The Use of Anatomically Detailed Dolls in Forensic InterviewsHollida Wakefield and Ralph Underwager*Forensic interviewers may use a variety of techniques when
interviewing young children about sexual abuse allegations. These
include anatomically detailed dolls, books, puppets, drawings,
projective cards, clay, games and toys (Conte, Sorenson, Fogarty, Rosa,
1991; Kendall-Tackett, 1992). The anatomically detailed dolls are
the most controversial; in fact the controversies over the dolls led to
the California courts banning information obtained in interviews when
the dolls were used (In re Amber B. and Teela B., 1987 and In re
Christine C. and Michael C., 1987). Brief History of Research on Child Witnesses To better understand the anatomical doll controversy, it is helpful to review briefly the research on child witnesses. In the early part of the 20th century, research on children's memory focused on children as witnesses in court. Most of this research was conducted in Europe, especially Germany and France. The area was little studied in the United States until the 1920s and even then there were only a few studies on child witnesses until the 1980s (Ceci & Bruck 1993, 1995). The general conclusion from this research was that young children were suggestible and vulnerable to making serious errors in their court testimony (Ceci & Bruck, 1993, 1995; Goodman, 1984; Wakefield & Underwager, 1988). Following this early period, little research was done for years. But then the increases in reports and allegations of sexual and physical abuse led to changes in the legal system regarding the admissibility of child witnesses' testimony (Ceci & Bruck, 1993, 1995; Goodman, 1984). The requirement for corroboration of children's statements alleging sexual abuse was dropped. Therefore, children's credibility, their reliability as witnesses and their susceptibility to leading questions became important to researchers and there are now hundreds of articles addressing this issue. (For a review see Ceci & Bruck, 1995.) During the beginning of this current period, it was often assumed that young children were telling the truth and that false allegations of sexual abuse were rare (i.e., Faller, 1984; Summit & Kryso, 1978). Professionals often assumed that children did not lie about sexual abuse and could not be "coached" to make false statements about important central events such as sexual abuse. This sometimes resulted in children's accounts of bizarre, improbable abuse being believed by adults. Several highly publicized cases during the 1980s involving satanic, ritual abuse allegations resulted in convictions, (e.g., deYoung, 1998; Nathan & Snedeker, 1995). During this time, a few forensic psychologists and psychiatrists began to report on their analyses of child interviews (e.g., Coleman, 1986; McIver, 1986; Underwager, Wakefield, Legrand, Bartz, & Erickson, 1986). These early reports suggested that coercive questioning and suggestive interview techniques could produce serious errors in a child's statements. As academic researchers reviewed videotapes of actual interviews, they began conducting studies that more closely approximated what happens in the real world. These studies demonstrated conclusively that children who were interviewed suggestively could produce false narratives about fictitious events including central events. (For descriptions of several of these studies, see Ceci & Bruck, 1995 and Poole & Lamb, 1998). It is now understood that, although even very young children can
produce accurate, forensically useful information when they are
interviewed properly, suggestive questioning can lead them, and even older
children, to provide accounts of events that never occurred, even when
they first denied them (Bruck & Ceci, 1995; Ceci, 1994; Ceci & Bruck,
1993, 1995; Ceci, Loftus, Leichtman, & Bruck, 1994). Unfortunately,
despite the available knowledge about how to correctly interview children
(e.g., Bourg, 1999; Ceci & Bruck, 1995; Poole & Lamb, 1998; Orbach et al.,
2000; Yuille, Hunter, Joffe, & Zaprniuk, 1993; Work Group on Quality
Issues, 1997), many interviews in actual cases are suggestive and
contaminating (Underwager & Wakefield, 1990; Warren, Woodall, Hunt, &
Perry, 1996). It is within this context that the controversy over
the anatomically-detailed dolls has developed. Anatomically Detailed Dolls Anatomically detailed dolls are made of plastic or cotton and come
dressed with easily removable clothing. There are several commercial
manufacturers who sell the dolls but they are also sometimes handmade.
The mature female dolls have breasts that protrude and the boy and mature
male dolls have penises and scrotums. There are holes in the dolls
representing the mouth, anus and vagina. The penis is able to fit
into these openings. Often, the dolls have fingers that also fit
into the openings. The mature male and female dolls have simulated
pubic hair. Although some early versions of the dolls appear to have
genitals that are disproportionately large, a survey of 17 sets of
anatomical dolls (Bays, 1990) indicates that the genitals are not
exaggerated in size. The design of the dolls is not standardized and
there is considerable variation in the dolls available in the commercial
market (Simkins & Renier, 1996). CRITICAL ANALYSIS Children's Interactions with the Dolls Several studies have examined the interactions of non abused children with the anatomical dolls. The consistent conclusion from these studies is that the behavior of children in interaction with the dolls cannot be used to support a suspicion of sexual abuse. Although some researchers claim the dolls are not necessarily suggestive (e.g., Everson & Boat, 1994), some non-abused children put the dolls in sexual positions or use them in other ways that may trigger suspicions of sexual abuse (Boat, Everson, & Amaya-Jackson, 1996; Dawson & Geddie, 1991; Dawson, Vaughan, & Wagner, 1992; Everson & Boat, 1990; Gabriel, 1985; Geddie, Dawson, & Weunsch, 1998; Glaser & Collins, 1989; Herbert, Grams, & Goranson, 1987; McIver, Wakefield, Underwager, 1989). Even Boat and Everson, who support the use of anatomical dolls, note that non-abused children frequently touch the dolls' genitalia and may even put the dolls in clear sexual positions (Boat, et al., 1996). Bruck, Ceci, Francoeur, & Renick (1995) found that half of their three year old children who were given a physical that did not include a genital examination falsely demonstrated genital or anal touching when questioned with the dolls. The behaviors of the children with the dolls are not reliable.
Boat, et al. (1996) interviewed 20 children twice, 16 months apart, and
found significant changes in the avoidant (avoiding any contact with the
unclothed dolls) and sexualized (placing the dolls in clear intercourse
positions) behaviors with the dolls. In addition, an interview with
the anatomical dolls has been found to increase later sexually focused
behavior in some children (Boat, Everson, & Holland, 1990). The Use of the Dolls is Not Standardized There are no accepted standards for the use of the dolls (APA Council
of Representatives, 1991; Koocher et al., 1995; Levy, Markovic,
Kalinowski, Ahart, & Torres, 1995). In the research studies using
the anatomical dolls, there is significant variability both in the
protocols used and in the definitions of sexual behavior (Elliot,
O'Donohue, & Nickerson, 1993; Simkins & Renier, 1996). Professionals
who use the dolls often fail to use any agency guidelines or protocols (Froum
& Kendall-Tackett, 1998) and are likely to develop personal norms based on
their own experience (Skinner, Berry, & Giles, 1992). Levy, et al.
(1995) found "wide variations in the extent to which interviewers and
observers agreed on various facets of the interview" Boat and Everson (1988) report that not only did few of the
professionals in their sample follow a set of guidelines, there were
disparities as to the types of doll interactions that the professionals
thought were evidence of sexual abuse. Some, for example, believed
that avoidance or anxiety about an unclothed doll constituted "very
convincing" evidence that the child had been sexually abused. Also,
the dolls that were used showed substantial variation (in features such as
having vaginal, anal and mouth openings and individual fingers) from
professional to professional. Kendall-Tackett and Watson (1992)
found that most (77.8%) of their respondents reported using a set of
guidelines, but a substantial minority did not. But even if all
interviewers used some type of guidelines, these guidelines are not the
same from agency to agency. There is no indication that using the
dolls enables the interviewer to get accurate information. The Dolls May Be Leading and Suggestive, Especially if Used With Leading Questions The dolls are sometimes used in ways that can cause serious error in the interview (Boat & Everson, 1996; Wakefield & Underwager, 1988, 1998; Underwager & Wakefield, 1990). This can happen even if the dolls are only used as an anatomical model to determine the names the child uses for body parts. When the dolls are introduced prematurely or in combination with inappropriate questions, they can be suggestive (Poole & Lamb, 1998). When introduced early in the interview, the dolls can focus the child's attention on genitals. If the child is instructed to "pretend" with the dolls, this instruction may trigger the child into a fantasy speculative world. Boat and Everson (1996) report that the terms "play" or "pretend" were used in 28% of the interviews with 2 to 5 year olds and 9% of the interviews with 6 to 12 year olds. This means that the interviewers risked encouraging the child to confuse imaginary or playful scenarios with actual events. The dolls may become learning experiences for a child when interviewers
model handling the dolls, undressing them or naming them for the child.
This is especially true if the interviewer asks the child to show with the
dolls what the accused person did or places the dolls in sexually explicit
positions. Bruck and Ceci (1995) note that "Anatomically detailed
dolls may serve as a nonverbal suggestive device which promotes subsequent
sexualized play and sexualized verbalizations, none of which are accurate
indictors of past abuse" (p. 293). Very Young Children Have Developmental Limitations A basic assumption underlying the use of the dolls is that they will help a young child with limited verbal skills communicate information by demonstrating with the dolls. Therefore, the dolls are seen as particularly useful for preschool children (Yates & Terr, 1988). But very young children cannot use one object to represent another. Symbolic representation (the cognitive capacity to represent one thing by another thing) is learned during the developmental process of the individual from infant to adult (DeLoache, 1995a). It is not until age 3 that children begin to understand and successfully use symbols. Therefore, although adults may use the dolls in an attempt to overcome a young child's verbal limitations, this may instead increase the likelihood of error. DeLoache (1995b) examined this in a study with preschool children. Three groups of children ages 2 1/2, 3 and 4 participated in a play session with a male experimenter that involved touching the child and placing stickers on the child's body. Afterwards, the children were asked where they had been touched and were also asked to show where they were touched on the anatomical doll. The youngest children had great difficulty with this task and were unable to use the doll to show where the stickers had been placed on their bodies. Children in all groups provided less information using the doll than they did through talking or pointing at their own bodies. The basic assumption for using the dolls is that children can show by
their behavior useful information they cannot talk about. This
assumption is also refuted by the research showing that we do not have
memories before we have the verbal skills to talk about them (Awh, et al.,
1996; Simcock & Hayne, 2002; Tessler & Nelson, 1996). The Dolls Do Not Add Incremental Validity Researchers have not found consistent differences between the interactions of abused and non abused children with the dolls (Ceci & Bruck, 1995). Studies that claim to show such differences have major methodological shortcomings which limit any conclusions that may be drawn from them (Ceci & Bruck, 1993; Skinner & Berry 1993; Underwager & Wakefield, 1990, Wakefield & Underwager, 1988, 1989, 1994; Wolfner, Faust, & Dawes, 1993). Abused and non-abused children in the research studies are often not comparable in terms of economic background and living situations. In the doll studies, the children suspected of being abused tended to come from poor families living in poor neighborhoods. In contrast, the control groups tended to consist of children whose parents were willing to let them serve as subjects. The two groups also differed as to whether the children had undergone an abuse investigation including prior formal and informal interviews about sexual abuse. The anatomical dolls have no incremental validity (Wolfer, et al., 1993). That is, they do not enable the interviewer to get additional useful and valid information that adds to the information obtained from an interview alone. Saywitz, Goodman, Nicholas, and Moan (1991) report that the dolls did not often result in 5- and 7-year-old girls giving more details of vaginal or anal touch. Lamb, Hershkowitz, Sternberg, Boat, & Everson (1996) reported that children interviewed with dolls gave fewer and less detailed responses to open ended questions than did the children interviewed without dolls. In contrast, however, Leventhal, Hamilton, Rekedal, Tebano-Micci, and Eyster (1989) found that more detailed information was obtained when the doll interview was used and that the use of the dolls increased the level of suspicion of abuse. Wolfner et al. (1993), however, note that since the children's actual abuse status was unknown in this study, there is no way to tell whether the changes in conclusions about abuse were justified. Most important, the research on the dolls does not address the crucial Issue. The key problem is not to distinguish between children who are known to be either sexually abused or non abused. Instead, the task is to distinguish the children who have and who have not been abused from a group of children who are all suspected of having been abused. Therefore, the necessary research to determine whether the dolls provide any incremental validity would involve a group of children who are all suspected of being abused. Based on later evidence, these children, all who are initially suspected to have been abused, could be definitely divided into those who have and have not been abused. The doll interviews would have to take place before the children are interviewed by social workers and police officers, since the process of being questioned about abuse could affect their reactions to the dolls. Such research has not been done. (See Wolfner, et al. (1983) for a discussion of incremental validity as it relates to the doll research.) Even if the anatomical dolls produced useful information in addition to
what was obtained in an interview alone, this does not necessarily mean
that the professionals will properly interpret these data. Research
examining this issue was conducted by Realmuto and his colleagues
(Realmuto, Jensen, Wescoe, & Garfinkel, 1987; Realmuto, Jensen, & Wescoe,
1990). These researchers had an interviewer who did not know the
child's status use dolls to interview children known to have been abused
along with non abused control children. Neither the interviewer nor
three other professionals who reviewed the taped interviews did better
than chance in identifying which children had been abused on the basis of
the doll interviews. Although Widely Used in the Field, the Dolls are Not Generally Accepted in the Scientific Community The anatomical dolls are often used by social workers and law enforcement personnel in the field. But they are not accepted by many scientists and other professionals who have conducted research on interviewing child witnesses and formulated guidelines on how children must be interviewed to obtain reliable and forensically useful information. Therefore they cannot be claimed to be generally accepted in the scientific community and are unlikely to meet the Frye test. Surveys since 1985 indicate that the dolls are used by large numbers of police officers, social workers, and other professionals. Boat and Everson (1988) found doll use ranging from 40% for law enforcement officers to 94% for child protection workers. Kendall-Tackett and Watson (1992) found that 62% of law enforcement officers and 80% of mental health professionals in the Boston area used the dolls. Conte, Sorenson, Fogarty, and Rosa (1991), in a nationwide survey of professionals who "validated" child abuse allegations, found that 92% used them. More recently, Davey and Hill (1999) reported that 36% of the professionals in the United Kingdom used the dolls. The National Center for the Prosecution of Child Abuse (Holmes, 2000) supports their use and notes that the Hennepin County, Minnesota's child abuse evaluation center, CornerHouse, routinely employs anatomical dolls in their child interviews. Because of the widespread use of the dolls by workers in the field it may be claimed that the dolls are generally accepted. But the dolls remain controversial in the scientific community. The American Psychological Association took an equivocal position by acknowledging that the dolls have no standardization, normative data, or uniform standards, but still stating that they can be used (APA Council of Representatives, 1991; Koocher et al., 1995). The American Professional Society on the Abuse of Children (APSAC, 1996) also said that the dolls and other props could be used, but with care and discretion. The position that the dolls my be used with care, however, does not
represent a consensus of the scientific community since a substantial
number of professionals and scientists are against their use (e.g.,
Bigelow, 2000; Bruck & Ceci, 1995; Ceci & Bruck, 1995; Fisher & Whiting,
1998; Gardner, 1992; Levy, 1989; Mason, 1991; Skinner, 1996; Skinner &
Berry, 1993; Underwager & Wakefield, 1990, 1995; Wakefield & Underwager,
1998; Wolfner, et al., 1993). Some of these scholars feel so
strongly that the dolls have no place in forensic interviews of children
that they question the ethics of using them as a way of determining
whether a child has been sexually abused (e.g., Fisher & Whiting, 1998;
Skinner & Berry, 1993; Wolfner, et al., 1993). In addition to
lacking general acceptance, the dolls do not meet Daubert standards
because they are not grounded on scientifically informed principles and
methodology. They are not reliable and they have no demonstrated
validity, that is, there is no indication that the dolls measure what they
are supposed to measure. There is no evidence that they help
investigators obtain accurate, truthful and forensically useful
information from the children they are interviewing. RECOMMENDATIONS The use of anatomical dolls in forensic evaluations remains controversial. Although some professionals claim they are useful, others argue that using the dolls risks compromising the accuracy of the information obtained. Their use is especially problematic with very young children or if the child's interaction with the dolls forms the basis for a conclusion about sexual abuse. Some professionals believe that the dolls can be used if great care is taken not to be suggestive, if the child's interaction with the dolls is not the basis for an opinion about sexual abuse and if they are not used with very young children. Others, however, maintain that the dolls should not be used at all, even with great care. The dolls are not necessary with older children and risk introducing error into the accounts of younger children. The level of error is such that when a citizen's liberty interests are at stake great injustice may be done by wrongful convictions. There is no empirical evidence that doll interviews are a valid and a reliable method for getting accurate information. The use of the dolls as an assessment or investigatory technique is not generally accepted within the scientific community, rather, their use remains highly controversial. The dolls meet neither Daubert/Kumho Tire nor Frye requirements for admissibility. Given this, we recommend: Interviewers should use the techniques that are generally accepted in the scientific community (e.g., Bourg, 1999; Ceci & Bruck, 1995; Poole & Lamb, 1998; Orbach et al., 2000; Yuille, Hunter, Joffe, & Zaprniuk, 1993; Work Group on Quality Issues, 1997). When interviewed properly, even young children may be able to provide accurate and forensically useful information. Interviewers should not use the anatomically detailed dolls. They are not useful in obtaining relevant information and may affect the accuracy of what the child ultimately reports. They are controversial and their use may result in the information obtained in the interview being ruled inadmissible in court or being discredited by the opposing attorney. Attorneys should be familiar with the research on child witnesses and the generally accepted guidelines for interviewing children in cases of suspected sexual abuse. If anatomical dolls have been used in a forensic interview, the attorney must determine whether this may have compromised the reliability of the interview and take the appropriate legal steps. All investigatory interviews of child witnesses should be videotaped,
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