The Child Sexual Abuse Accommodation Syndrome (CSAAS) “. . . (is a manifestation of) secondary trauma in the crisis of discovery.” (Roland C. Summit, M.D.)

CSAAS was first articulated by Dr. Roland Summit in 1983 CSAAS has 5 categories (each contradicts basic adult assumptions) ? Secrecy

? Helplessness

? Entrapment/accommodation

? Delayed, conflicted and unconvincing disclosure

? Retraction/recantation Child Sexual Abuse Accommodation Syndrome helps to explain the experience of child sexual abuse ? The child-victim tries to reconcile her/his experience (of abuse) with adult norms and realities ? The juvenile’s necessary coping behavior/survival techniques contradict adult expectations and beliefs (i.e., do not correspond with how a ‘normal” adult victim would react in similar circumstances) ? This coping behavior (i.e. delayed disclosure, secrecy, recantation) results in virtual abandonment of victim by disbelieving adults— which then drives victim farther into self-blame, alienation, re-victimization Understanding CSAAS

? It is not a diagnostic tool, Summit would have changed the word “syndrome” had he known that it CSAAS would be misused. ? “Their attempts to reconcile their private experiences with the realities of the outer world are assaulted by disbelief, blame and rejection they experience from adults.” Summit, 1992. Unfortunately, what works for the child may not present well in court ? When abuse occurs, the victim is forced to adapt to her/his changed environment, to survive ? The victim’s behavior, in the eyes of the larger (adult) society that exists outside of the victim’s family, eventually will tend to make the victim less believable because it is not consistent with adult expectations and reality ? Adults, too, seek to isolate and protect themselves from the shattering implications of childhood sexual abuse and thus will reject those who threaten family stability One size does NOT fit all

? Procrustes, according to Greek myth, was an over- zealous, somewhat fanatical host. His guests always had adequate beds in which to sleep—but he would not hesitate to cut their legs off, if need be, to ensure a proper fit ? Similarly, forcing child victims to meet adult (“normal”) expectations of self-determinism and rational choice--expecting them to act as most adults would have--is inappropriate. It victimizes and erroneously discredits the already powerless victims Secrecy – the first category of CSAAS ? There are usually no witnesses to sexual abuse

? usually some combination of direct threats, guilt and shame require that kids keep the secret

? virtually no child is prepared to deal with sexual abuse

? therefore, the child is dependant on the perpetrator for the meaning and reality of the experience Secrecy

The perpetrator tells the child things such as: ? - this is our secret ? - this is your fault for being seductive ? - no one else will understand or believe you ? - your mother will hate you / be angry with you / will hate me ? - Mom will send you away / send me away / hurt you / hurt me ? -the family will break up / I won’t love you / I will hurt (kill) you or your family or your pets Secrecy

The secrecy alone tells the child that the act is bad and dangerous -

? “Everything will be okay if you just don’t tell…”

? The world inverts (the child is now responsible for the stability of the family) Secrecy: most child victims never tell anyone And if they eventually do, what do they often hear? ? -- that couldn’t happen in our family ? -- that’s not nice to talk about ? -- he didn’t mean any harm ? -- I don’t want to hear you talk like that again! ? --You are a slut ? --You are a liar Secrecy again – adult expectations determine the child’s credibility

? Most children who don’t tell (the majority don’t) fear rejection and anger if they do. When/if they eventually tell, they might hear: ? -- Why didn’t you tell me? ? -- How could you keep that secret? ? -- What are you trying to hide? ? -- Why did you wait so long? ? -- How can I believe such an incredible story? Secrecy – the bottom line

? Unless the victim has the opportunity and permission to share with a receptive adult the existence of the powerful secret of sexual abuse, the crime may never come to light, the perpetrator will remain free to victimize others and the victim may spend a lifetime filled with pain, lack of intimacy and anger Helplessness – the 2nd CSAAS category: Children are expected to protect themselves as an adult would ? Adult expectations that children will immediately disclose ignores the subordinate helplessness of children within authoritarian relationships ? The vast majority of child victims are victimized by caregivers and trusted adults, NOT by lurking strangers ? nevertheless, it is considered ok for children to learn to avoid strangers but disobedience and suspicion of “responsible” adults is not encouraged Helplessness (2) – uncomplaining victims are popularly assumed to be consenting participants, and yet

? What child has the authority or the maturity to effectively oppose a parental figure? ? What child can anticipate the consequences of sexual involvement with an adult caretaker? ? Who should bear the responsibility for a sexual mismatch—the child or the adult? Helplessness (3) – the Lolita myth ? In reality, most child victims are neither sexually attractive nor seductive in any conventional sense ? This myth is perhaps a reflection of the adult need to define child sexual abuse in a way that approximates logical (adult) behavior—one way to explain the otherwise unexplainable Enough of Lolita!

? Literature aside, the prevailing reality for most child victims is a relentless and progressive intrusion of sexual control by an all-powerful adult in a one-sided victim-perpetrator “relationship” ? And yet, like adult rape victims, children are expected to forcibly resist, to cry out, to struggle and escape.

Nearly every child victim fails to meet this standard This is how child victims “resist”

? Small children, as a rule, simply do not / cannot use force to protect themselves against adult control ? Many try to feign sleep and unconcern ? Most try to hide but very few cry out or protest ? Many dissociate

And we wonder why their testimony and behavior appear unconvincing to adults? Adults don’t admire helplessness

? It clashes with our sense of personal autonomy; it makes us uncomfortable ? We think victims look like accomplices unless overwhelming fear or violence was used against them ? We forget that a parent’s mere gesture or wordless action is compelling to a child; even a hint of familial rejection can be devastating But what if the child’s account seems illogical or incredible – what if the act would have required the perpetrator to take breathtaking risks?

? What if the mother was asleep in the next room?

? Who would take such a chance?

This inquiry, while logical, is naïve, because . . . Why naïve?

First, it assumes the molestation is deliberate and thoughtful

Second, that the act of molestation is risky

(Neither assumption is likely to be true) Molestation is not a caring and thoughtful act; it is a compulsive, greedy and desperate attempt to exert dominance over another and fulfill sexual desire, and there is little risk of exposure when the victim is young, there is a pre-existing relationship, the perpetrator uses that relationship and the power dynamic to ensure secrecy, and the perpetrator is motivated to maintain secrecy to avoid the consequences of his actions and to ensure continued access to the child for sex Not risky? Why not?

? Because pedophiles and other child molesters soon discover another truth that we simply do not want to accept, which is:

Dependent children are helpless or powerless to resist or complain Entrapment & Accommodation – the 3rd category of CSAAS

? For the child victim in a dependent relationship, the molestation is rarely a one- time occurrence ? The molester finds it thrilling and easy, thus it goes on and on ? And continues until the child reaches maturity or the perpetrator is stopped Entrapment & Accommodation ? Unless the child seeks or receives intervention, no option exists to stop the abuse ? Escape is not possible so accommodation mechanisms are survival skills ? The child, then, must learn to accept and adapt to the situation ? The child must find a way to adapt to the betrayal by an otherwise idealized figure Entrapment & Accommodation

? Faced with continuing victimization, the child seeks to achieve some sort of control in her life

? Unable / unwilling to recognize that the victimizer (usually a loved one) is actually ruthless and cruel, the child has only one alternative – to blame herself for her predicament Entrapment & Accommodation

? This conclusion and her failure to achieve any control leads to self-hate and self- debasement. ? Psychological ways a kid accommodates can include fragmenting, dissociating, or in extreme case can develop multiple personality disorder(MPD). Entrapment & Accommodation – the child must now protect the abuser

She finds solace where she can:

- imaginary companions

- multiple personalities

- altered states of consciousness Entrapment & Accommodation – it gets worse If the victim cannot create psychological coping mechanisms, then the rage and helplessness will seek active expression

? Girls may react with mutilation, suicide, promiscuity, running away, substance abuse

? Boys are more likely to turn the rage against others—depression, misogyny (sparked by mom’s abandonment of them), violence, sexual aggression and substance abuse Delayed, Conflicted and Unconvincing Disclosure – the 4th Category of CSAAS ? Most sexual abuse cases are never reported; only a small minority are ? If the victim does report, the corrosive results of her accommodation strategies (drug abuse, running away, delinquency,dissociation, accommodation) damage her credibility as a witness against her abuser ? She often reveals the secret and seeks help when she is least likely to appear convincing ? After all, she never complained of abuse before… Delayed, Conflicted and Unconvincing Disclosure ? Adults (judges, attorneys, jurors, parents) believe a normal, truthful child would immediately report abuse ? Adults are inclined to doubt any child who reports sexual abuse -- angry juvenile delinquents are even less credible ? Troubled adolescent victims face disbelief - - then scapegoating, humiliation and punishment Delayed, Conflicted and Unconvincing Disclosure- an alternative approach to accommodation ? Not all victims are angry and delinquent ? Some hide all indications of conflict ? They may appear popular and successful (honor student, star athlete, etc.)

Adult reactions to disclosures from these victims are equally dismissive, however (“you don’t act like you were abused; you are too well-adjusted to have been victimized…”) Delayed, Conflicted and Unconvincing Disclosure – what adults see

? Both kinds of victims—the angry and the seemingly well-adjusted—can seem equally unconvincing, for different reasons ? The accommodation pattern of the child— whatever it might be-- is easily interpreted to invalidate his or her complaint What did the mother know?

? Most probably were / are not aware of the on-going abuse ? After the revelation, she is then confronted with an agonizing choice: who is lying and untrustworthy, her child or her (husband, boyfriend)the alleged perpetrator? ? Whatever her choice, few mothers subsequently report the allegation to outside agencies Retraction – the 5th category of CSAAS ? Whatever the victim says, she is very likely to retract and recant ? She soon learns that the reasons for the secrecy are valid – the perpetrator does abandon her, her mother does not believe her, the family is fragmented, she is blamed for the uproar . . . ? Once again, the child is responsible for the preservation or destruction of the family How many times have prosecutors and victim- advocates heard this? I was mad at _____ for punishing me. He hit me and said I would never get out of the house again. I’ve been out-of-control for a long time and can’t seem to stop. He was right to do what he did. I was, like, just really wanting to get out of the house so I made up the story about him fooling around with me. I guess I made him angry; I didn’t mean to cause so much trouble. Retraction

And, why does the retraction sound so much more credible than the original complaint (even if it was quite explicit)? ? It confirms adult suspicions that the child is not to be trusted ? It restores the integrity of the family ? Children learn to keep quiet; adults learn not to listen ? And, prosecutors learn to doubt “conniving” children CSAAS – in conclusion

? Left unchallenged, the society pre-conceptions about sexual abuse reinforce child victimization, societal complacency and prosecutorial ineffectiveness ? Moreover, if not accounted for, it allows the crime (and the tragedy) of sexual victimization to thrive and perpetuate itself ? Recognition of the inequities and special dynamics inherent in the adult-child relationship is the first step in understanding CSAAS Using Expert Witnesses in Child Sexual Abuse Prosecutions Various uses for experts in sex abuse prosecutions

? To rehabilitate the credibility of the child victim/witness ? To show, by evidence of profiles/behaviors, that the victim was, in fact, abused ? To show that the victim exhibited behavior consistent with sexual abuse ? To demonstrate that the victim was credible and worthy of belief ? To testify about characteristics of typical sexual offenders Category one: expert testimony for rehabilitative purposes is usually admissible because

? It is not offered to prove existence of abuse ? Instead, child’s contradictory or puzzling behavior is analyzed (with reference to the CSAAS) ? Is used to answer implied/express assertion by the defense that child is lying Two more reasons why expert witness testimony is generally admissible for rehabilitative purposes

? It is offered to show that certain behaviors are not inconsistent with abuse

? It is usually offered after cross- examination, during prosecution’s case-in- chief or as rebuttal These types of sexual abuse or CSAAS expert witness testimony are less often admissible

? Descriptions of typical behaviors/common reactions found in sexually abused children in general ? Usually an opinion on the likelihood of sexual abuse of a particular child is not offered or allowed (no ultimate issue testimony) Nor are these opinions usually allowed either (your jurisdiction may differ, however!)

? That a particular child’s behaviors are consistent with characteristics of sexually abused children ? That a particular child was/is a sexual abuse victim (medical evidence, if available, is a different case) ? That a child is truthful or untruthful ? Testimony regarding profiles of sexual offenders the Frye test . . .

? Most of the excluded testimony is excluded under this standard (which says that expert testimony based on science not yet judicially recognized must be shown to be reliable—by general acceptance in its field—before it will be admissible) Or, if you prefer, the Daubert test (if your state uses rules similar to the F.R.E.)

? in 1993 the U.S. Supreme Court, in Daubert v. Merrell Dow Pharmaceuticals, Inc., overruled Frye, saying it was superceded by Federal Rules of Evidence (F.R.E.) 702

? Rule 702 allows expert testimony if it will assist the trier of fact to understand the evidence or to determine a fact at issue—a more permissive standard than Frye, obviously And the Daubert court defined when expert testimony/evidence qualifies as “scientific”

? When grounded in the methods/procedures of science ? When derived from the scientific method ? When supported by appropriate validation ? Peer review/support/agreement of and for the data or theory, while relevant, is not dispositive to its admissibility Daubert suggested 4 ways to determine admissibility

? Whether a theory or technique can be/has been tested ? Whether it has been subjected to peer review and publication ? The known or potential error rate and the existence of standards for its operation ? A degree of general acceptance in the scientific community is persuasive, too Objections to admitting expert witness testimony (even for rehabil- itative purposes) are:

? Child sexual abuse theory/study is relatively new and not reliable

? Profiles or syndromes lack firm scientific foundation Specifically, the objections to using syndrome experts for rehabilitation purposes are Syndromes were developed as therapeutic tools, not as methods of proof, and ? - are too subjective in application ? - “typical” victim doesn’t exist ? - different victims display different reactions ? - the behaviors, even if present, may be caused by other causes (other traumas, etc.) Defense attorneys ask: what about the possible prejudicial impact on the jury of expert testimony? ? Prosecutors must emphasize that rehabilitative testimony is least likely to create this problem, because ? - it generally only answers the behaviors/issues discussed in defendant’s own cross-examination, and ? - it addresses only the credibility issue; is not offered to prove the abuse (the proper jury instructions can help here ) Definition of ‘syndrome’

? A set of symptoms that occurs together ? A set of manifestations that occur together ? More than the mere occurrence of two or more findings in a patient Definition of ‘profile’

? Often used interchangeably with ‘syndrome’ and ‘disorder’

? Can also refer to a set of symptoms, characteristics or behaviors A syndrome is not a disease

? The concepts overlap but are not identical ? Patterns with features that recur with such frequency as to suggest a common cause are diseases ? Other clusters of attributes, less closely related to a single cause—known by a combination of features—are syndromes ? Both share the medically valuable feature of diagnostic value Ok, then -- just remember this

? A syndrome is more challenging than a disease because its cause (causes) is less clear

? And, the relationship between a symptom and its etiology (the determination of a cause, an origin) is also more obscure

? However, despite lower degree of diagnostic certainty, symptoms are suggestive of particular causes And one more thing (since both syndromes and diseases use the term), a ‘diagnosis’ is

? - a process ? - the art of distinguishing one disease from another ? - the end-product of the diagnostic process itself ? - a term used with syndromes as well as diseases Diagnosis and syndromes

? The certainty with which a syndrome points to a particular cause will vary with the syndrome ? Syndromes are on a continuum of certainty—some point to a cause with greater certainty than others An example of a syndrome that points to a cause with a high degree of certainty is Battered Child Syndrome

? A child with battered child syndrome is very unlikely to suffer from accidental injury so this syndrome, when diagnosed, has both high diagnostic value (in the medical sense) and high evidentiary/probative value (in the legal sense) An example of one with a lesser degree of certainty is Rape Trauma Syndrome

? Its value and certainty? Less all around ? Why? ? Because this syndrome consists of symptoms that can be caused by several events including, but not limited to, rape/sexual assault ? Which is why courts differ on its admissibility (admissible in some courts as evidence of rape/lack of consent; in others only to rehabilitate victims’ credibility) Another way to think of some syndromes – some are non- diagnostic

? Non-diagnostic syndromes do not point clearly or with any measurable degree of certainty to a particular cause ? They fall outside the traditional medical meaning of ‘syndrome’ ? CSAAS might be considered one of these

? Dr. Summit says: CSAAS is a clinical opinion, not a scientific instrument CSAAS and the 5 categories

? The presence of one or more of these categories does not necessarily indicate the presence of sexual abuse ? Delay, retraction, etc., cannot be considered evidence of sexual abuse ? CSAAS is not an illness nor a diagnosis; it was not designed to measure abuse ? It can explain children’s reactions to sexual abuse CSAAS is meaningless as evidence unless the victim made a disputed disclosure

Failure to understand this can lead to unfortunate consequences, because CSAAS does not diagnose

? Some prosecutors thought that it did . . .

? Its value is not as substantive evidence but it nevertheless has an important place in prosecution CSAAS

? Is useful to rehabilitate, to explain that behaviors such as delay and recantation are not inconsistent with sexual abuse, to rebut the myths and prejudices that attach to acceptance or endorsement of delayed or inconsistent disclosure, and to show that such behavior is not necessarily indicative of deceit in children ? This web cast was developed with support from the Office of Juvenile Justice and Delinquency Prevention, Department of Justice, under Grant Number 95-MU-FX-0017. Points of view or opinions in this presentation or the materials that accompany it are those of the presenters and do not necessarily represent the official position of the National District Attorneys Association, the American Prosecutors Research Institute or the U.S. Department of Justice.