The assessment of child sexual abuse allegations: using research to guide clinical decision making

As reports of child sexual abuse (CSA) have risen, greater attention has been focused on how clinicians evaluate allegations of abuse. A common theme in the CSA assessment literature is to encourage comprehensive, multimodal assessments. This recommendation, however, is rarely accompanied by suggestions regarding how clinicians might integrate and differentially weight the information gathered. The present article is designed to address the issue of which sources of information clinicians should rely upon when conducting CSA assessments. Specifically, the commonly used indicators and procedures for assessing allegations of abuse are identified and then examined in light of their respective empirical literatures. It is concluded that medical examinations and the child's report are among the best sources of information, and should therefore be most heavily relied upon to arrive at accurate decisions. Clinicians are encouraged to adopt the mind set of a scientist conducting an a priori, hypothesis-driven research investigation. This approach should help clinicians avoid the temptation of post hoc analyses that reflect personal biases more than the actual data.