By Lori S. Holmes, MA, LISW1 and Martha J. Finnegan, MSW2

Introduction

Minimal research has been done on the use of anatomical diagrams in child sexual abuse forensic interviews. Unlike anatomical dolls, which have been researched in depth, anatomical diagrams3 have been used for years with little or no guidance on their proper use in the forensic setting. Lately, there has been much discussion regarding the type of diagrams to use and how to use them during a child sexual abuse interview. To assist users of anatomical diagrams, the following suggestions are offered.

What Are Anatomical Diagrams?4

Like anatomical dolls, anatomical diagrams are an interview aid.5 Anatomical diagrams are outline drawings of nude people at various stages of development: young school-age children, adolescents, and adults. The diagrams look like real people in that they include facial and age-appropriate body features. The diagrams are of both males and females of various ethnicities.6

For What Ages Are Anatomical Diagrams Appropriate?

Although some may disagree,7 anatomical diagrams can be used with any age child. With young children the diagrams are often invaluable to obtain names for body parts or to direct questioning regarding sexual touch.8 For older children (or even developmentally delayed adults) the diagrams provide another method of communication that allows interview subjects to distance from their own bodies.9

Using Anatomical Diagrams In an Interview

The purpose:

As with any interview aid, interviewers should be able to articulate the purpose for using anatomical diagrams. There are at least four purposes for using the diagrams. First, a number of authorities recognize the value of the diagrams in assisting the child to identify body parts,10 thereby lessening the chance the interviewer will unwittingly suggest the name of a body part and the child will adopt that name. Second, the diagrams may assist the interviewer in determining a preschool or developmentally delayed child’s understanding of, and ability to distinguish between male and female gender.11 Third, interviewers can ask children to indicate on the diagrams where sexual touching occurred.12 Research findings indicate that anatomical diagrams are effective in obtaining body touch information from children.13 Fourth, anatomical diagrams are useful for clarification purposes.14 For example, if a child uses different words to name a certain body part, the interviewer can ask the child to indicate the location of that body part on the diagram.

The process:

The usefulness of any aid is influenced by the way it is presented and how the child is instructed regarding its use. Anatomical diagrams are no exception. This process applies to the four acceptable uses identified above.

After building rapport, show the child a male and female anatomical diagram that is consistent with the child’s ethnicity and age. When interviewing an adolescent, use the adolescent diagrams and when interviewing an adult, use the adult diagrams. When interviewing a four-year-old girl, the interviewer would show the child a girl and boy diagram of a preschooler. The diagram that is the same gender as the child should be shown to the child first. Both genders are used in order for the interviewer to show neutrality. If the initial report suggests the girl’s mother is the perpetrator, showing only the girl diagram may subject the interviewer to being attacked in court as a biased investigator who assumed the mother was the perpetrator and thus chose to limit the child’s options.

For preschool children (to determine the child’s understanding of and ability to distinguish between gender), fold the diagram in half so that just the front side of the diagram is showing. To show both the front and backside at the same time can be confusing to a young child. The child may think she is looking at a picture of two separate children. Ask the child, “Is this a picture of a girl or a boy?” Next show the child the opposite gender diagram and repeat the question. Then ask the child “Which picture is most like you?” For children ages six and older, gender differentiation does not need to be established, unless the child has developmental delays or there are concerns about the child’s ability to differentiate genders. With children in this age range, simply tell them that you are going to show them a couple of pictures. Explain that you show these pictures to kids that you talk to because the pictures have all of their body parts, and you want to know what they call different parts of their body. The next step of the process applies to all children. Starting with the same gender diagram as the child, ask the child to name the body parts on both the front and backsides of the diagrams. There is no prescribed order to proceed, but generally start at the head and ask the child “What do you call this?” as you point to a variety of body parts, such as the eyes, mouth, hands, breasts, bellybutton, genitals, buttocks, leg, and foot. As the child names each body part, the interviewer can label the part on the diagram.15 The child should never be made to feel that there are “correct” or “incorrect” names for body parts. Questions like, “Do you call that part anything else?” or “Have you ever heard another name for that part?” may imply to the child that he has given you a wrong answer. Whatever the child calls the body part is okay. Also, interviewers should refrain from any judgmental comments or emotional displays of shock or disgust. If interviewers are uncomfortable with the words a child uses for her body parts, the child will pick up on these cues and will likely shut down.

Some children may be hesitant about naming certain body parts or claim they don’t know what that part is called. If this occurs, first offer the child reassurance. Let the child know that it is okay to use any words she wants while talking with you in the interview room. If the child is still hesitant, an interviewer can ask what her same gender parent calls that body part. Another option is to tell the child “Think about what you want to call that part and we’ll come back to it in a minute.” A final option may be to ask the child a multiple-choice question. For example, if a child is hesitant about naming breasts, the interviewer can say, “Some kids call them breasts, chest, or something else. What do you want to call them today?” Once the child hears the interviewer using words for breasts, she may feel more comfortable using her own term. She may, however, pick one of the options. This should not be considered a suggestive question as the interviewer offered the child the choice of “or something else,” allowing the child the opportunity to choose her own name for the body part.

Understanding a child’s terminology for body parts at the outset of a forensic interview will help the interview process flow more smoothly. If the child discloses later on, the interviewer and child will already have a common understanding for body part names and will not have to take the time mid-disclosure to name the parts of the body. Herein lies the opportunity to also use the diagrams to allow the child to point to the places where he was touched or was made to touch. Once used for this purpose, the diagrams may also serve as a memory aid, cueing the child’s memory regarding other incidents involving his or the perpetrator’s body.16

The Cover-Up “Controversy”

As mentioned above, anatomical diagrams are nude diagrams of males and females of different ethnicities at various stages of development. Some authors suggest alternatives to these diagrams, which may include “gingerbread” diagrams, or diagrams where the genitalia are covered by a swim suit.17 Some interviewers have decided to use diagrams with no anatomy.18 Some jurisdictions have requested diagrams with “clothes on” in case the child reports fondling “over the clothes.”19

By introducing diagrams with bathing suits or clothes the interviewer may be displaying her own discomfort with the discussion of breasts, buttocks, and genitalia. This is not an uncommon occurrence since many adults in our society have learned from their own upbringing that private parts are not to be discussed. Children often learn the correct names of most body parts, but they may not have been taught any names for the intimate parts of the body or they may have been taught names that are silly or incorrect. This creates an atmosphere of shame and sends children the message “that these parts of the body are uncomfortable or different”20 from other body parts. A child interviewer may inadvertently be introducing “a sense of shame or guilt”21 to the child by covering up the genitalia, which ultimately influences the child’s ability to disclose sexual abuse. Interviewers spend time creating a child-friendly interview setting because they want children to feel comfortable talking about sexual touches, even if it is a difficult subject. Why then, would an interviewer cover-up the sexual areas of the body on the diagram, adding to the child’s sense of shame and secrecy and ultimately conveying the message “It’s not okay to talk about those body parts here”? Introducing the type of anatomical diagram shown in this article does not imply if, where, or how a child was touched. Those issues are explored in detail throughout an interview. However, even if a child was touched “over the clothes” the interviewer should clarify exactly “where” on the body the child was touched. The diagrams shown here are the best way to do that.

It is helpful to remember that the diagrams do not replace a child’s verbal account of the abuse but are simply tools to assist children in communicating their experience. Numerous courts have permitted children to use anatomical diagrams, anatomical dolls or other props as demonstration aids while testifying.22 If courts allow the use of diagrams or dolls to assist children when testifying, it is puzzling that interviewers would deny or dilute this assistance to children during an investigative interview.

Conclusion

The preceding information reviews the uses for anatomical diagrams in child sexual abuse forensic interviews. As with any tool, anatomical diagrams are not an end to themselves, but rather one aid that can enhance the child sexual abuse forensic interview. Determinations regarding sexual abuse should never be made on the use of anatomical diagrams alone. Various organizations have the anatomical diagrams for purchase, including Forensic Mental Health Associates of Orlando, FL (407-351-2308) and CornerHouse, an Interagency Child Abuse Evaluation and Training Center in Minneapolis, MN (612-813-8300).

1 Lori S. Holmes is the Training Coordinator at CornerHouse, an Interagency Child Abuse Evaluation and Training Center in Minneapolis, MN.
2 Martha J. Finnegan is the Child Interview Specialist at the FBI’s Innocent Images National Initiative in Calverton, MD.
3 Jon R. Conte et. al., Evaluating Children’s Reports of Sexual Abuse: Results from a Survey of Professionals, 61 Am. J. Orthopsychiatry 428 (1991); Mary E. Large, The Interview Setting, in MDIC Handbook: A Guide to the Establishment of Multidisciplinary Interview Centers for the Investigation of Child Sexual Abuse (Kee MacFarlane ed., 1995).
4 The diagrams below depict a pre-school aged Asian boy and African American girl. For a description or copy of diagrams depicting other ethnicities and age groups, contact CornerHouse at (612) 813-8300.
5 While this article is written about child sexual abuse interviews, it should be noted that many of the principles can also be applied to child physical abuse and child witness interviews.
6 CornerHouse, Anatomical Diagrams (2001); Groth, N and Stevenson, T., Anatomical Diagrams for Use in the Investigation and Intervention of Child Sexual Abuse (1990).
7 Wendy Bourg et. al., A Child Interviewer’s Guidebook (1999).
8 Barbara W. Boat & Mark D. Everson, What Tools Are Appropriate to Facilitate Interviews with Children? in Handbook for Child Protective Practice 70 (Howard Dubowitz & Diane DePanfilis eds., 2000).
9 Melissa M. Steinmetz, Interviewing for Child Sexual Abuse: Strategies for Balancing Forensic and Therapeutic Factors (1997).
10 CornerHouse, CornerHouse Interagency Child Abuse Evaluation Center Child Sexual Abuse Forensic Interview Training Manual (2002); Assessing Sexual Abuse of Young Children (Kee MacFarlane & Jill Waterman eds., 1986); Erin Sorenson et. al., Handbook on Intake and Forensic Interviewing in the Children’s Advocacy Center Setting (1997); Am. Prof’l Soc’y on the Abuse of Children, American Professional Society on the Abuse of Children Practice Guidelines: Investigative Interviewing in Cases of Alleged Child Abuse (2002).
11 CornerHouse, supra note 6.
12 Am. Prof’l Soc’y on the Abuse of Children, supra note 10.
13 Margaret S. Steward & David S. Steward, Interviewing young children about body touch and handling, in 61(4-5) Monographs of the Society for Research in Child Development, 61 ( Serial No. 248, 1996).
14 Bourg et. al., supra note 7.
15 These diagrams should be retained as evidence for possible use in court.
16 Bourg et. al., supra note 7.
17 Steinmetz, supra note 9 (1997).
18 Bourg et. al., supra note 7.
19 Personal communication with Lori Holmes, Training Coordinator, CornerHouse, in Minneapolis, Minn. (2002).
20 Debra W. Haffner, From Diapers to Dating: A Parent’s Guide to Raising Sexually Healthy Children (1999).
21 Id.
22 See e.g. Phillips v. State, 505 So.2d 1075, 1077 (Ala. Crim. App. 1986) (permitting the use of dolls as a demonstration aid); Pittman v. State, 178 Ga. App. 693, 344 S.E.ed 511, 512 (1986) (permitting use of diagrams as demonstration aid); See generally, John E.B. Myers, Evidence in Child Abuse and Neglect Cases § 6.10 (2000).