recognition and reporting of child
physical and sexual abuse. This, coupled with the
current 50% divorce rate and the fact that many of
these separations involve child custody decisions, has
led to an increasing need for children to appear in
court.
Custody decisions usually involve family or civil
courts; however, allegations involving sexual abuse
may require a child to appear as a witness in criminal
court. Although the procedures and potential
conse-quences of these legal processes are quite distinct, all
situations in which children offer testimony can be
quite stressful and merit the awareness and support
of pediatricians.
Pediatricians can become involved with children
who are to be witnesses at several levels, including: 1) supporting patients in the pediatric office; 2) par-ticipating in legal proceedings; and 3) advocating for legal reform.
SUPPORT IN THE PEDIATRIC OFFICE
The pediatrician is an important source of support
for the child who is to be a witness, from the initial
contact through preparation for court appearance,
and after the court proceedings. A pediatrician should
attempt to keep the legal process in the child’s best
interest and should help the child maintain a healthy adaptation to a stressful experience. The pediatrician
should also address the psychological impact of the
event responsible for the child’s court appearance.
When parents plan to separate, pediatricians may
help the family by discussing living arrangements
and visitation during an office visit. If custody is
disputed, which is the case in 10% of divorces, and a
child is asked to appear in family court, the pediatri-cian can provide counseling to help prepare the child for the court appearance. If sexual abuse is suspected, the case will involve the criminal justice system, and a pediatrician is often the first person contacted. In such cases, the pediatrician needs the skills to
sensi-tively and appropriately interview, examine,
docu-ment, report, and provide ongoing counseling for the
child. The pediatrician also needs to have knowledge
of behavioral and physical indicators of abuse and of
variations and current trends in sexually transmitted
This statement has been approved by the Council on Child and Adolescent
Health.
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into
account individual circumstances, may be appropriate.
PEDIATRICS (ISSN 0031 4005). Copyright © 1992 by the American
Acad-emy of Pediatrics.
diseases.’ In one study of sexually abused children, more than half of the children were involved in court
cases, and 15% were asked to testify.2
Separate attention must be devoted to preparing a child for the stress that accompanies a legal hearing. Appearances in family court are often in the judge’s chambers and are markedly different from criminal court experiences in which child witnesses may be examined for weeks by defense attorneys. Pediatri-cians can help prepare children for court appearances
by explaining what will occur and that the child will
always be accompanied by a supportive person, such
as a parent. Pediatricians must be aware of children’s
concerns about recrimination. A pediatrician can help
minimize a child’s anxiety by explaining that the child will not be judged on his/her performance in the
courtroom, that efforts will be made to ensure that
the child will be safe from recrimination, and that the child should answer questions to the best of his/her
ability.
Because of the stressful events leading up to and surrounding a court appearance, a follow-up visit with the pediatrician is indicated after a child appears
as a witness. Children should be checked for
behav-ioral manifestations of acute stress (sleep disorders,
somatic complaints), adjustment, and functional
sta-tus (school activities, resumption of usual activities, physical functioning, social functioning, mental health).
One study has shown that participating in legal
proceedings may actually benefit a child
psychologi-cally.2 The study showed that waiting for court
pro-ceedings was likely to prolong depression in sexually abused children, whereas testifying helped decrease children’s anxieties.
PARTICIPATION IN LEGAL PROCEEDINGS
While the pediatrician’s principal role is to support and help the child and family cope with the stresses
of being involved in legal procedures, some
pediatri-cians will choose to use their knowledge and spirit of
advocacy to help with their patients’ trial processes, or to serve as experts testifying on children’s cognitive abilities. Pediatricians may also be asked to testify
based on their knowledge of and relationship with
the child.
Setting and Support
All children should have a supportive individual
present during court proceedings to explain
proce-dures, assist the child and parents, and provide sup-port by advising the court of the child’s needs. The courtroom and/or proceedings can also be adapted to
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514 CHILD AS A WITNESS
make the legal process more comfortable for the child. Specific adaptations include exclusion of spectators,
use of videotaped or closed circuit testimony, use of
child-size furniture, and eye-level interviewing. How-ever, a recent Supreme Court decision that affirmed the right of defendants in abuse cases to face their
accusers has raised questions about accommodations
provided by many state laws to protect children by
using videotape.3
Interview
The purpose of interviewing a child in legal
pro-ceedings is to obtain accurate information. The
set-ting, support persons, and interviewer’s skills will
influence the likelihood of success in accomplishing
this task. A supportive environment is essential for
two reasons: 1) so that the best interest of the child is
served and the child is not subjected to undue stress,
and 2) because the anxiety or emotional difficulties a
witness feels due to the stress of a court appearance
can hamper the process of obtaining valid and reliable information.
Individuals experienced in developmentally appro-priate interactions should be involved. A variety of
interviewing techniques may be appropriate,
includ-ing use of behavioral observation techniques, play,
story telling, and drawing, as well as verbal question-ing. The use of a single, well trained interviewer
capable of building rapport will enhance the process
and minimize trauma to children. However, none of these techniques is completely accurate in
determin-ing whether a child may have been abused.4’5
Principles of interviewing that apply to children in the office apply to children in the courtroom. These include building rapport and asking clear, simple
questions. For children testifying in abuse cases, a
time for ‘warm-up’ is especially important. Question-ing should be general at first and should gradually
become more specific.
Children may be confused by negatively worded
statements. They may also be eager to please, anxious
to provide the ‘right’ answer, and may have a
tend-ency to choose either the first or the last option when
given a number from which to select. Therefore, it is
essential that clearly worded questions that encourage children to provide answers that will be viewed
non-judgmentally are used. Correct answers or scenarios
should not be suggested as children may be influ-enced and are prone to suggestibility.
Determining Competence
The legal system is especially interested in three
questions about a child’s competence as a witness: 1)
Can the child receive and relay information
accu-rately? 2) Does the child know the difference between
telling the truth and a lie? 3) Does the child under-stand the need to tell the truth in court?
For adults, lying is an intentional deception that
involves either concealing or falsifying information
directed at an unsuspecting individual.6 Deception, as a developmental concept, has been studied exten-sively in young children, as has lying.4’79 Ekman has classified the reasons children lie. They include ‘to avoid being punished; to get something you couldn’t
get otherwise; to protect friends from trouble; to
protect yourself or another person from harm; to win
the admiration or interest of others; to avoid creating an awkward social situation; to avoid embarrassment;
to maintain privacy; and to demonstrate your power
over an authority.’4
When assessing the validity of information
pro-vided by children, many factors must be considered.
Younger children may not remember with as much
accuracy as older children, but the poignancy of an
event may enhance memory.7’8 A 3- or 4-year-old’s
ability to recall major events is excellent, although less important information is less well remembered.
Three-year-olds have actually been effective
wit-nesses.’#{176}A lack of accuracy may be due to the
follow-ing:
1. poor recall of event or sequences in an event
2. misinterpretation or confusion around an event
3. suggestibility
4. delusion or other mental disorder 5. mental retardation
6. intentional deception initiated by the child or re-suiting from adult coercion.
Older children, who are capable of understanding
the meaning of a lie, may be coerced into falsification
by adults who label the action an act of secrecy. The
child may conceptually consider a lie and a secret as
two separate entities and, therefore, may not feel a
lie is actually being told. Alternatively, children may be convinced that when a lie serves ‘a noble purpose’
they are not really doing something wrong.
The amount of literature that addresses the
accu-racy of children as witnesses is growing.4’9’6
ADVOCATING LEGAL REFORM
Finally, pediatricians may wish to collaborate with
other professionals to improve the legal procedures and policies for examining children.
Treating children sensitively throughout the
pre-trial period, along with the court’s increased
sensitiv-ity to the special needs of children, will help make
the legal examination easier for children. Specific
actions that can be helpful include educating judges
to be alert to lines of questioning that may confuse or
intimidate a child. They must recognize signs of em-barrassment or anxiety that may cloud or confuse a
child’s testimony and must take the initiative to help the child. For instance, a judge could call a recess to
explore a child’s discomfort.
It has been recommended that statutory reforms might be helpful. Possible reforms include: 1) abol-ishing competency requirements. Although state laws
vary widely, traditionally, children have not been considered competent witnesses. Adoption of the
more liberal Federal and Uniform Rules of Evidence, which allow children to testify and permit the trier of fact to determine the weight and credibility of the
testimony, would facilitate justice in cases involving children. 2) Authorizing special hearsay exceptions for child sexual abuse victims. This would enable the child’s statements to others, such as pediatricians and social workers, to be admitted as evidence.
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AMERICAN ACADEMY OF PEDIATRICS 515
Perhaps it is most important for pediatricians to
understand the current rights of children in their
states’ legal systems so they can advise children and
parents in their offices and determine what reforms
may be needed in their states. Many states have made
major legal strides in treating children sensitively as the following California codes illustrate: i) ‘Every person, irrespective of age, is qualified to testify. . .‘;
2) ‘The court should support, comfort, and protect
child witnesses.’; 3) ‘Up to two supporting persons
in the courtroom are allowed for any child under i6.’; 4) ‘The court is to take special care to protect the child
from embarrassment and restrict the unnecessary
rep-etition of questions.’; 5) ‘The intent and purpose of
the Legislature is to protect children from abuse. In
any investigation of suspected child abuse, all persons
participating in the investigation of the case shall
consider the needs of the child victim and shall do
whatever necessary to prevent psychological harm to
the victim.’; 6) ‘Contemporaneous closed circuit
tel-evision testimony is allowed in criminal prosecution.’
This last accommodation may need to be reviewed
based on the Supreme Court’s recent decision to
affirm the ‘right to confrontation’ of the Sixth
Amendment. Nevertheless, in a concurring opinion,
Justice O’Conner suggested that the ‘compelling state interest of protecting a child witness’ would allow for case-by-case decisions.3
In addition, it is possible for pediatricians to advo-cate for limiting the duration and frequency of child
interviews, to recommend that professionals
compe-tent in child interviewing question witnesses, and to
urge for expedient trials in abuse cases in order to
hasten the child’s healing process. Judges also have
considerable discretion to exclude spectators from
trials. Many other modifications in legal proceedings
for children have been recommended (AACAP).’7
Attempts to protect children from the stresses of a
trial will continue to conflict with the rights of the accused to face an accuser and to have cross-exami-nation of witnesses. We, therefore, anticipate that it will be necessary for pediatricians to engage in both
ethical and legal debates in the process of working
toward legal reform in the criminal court system.
Nevertheless, all of the recommended
accommoda-tions can occur in civil, family, and juvenile courts.
SUMMARY
i. Children are often involved with the courts in
cases of abuse and custody dispute and may be
required to be witnesses.
2. Pediatricians have important roles in assisting
chil-dren by providing psychosocial support for the
precipitant life event and the event of subsequent appearance in court.
3. A pediatrician also may be able to contribute to a
child’s adaptation by advocating for accommoda-tions in the legal process that are in the child’s best interest.
COMMrI-rEE ON PSYCHOSOCIAL ASPECTS OF CHILD
AND Finx HEALTH, 1991 TO 1992
Robert Pantell, MD, Chair William B. Carey, MD Stanford B. Friedman, MD Michael S. Jellinek, MD Lucy Osborn, MD Ellen C. Perrin, MD Martin T. Stein, MD Mark L. Wolraich, MD Liaison Representative Mervyn Fox, MD,
Canadian Paediatric Society Consultants
John B. Reinhart, MD
George J. Cohen, MD
National Consortium for Child
Mental Health Services REFERENCES
I. American Academy of Pediatrics, Committee on Child Abuse and
Ne-glect. Guidelines for the evaluation of sexual abuse of children. Pediat-rics. 1991;87:254-259
2. Runyan DK, Everson MD, Edelsohn GA, Hunter WM, Coulter ML. Impact of legal intervention on sexually abused children. JPediatr. 1988;1 13:647-653
3. Coy v Iowa,487 US 1012 (1988)
4. Ekman MAM. Kids’ testimony in court: the sexual abuse crisis. In: Edman P, ed. Why Kids Lie. New York, NY: Scribners; 1989
5. Faust D, Ziskin J.The expert witness in psychology and psychiatry. Science. 1988;241:31-35
6. Edman, P. Telling Lies: Clues to Deceit in the Marketplace, Politics. and Marriage. New York, NY: WW Norton & Company; 1985
7. Johnson MK, Foley MA. Differentiating fact from fantasy: the reliability
of children’s memory. ISoc Issues. 1984;40:33-50
8. Loftus EF, Davies GM. Distortions in the memory of children. JSoc Issues. 1984;40:51-67
9. Nurcombe B. The child as witness: competency and credibility. JAm Acad Child Psychiatry. 1986;25:473-480
10. Jones DPH, Krugman RD. Can a three-year-old child be a witness to her sexual assault and attempted murder? Child Abuse NegI. 1986;10:253-258
I 1. Berliner L, Barbieri MK. The testimony of the child victim of sexual
assault. ISoc Issues. 1984;40:125-137
12. Goodman GS. Child witness: an introduction. JSoc Issues. 1984;40:1-7 13. GOOdWin J, Sahd D, Rada RT. Incest hoax: false accusations, false
denials. Bull Am Acad Psychiatry Law. 1978;6:269-276
14. Green AH. True and false allegations of sexual abuse in child custody disputes. JAm Acad Child Psychiatry. 1986;25:449-456
15. Landwirth J.Children as witnesses in child sexual abuse trials. Pediatrics. 1987;80:585-589
16. Whitcomb D, Shapiro ER, Stellwagen LD. When the Victim Is a Child: Issues for Judges and Prosecutors. ABT Associates, Inc; 1985. Sr. Doc. No.
J28.23:V66. Dept of Justice, 86-5135
17. American Academy of Child and Adolescent Psychiatry. Statement on Protecting Children Undergoing Abuse: Investigations & Testimony. February 9, 1986
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1992;89;513
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