Journal of Consulting and Clinical Psychology 2004, Vol. 72, No.

2, 304 316

In the public domain DOI: 10.1037/0022-006X.72.2.304

Using a Human Figure Drawing to Elicit Information From Alleged Victims of Child Sexual Abuse
Jan Aldridge
University of Leeds

Michael E. Lamb, Kathleen J. Sternberg, and Yael Orbach

National Institute of Child Health and Human Development, National Institutes of Health

Phillip W. Esplin
Phoenix, AZ

Lynn Bowler
Derbyshire Constabulary

Ninety 4- to 13-year-old alleged victims of sexual abuse were interviewed by police officers using the National Institute of Child Health and Human Development (NICHD) investigative interview protocol, following which they were shown a human figure drawing and asked a series of questions. The drawing and associated questions elicited an average of 86 new forensically relevant details. They were especially productive with 4- to 7-year-olds, who provided an average of 95 additional details (27% of their total) after the drawing was introduced despite having previously exhausted their memories. Information elicited using the drawing may be less accurate, however, because recognition memory prompts predominated, so such drawings should only be introduced late in investigative interviews.

In the past decade, researchers have extensively studied interview techniques that enhance the amount and quality of the information elicited from child witnesses in both laboratory and field settings. Regardless of age, responses to individual free-recall prompts (i.e., invitations), which allow children to report remembered information without input from the interviewer, are at least three times more informative than responses to recognition memory prompts (i.e., yesno and forced-choice questions), which limit children to the mere affirmation, negation, or selection among options provided by interviewers (Lamb, Hershkowitz, Sternberg, Esplin, et al., 1996; Sternberg, Lamb, Davies, & Westcott, 2001). In addition, freely recalled information is more likely to be accurate than information retrieved in response to recognition memory

Jan Aldridge, Department of Psychiatry, University of Leeds, Leeds, United Kingdom; Michael E. Lamb, Kathleen J. Sternberg, and Yael Orbach, Section on Social and Emotional Development, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Phillip W. Esplin, independent practice, Phoenix, Arizona; Lynn Bowler, Derbyshire Constabulary, Ripley, United Kingdom. We are grateful to the police officers who conducted the interviews we studied; to Sally Pearson for helping us to gather the data; to Heather Stewart for assistance training the interviewers; and to Hana Shiloach Nasser, Anna Cederborg, Jessica Norris, Melissa Pelaez, Esther SleethKeppler, and Katrina Vickerman for assistance in coding, data analysis, and data management. Sadly, Kathleen J. Sternberg died on February 7, 2003 before completion and publication of the report. We gratefully acknowledge her contributions to the research. Correspondence concerning this article should be addressed to Michael E. Lamb, Section on Social and Emotional Development, National Institute of Child Health and Human Development, Rockledge One Center, Suite 8048, 6705 Rockledge Drive, Bethesda, MD 20892. E-mail: michael_lamb@ nih.gov 304

prompts in both laboratory and forensic contexts (Dale, Loftus, & Rathbun, 1978; Dent, 1986; Dent & Stephenson, 1979; Goodman & Aman, 1990; Goodman, Bottoms, Schwartz-Kenney, & Rudy, 1991; Hutcheson, Baxter, Telfer, & Warden, 1995; Lamb & Fauchier, 2001; Oates & Shrimpton, 1991; Orbach & Lamb, 2001; Ornstein, Gordon, & Larus, 1992). As a result, most professional and expert guidelines recommend that forensic interviewers should rely as much as possible on free-recall prompts when obtaining information from alleged victims of child sexual abuse (American Professional Society on the Abuse of Children, 2002; Bull, 1992; Jones, 1992; Lamb, Sternberg, & Esplin, 1998; Memorandum of Good Practice, 1992; Poole & Lamb, 1998; Saywitz & Goodman, 1996). Studies of autobiographical memory reveal important developmental changes in childrens retrieval strategies and capacities (Schneider & Bjorklund, 1998). Young children tend to remember less information and to provide briefer accounts of their experiences than older children do (e.g., Baker-Ward, Gordon, Ornstein, Larus, & Clubb, 1993; Lamb, Sternberg, & Esplin, 2000; Lamb et al., 2003; Ornstein et al., 1992; Sternberg, Lamb, Orbach, Esplin, & Mitchell, 2001). Young children, especially preschoolers, are also more likely than older children to respond erroneously to suggestive questions about their experiences and to select erroneous options when responding to forced-choice questions (Bruck, Ceci, Francouer, & Renick, 1995; Ceci & Bruck, 1995; Goodman & Aman, 1990; Lyon, 1999; Oates & Shrimpton, 1991; Poole & Lindsay, 1998). Despite these developmental differences, younger and older children do not differ significantly with respect to the total number of substantive details provided in response to invitations or the average number of details provided per invitation (Sternberg, Lamb, Orbach, et al., 2001), and their reports are equivalently accurate (Flin, Boon, Knox, & Bull, 1992; Goodman & Reed,

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1986; Johnson & Foley, 1984; Marin, Holmes, Guth, & Kovac, 1979; Oates & Shrimpton, 1991). In addition, young children can respond informatively to open-ended free-recall prompts (Lamb et al., 2003; Sternberg, Lamb, Orbach, et al., 2001). Half of the information provided by the 4- to 6-year-olds studied by Sternberg, Lamb, Orbach, et al. (2001) and Lamb et al. (2003) was elicited using free-recall prompts. Because their responses are briefer than those of older children, however, children under the age of 6 require more prompts in order to elicit the fullest possible accounts of experienced events (Orbach & Lamb, 2000), and they often have difficulty responding to the most general openended prompts (What happened?). As a result, many interviewers use more recognition memory prompts and even leading (suggestive) prompts when questioning young children, even though such prompts are more likely to elicit inaccurate information. Because forensic interviewers often have difficulty adhering to recommended interview practices in the field (Cederborg, Orbach, Sternberg, & Lamb, 2000; Craig, Scheibe, Raskin, Kircher, & Dodd, 1999; Lamb, Hershkowitz, Sternberg, Esplin, et al., 1996; Sternberg, Lamb, Davies, Westcott, 2001; Walker & Hunt, 1998), researchers at the National Institute of Child Health and Human Development (NICHD) developed a structured interview protocol designed to translate professional recommendations into operational guidelines (Orbach et al., 2000). The structured protocol guides interviewers through all phases of investigative interviews and provides them with open-ended prompts and techniques to maximize the amount of information elicited from free-recall memory. Two independent field studies demonstrated that (a) interviewers who use the protocol adhere to recommended practices more than interviewers who do not use the protocol and (b) 4- to 13-year-old children interviewed using the protocol provide more free-recall details than do children interviewed without the protocol (Orbach et al., 2000; Sternberg, Lamb, Orbach, et al., 2001). Interviewers using the NICHD protocol thus elicited information likely to be of higher quality (more accurate) than the information elicited by nonprotocol interviewers. In addition, protocol interviews elicited less information using yesno questions and suggestive prompts, which are especially likely to elicit inaccurate information from young children (Bell, 1984; Goodman & Aman, 1990; OCallaghan & DArcy, 1989; Peterson & Biggs, 1997; Price & Goodman, 1990; Saywitz, Goodman, Nicholas, & Moan, 1991). In exploring alternatives to risky recognition memory prompts, researchers have shown that contextual cues referring to previously disclosed information (i.e., cued invitations) can be very effective in eliciting information from alleged victims of between 4 and 13 years of age nonsuggestively (Lamb et al., 2003; Orbach & Lamb, 2000; Sternberg, Lamb, Orbach, et al., 2001). Lamb et al. (2003) found that 4- to 8-year-old alleged victims provided considerable amounts of forensically relevant information in response to cued invitations (e.g., You said that he touched your peepee. Tell me more about that), which thus represent productive alternatives to risky recognition memory prompts (e.g., So did he put his finger in your vagina?) when general invitations appear to be ineffective. By structuring recall of experienced events, associating them with details that have been mentioned by the child, the cued invitation technique enhances the capacity of young children

to reconstruct past events and to elaborate on their narrative accounts, avoiding interviewer contamination during the recall. Building on the notion that disclosed actions can be used as cues to elicit new event information nonsuggestively, investigators in the present study used references to disclosed actions (i.e., touch) in association with human figure drawings as contextual cues. Although the human figure drawings were presented following an exhaustive interview, the drawings gave the children further opportunities to provide body-part information in response to the associated yesno questions. Recall prompts were then used to foster elaboration. Although perhaps less popular than anatomically detailed dolls, human figure drawings are frequently used by and widely recommended to therapists and forensic interviewers, but they have never been studied systematically (Poole & Lamb, 1998). Building on earlier findings regarding the usefulness of nonsuggestive cues (Lamb et al., 2003; Orbach & Lamb, 2000), we designed the present study to determine whether using disclosed information in association with a nonsuggestive human figure drawing might help elicit additional information from young abuse victims and whether the usefulness of such props varied depending on the childrens ages. Obviously, human figure drawings can be suggestive intrinsically and can also be used in combination with suggestive prompts. Suggestion increases the risks of eliciting inaccurate information and of contaminating childrens memory in ways that compromise the value of later interviews (Ceci & Bruck, 1995). In the present study, we took a number of steps to minimize these risks. First, we used a gender-neutral outline drawing rather than an anatomically detailed drawing, reasoning that explicit drawings might be too suggestive. Second, the drawing was only introduced after the interviewers felt they had elicited as much information as possible from the children using the structured NICHD protocol. Because the drawing was introduced following exhaustive retrieval, any contamination was minimized, and the forensic value of the information elicited earlier in the interview was not compromised. Third, use of the drawing was carefully and systematically structured. Although the drawing had to be used in association with recognition memory (but not suggestive) prompts, the first question offered after the introduction of the drawing prompted for recall. Whenever recognition memory prompts elicited information, furthermore, interviewers offered free-recall prompts. This strategy was adopted to minimize adverse effects on the quality of information elicited. On the basis of previous research (Lamb et al., 2003; Orbach et al., 2000), we expected that (a) there would be developmental increases in the total amount of information provided by alleged victims; (b) additional incident information would be elicited using the human figure drawing following a protocol interview; (c) most of the information elicited before introduction of the human figure drawing would be provided in response to free-recall prompts, whereas most of the information provided after the introduction of the human figure drawing would be provided in response to recognition-memory prompts; and (d) a human figure drawing would be particularly useful when interviewing young children. Because they have less effective retrieval strategies and thus tend to provide fewer details, young children should be especially responsive to the concrete visual cues provided by the human figure drawing.

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ALDRIDGE ET AL. mentioned by the child), such as When did it happen? If crucial details are still missing at the end of the interview, interviewers may ask limited option-posing questions (mostly yesno questions referencing new issues that the child failed to address previously) such as Did he touch any part of your body when he was talking to you? Suggestive utterances, which communicate what response is expected (At that time he was lying on top of you, wasnt he?) are strongly discouraged in all phases of the interview. Both Orbach et al. (2000) and Sternberg, Lamb, Orbach, et al. (2001) showed that use of the NICHD protocol greatly increased the amount of free-recall information elicited from alleged abuse victims using openended prompts. In the present study, the protocol was followed by a series of structured questions (see Appendix A) in which reference was made to an unclothed (frontal and dorsal), gender-neutral outline drawing (see Appendix B). Questioning began with a general summary to refocus childrens attention on any touching disclosed earlier in the interview. Because all of the children had already mentioned being touched by the perpetrator, the next prompt (Number 4 in Appendix A) was a directive recall prompt (i.e., Show me on the picture where . . . .) that was followed by a series of alternating yesno questions and open-ended free-recall prompts concerning the parts of the childs body that were touched by the perpetrator and the parts of the perpetrators body that made contact with the child. Free-recall prompts were used to elicit further information whenever body contact was mentioned.

The sample included investigative interviews of 90 children (72 girls and 18 boys), ranging from 4 to 13 years of age (M 9.07, SD 2.57). These interviews were conducted by six police officers from a single Constabulary in the United Kingdom who had been trained to use the NICHD investigative interview protocol (Orbach et al., 2000; Sternberg, Lamb, Orbach, et al., 2001). During the study period, these police officers rather than their colleagues were asked to investigate sexual abuse allegations involving 4- to 13-year-old victims whenever possible. Forty-two of the 132 interviews conducted by these interviewers during this period were excluded from this study: 2 yielded no allegation of abuse; 8 did not follow the protocol; 5 yielded allegation of physical rather than sexual abuse; 3 yielded allegations of exposure only; 6 were interviews of witnesses rather than alleged victims; 2 were second interviews; and 16 did not include the figure drawing. Thus, all available protocol-guided interviews that included the figure drawing and yielded explicit allegations of fondling or penetrating sexual abuse were included in the study. All of the alleged complaints were deemed valid by police investigators, but conclusive corroborating evidence was seldom obtained. Thirty-five (39%) of the children reported a single incident, whereas 55 (61%) reported two or more incidents. In 24 (27%) of the cases, the reported offender was an immediate family member, 22 (24%) were more distant relatives, 41 (46%) were familiar but unrelated individuals, and only 3 (3%) were unfamiliar to the alleged victims. Eighteen (20%) of the children reported being fondled over their clothes, 32 (36%) reported touching under their clothes, and 40 (44%) described oral, anal, or vaginal penetration. There were no significant differences between children of each age with respect to the proportions involving different types of abuse, relationship to the perpetrator, or the reported number of abusive events.

Data Coding
Audiotapes of the interviews were transcribed and checked to ensure their completeness and accuracy. Two trained raters reviewed the substantive portions of the interviews and categorized each interviewer utterance, defined by a turn in the conversation. Four categories introduced by Lamb, Hershkowitz, Sternberg, Boat, and Everson (1996) were used to characterize all substantive interviewer utterances: invitations, directive utterances, option-posing utterances, and suggestive utterances. 1. Invitations prompted free-recall responses from the child either in a general way (for example, Tell me everything that happened) or using details disclosed by the child as cues (for example, You mentioned that he touched you. Tell me everything about the touching.). Directive utterances refocused the childs attention on details that had already been mentioned, typically requesting additional information in the form of wh- questions. Examples include When did it happen?(when the child had disclosed it ) or What color was his T-shirt? (when the child had mentioned a T-shirt). Option-posing utterances prompted the child to affirm, negate, or select an investigator-given option using recognition memory processes, but they did not imply that a particular response was expected. For example, the investigator might ask Did he touch you over or under your clothes? (when the child had mentioned being touched). Suggestive utterances were stated in such a way that the interviewer strongly communicated what response was expected (e.g., He forced you to do that, didnt he?) or assumed details that had not been revealed by the child (for example: Child: We laid on the sofa. Interviewer: He laid on you or you laid on him?).

NICHD Investigative Protocol

The NICHD protocol structures all phases of the investigative interview. In the introductory phase, the interviewer introduces him- or herself, clarifies the childs task (the need to describe events truthfully and in detail), and explains the ground rules and expectations (i.e., that the child can and should say I dont remember, I dont know, I dont understand, or correct the interviewer when appropriate). The first part of the rapport-building phase is designed to create a relaxed, supportive environment. Children are then prompted to describe a recently experienced neutral event in detail. This training is designed to simulate the open-ended investigative strategies and techniques used in the substantive phase while demonstrating to children the specific level of detail expected. In a transitional phase between the presubstantive and the substantive parts of the interview, a series of prompts are used to identify the target event(s) under investigation nonsuggestively, beginning with Tell me the reason you came to talk with me today. The interviewer only moves on to some carefully scripted and increasingly focused prompts (in sequence) if the child fails to identify the target event(s). Following disclosure of the allegation, the free-recall phase begins with the main invitation (Tell me everything that happened from the beginning to the end as best you can remember). Follow-up open-ended prompts (i.e., invitations) are then recommended (Tell me more about that). As soon as the first narrative is completed, the interviewer asks whether the incident occurred one time or more than one time and then proceeds to secure incident-specific information, using follow-up and cued invitations (e.g., Earlier you mentioned a [person/object/action]. Tell me everything about that), making reference to details mentioned by the child to elicit uncontaminated free-recall accounts of the alleged incident(s). Only after exhaustive open-ended questioning do interviewers proceed to directive questions (focused questions addressing details previously

2.

3.

4.

When a single turn in the dialogue included two or more statements or questions that could be coded differently, the highest category defined by

USING HUMAN FIGURE DRAWING the numerical label in the previous list was applied. The interviewers also made frequent use of facilitatorsnonsuggestive prompts such as OK designed to encourage the child to continue an ongoing response. These were not considered interruptions to the childs response for purposes of the analyses discussed here. Coders also tabulated the number of new details conveyed by the child (Lamb, Hershkowitz, Sternberg, Esplin, et al., 1996). By definition, details involved the identification of individuals, objects, and events and descriptions of their features (e.g., appearance, actions, locations). All were thus forensically relevant. Central details were defined as plot-crucial details changes would imply substantial alteration to the incident being described. Although still forensically relevant, peripheral details (such as references to appearance or clothing) were not plot crucial, meaning that changes in these details would not affect the description of the incident per se. Details were only counted when they added to understanding of the target incidents, so restatements of facts were not counted. Details provided following facilitators were attributed to the preceding substantive utterance (invitation, directive, option posing, or suggestive).

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involving gender. Neither gender nor number of incidents was included in any of the analyses reported below.

Interviewer Utterances
A three-way Age Abuse Type Phase of Interview (before vs. after drawing) multivariate analysis of variance (MANOVA) concerned with the number of interviewer prompts of each type (invitation, directive, option posing, suggestive) was conducted to explore sources of variation in the investigators strategies. There was a multivariate main effect for interview phase, F(4, 78) 41.78, p .001, and an Interview Phase Age interaction, F(8, 146) 2.41, p .05, but only nonsignificant trends ( ps .10) with respect to abuse type and age. Subsequent univariate analyses revealed significantly ( ps .001) more interviewer utterances of all types, Fs(1, 81) 73.88, 29.99, 19.18, and 32.07 for invitations, directives, option-posing, and suggestive prompts, respectively, before as opposed to after introduction of the drawing (see Table 1). Univariate analyses showed significant Age Phase interactions only with respect to directive prompts, F(2, 81) 5.01, p .01. The average number of directives before the drawing increased with age, whereas there was no comparable trend earlier. Analyses of the proportions (rather than the absolute numbers) of interviewer prompts of each type confirmed that introduction of the drawing changed the interviewing strategies quite dramatically. An Age Abuse Type Phase of Interview MANOVA concerned with these proportions revealed effects for age, F(6, 158) 3.47, p .01; and phase, F(3, 79) 104.46, p .001; as well as an Age Phase interaction, F(6, 158) 2.77, p .05. Subsequent univariate analyses revealed that the proportion of utterances that were invitations, F(1, 81) 90.70, p .001; directives, F(1, 81) 24.99, p .001; and suggestive prompts, F(1, 81) 26.93, p .001, decreased from .35 (.17), .43 (.15), and .05 (.06) to .17 (.10), .32 (.15), and .02 (.03), respectively, after the drawing was introduced, whereas the proportion of option-posing prompts increased from .17 (.09) to .48 (.16); F(1, 81) 287.01, p .001. Univariate analyses revealed effects for age only in the proportions of option-posing, F(2, 81) 4.27, p .05, and directive, F(2, 81) 6.80, p .01, prompts, with Age Phase interactions in the proportions of directives, F(2, 81) 6.80, p .01, and optionposing, F(2, 81) 4.27, p .05, prompts qualifying these effects. Specifically, in the case of option-posing prompts, the proportions were highest among 8- to-10-year-olds, but the differences between these children and those who were either younger or older

Interrater Reliability
All coding was conducted by one of two experienced coders who trained on an independent set of transcripts until they agreed with one another concerning the classification or identification of at least 90% of the utterance types and details, respectively. Both coders had coded hundreds of transcripts reliably before beginning work on transcripts for this study. During the course of rating, 20% of the transcripts were independently coded by both of the raters to ensure that they remained equivalently reliable. In these assessments, raters again agreed regarding identification of at least 90% of the details. Agreement regarding the classification of the utterance types was assessed using Cohens kappa: Overall agreement was .96, and agreement regarding individual categories ranged from .89 to .97.

Results Preliminary Analyses

Preliminary Age (4 to 7, 8 to 10, and 11 to 13 years) Phase (before vs. after drawing) Type of Abuse (touching over clothes, touching under clothes, penetration) Number of Incidents (one vs. more than one) analyses of variance (ANOVAs) with the total number of details and the total number of central details as dependent variables revealed significant effects for number of incidents on the numbers of details, F(1, 72) 6.08, p .05, and the numbers of central details, F(1, 72) 5.94, p .05, reported but no interactions involving this factor. Children consistently provided more details when they reported more than one incident of abuse. There were no significant main effects or interactions

Table 1 Age Differences in the Number of Different Interviewer Utterance Types Before and After Introduction of the Human Figure Drawing
4- to 7-year-old Before Utterance Invitations Directives Option posing Suggestives M 19.69 15.17 18.55 4.66 (SD) (10.22) (4.71) (8.79) (4.65) M 8.59 17.14 11.03 1.52 After (SD) (5.91) (12.96) (10.49) (1.86) M 22.23 31.80 20.00 2.77 8- to 10-year-old Before (SD) (20.58) (23.19) (9.62) (2.79) M 6.63 13.17 11.47 1.13 After (SD) (5.10) (11.37) (9.04) (1.83) M 26.39 40.26 19.39 2.97 11- to 13-year-old Before (SD) (20.58) (22.34) (11.29) (2.87) M 6.97 15.00 13.81 1.09 After (SD) (7.20) (11.43) (10.25) (1.64)

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ALDRIDGE ET AL. 21.9 20.6 54.1 3.4 Invitations Directives Option posing Suggestives 134.59 73.00 26.45 15.86 (134.47) (62.02) (34.53) (19.69) 47.9 30.9 11.3 6.8 31.48 34.00 27.31 2.07 (29.86) (31.78) (20.04) (2.93) 29.1 33.1 33.7 3.3 219.50 103.77 29.50 9.07 (217.58) (80.88) (35.36) (12.98) 56.2 28.8 9.0 3.0 26.27 24.07 44.45 4.17 (33.33) (27.88) (34.29) (9.03) 23.9 22.1 49.9 3.6 329.68 154.87 36.29 16.19 (270.32) (110.04) (29.46) (18.97) 56.8 31.1 7.8 3.4 23.97 18.19 31.87 1.04 (47.75) (21.24) (25.61) (5.01)

Table 2 Age Differences in the Number and Proportion of Details Elicited Using the Different Types of Prompts Before and After Introduction of the Human Figure Drawing

was more dramatic after the drawing than before. In the case of directives, the proportions increased steadily with age before the drawing, whereas they were most prominent after the drawing in interviews of 4- to 7-year-olds and least common in interviews of 8- to 10-year-olds.

Childrens Responses
Age Phase Type of Abuse ANOVAs on the number of details revealed effects for phase, F(1, 81) 79.15, p .001; and age, F(2, 81) 4.09, p .05; as well as an Age Phase interaction, F(2, 81) 6.98, p .01. More details were elicited before (M 389.12, SD 313.22) rather than after (M 85.94, SD 74.40) the drawing was introduced, and the total number of details provided increased with age. The Age Phase interaction revealed that the number of details increased with age only before the drawing was introduced (Ms 252.0, 365.0, 540.74, SDs 204.19, 300.38, 349.86, respectively, for the 4- to 7-, 8- to 10-, and 11- to 13-year-olds) because the number of details after the drawing actually decreased with age (Ms 95.48, 87.13, 75.87, SDs 70.16, 74.72, 78.97, respectively). Parallel analyses concerned only with central details, F(1, 81) 59.09, p .001, for phase; F(2, 81) 2.56, p .08, for age; and F(2, 81) 5.25, p .01, for Age Phase, or peripheral details; F(1, 81) 80.04, p .001, for phase; F(2, 81) 5.46, p .01, for age; and F(2, 81) 7.05, p .01, for Age Phase, revealed similar effects. Multivariate Age Phase Type of Abuse analyses of the numbers of details in response to invitations, directives, optionposing, and suggestive prompts revealed effects for phase, F(4, 78) 28.23, p .001, and an Age Phase interaction, F(8, 156) 2.52, p .05. Univariate analyses revealed that more details were elicited using invitations, F(1, 81) 68.17, p .001; directives, F(1, 81) 67.51, p .001; and suggestive prompts, F(1, 81) 32.41, p .001, before rather than after the drawing. Age Phase interactions with respect to the number of details elicited using invitations, F(2, 81) 5.37, p .01, and directives, F(2, 81) 7.85, p .001, indicated that the number of details elicited using either invitations or directives only increased with age before the drawing. Comparable analyses concerned with the proportions of details elicited using prompts of each type revealed multivariate effects for phase, F(4, 78) 58.03, p .001; age, F(8, 156) 2.47, p .05; and Age Phase, F(8, 156) 2.60, p .05. Subsequent univariate analyses revealed significant or near significant effects for phase on the proportion of details elicited using invitations, F(1, 81) 120.91, p .001; directives, F(1, 81) 3.83, p .05; option-posing prompts, F(1, 81) 199.61, p .001; and suggestive prompts, F(1, 81) 2.98, p .09; significant effects for age on the proportion of details elicited using directives, F(2, 81) 4.73, p .05, and option-posing prompts, F(2, 81) 4.71, p .05; and significant or near significant Age Phase interactions for invitations, F(2, 81) 2.79, p .07; directives, F(2, 81) 3.71, p .05; and option-posing prompts, F(2, 81) 8.74, p .001. Inspection of Table 2 shows that proportionally more details were elicited using invitations, directives, and suggestive prompts before the drawing, whereas proportionally more were elicited using option-posing prompts after the drawing. The proportions of details elicited using directives and option-posing prompts were greatest for the youngest children.

11- to 13-year-old

After Before 8- to 10-year-old After Before 4- to 7-year-old After Before

Utterance

(SD)

(SD)

(SD)

(SD)

(SD)

(SD)

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Comparable analyses of the number of central details yielded multivariate effects for phase, F(4, 78) 22.78, p .001, and for the Age Phase interaction, F(8, 156) 2.08, p .05. Univariate analyses revealed that more central details were elicited using invitations, directive prompts, and suggestive prompts before rather than after the drawing was introduced, Fs(1, 81) 51.83, 50.25, 27.24, respectively, ps .001. Univariate analyses revealed interactions only in response to invitations, F(2, 81) 4.42, p .05, and directive prompts, F(2, 81) 4.96, p .01. Multivariate analyses of the proportions of central details elicited using different prompts yielded effects only for phase, F(4, 78) 27.01, p .001. Univariate analyses revealed phase effects for invitations and option-posing prompts, F(1, 81) 68.05, 58.48, respectively, ps .001. Inspection of means revealed that proportionally more central details were elicited using invitations (Ms .62 and .30, respectively) and proportionally fewer using option-posing prompts (Ms .07 and .32, respectively) before rather than after the drawing was introduced.

suggestive, F(2, 78) 3.47, p .05, prompts. The 4- to 7-yearolds provided the greatest number of central details in response to directives, whereas the 11- to 13-year-olds provided the most central details in response to suggestive prompts.

Discussion
These results show that use of a human figure drawing helped investigators to elicit forensically important information from alleged victims even after the investigators believed that they had already exhausted the childrens memories. Overall, the human figure drawing elicited 18% of the total number of forensically relevant details obtained. With the 4- to 7-year-olds, however, the drawing elicited 27% of the total number of details, compared with 19% for the 8- to 10-year-olds and 12% from the 11- to 13-yearolds, indicating that the drawing was especially useful with the youngest children. The additional information was obtained at a price, however, as the interviewers relied more on focused recognition-memory prompts (which are associated with higher error rates) when using the drawing. To minimize contamination, therefore, it is preferable that human figure drawings be introduced as late as possible in investigative interviews, as they were here. The NICHD protocol helps investigators elicit much more information using free-recall prompts than do traditional interview practices (Orbach et al., 2000; Sternberg, Lamb, Orbach, et al., 2001). As in those studies, half of the information elicited by the interviewers before introduction of the drawing in the present study was elicited using invitations, which are more likely to elicit accurate information in both laboratory and forensic contexts (Dale et al., 1978; Dent, 1986; Dent & Stephenson, 1979; Goodman et al., 1991; Goodman & Aman, 1990; Hutcheson et al., 1995; Lamb & Fauchier, 2001; Oates & Shrimpton, 1991; Orbach & Lamb, 2001; Ornstein et al., 1992). Using the NICHD interview protocol, the interviewers in the present study attempted to exhaust the childrens recollection (primarily using invitations, cued invitations, and more focused prompts) before introducing the human figure drawing. The drawing served as a visual cue that was accompanied by a series of carefully formulated questions designed to probe for information that had not been provided earlier. Because the questions made reference to the drawing, however, many were focused recognition prompts and were thus riskier than those used in the earlier phase of the interview. The recognition memory prompts were option posing rather than suggestive (i.e., asked about undisclosed issues but did not imply the expected response), however, and investigators probed for additional details

Responses Per Prompt

Analyses concerned with the average number of details per prompt of each type (see Table 3) revealed multivariate effects for phase, F(4, 78) 22.46, p .001, and an Age Phase interaction, F(8, 158) 2.12, p .05. Univariate analyses revealed that the average invitation, F(1, 81) 69.35, p .001; directive prompt, F(1, 81) 67.08, p .001; option-posing prompt, F(1, 81) 16.07, p .001; and suggestive prompt, F(1, 81) 12.04, p .001, elicited more details before rather than after the drawing. Univariate analyses revealed significant Age Phase interactions only for invitations, F(2, 81) 5.25, p .01, and directives, F(2, 81) 5.77, p .01. The average number of details per invitation increased with age before the drawing but declined marginally after the drawing. The average number of details per directive prompt was the same for the 4- to 7- and 8- to 10-year-olds and slightly higher for 11- to 13-year-olds before the drawing, whereas it decreased consistently over age after the drawing. Comparable analyses of central details per prompt yielded multivariate effects for phase, F(4, 75) 18.06, p .001, and age, F(8, 152) 3.09, p .01, but no interactions. Univariate analyses revealed phase effects for invitations, F(1, 78) 55.23, p .001; directives, F(1, 78) 40.97, p .001; option-posing prompts, F(1, 78) 9.59, p .01; and suggestive prompts, F(1, 78) 8.58, p .01, whereas univariate effects for age were evident only on average responses to directive, F(2, 78) 3.37, p .05, and

Table 3 Age Differences in the Average Number of Details Elicited Per Prompt of Each Type Before and After Introduction of the Human Figure Drawing
4- to 7-year-old Before Utterance Invitations Directives Option posing Suggestives M 7.31 3.31 2.27 3.15 (SD) (6.55) (2.03) (2.33) (3.67) M 3.71 2.06 1.55 1.05 After (SD) (3.73) (1.35) (0.94) (1.95) M 10.37 3.31 2.15 2.23 8- to 10-year-old Before (SD) (5.70) (1.68) (1.28) (2.48) M 3.17 1.38 1.60 1.53 After (SD) (3.15) (1.21) (1.17) (3.15) M 13.93 4.62 2.77 5.99 11- to 13-year-old Before (SD) (11.05) (3.18) (1.68) (10.89) M 2.73 1.11 1.57 1.16 After (SD) (3.42) (1.31) (1.16) (2.09)

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using invitations following each affirmative response to a focused question. Nevertheless, the free-recall information that is most likely to be accurate became less prominent after the drawing was introduced, whereas the riskier information obtained using recognition prompts became much more significant in both absolute and relative terms. Introduction of the drawing thus helped the investigators elicit substantial amounts of information, but the quality of this information was likely to be lower because of the way in which it was elicited. Introduction of the human figure drawing altered the usefulness of all investigative prompts, such that each elicited significantly fewer details, and fewer central details, after the drawing than they had before, probably because of the timing; to avoid contamination, the drawing was always introduced at the end of the interviews when many details had already been disclosed and thus relatively few new details could be retrieved. Although it might be of interest to determine whether this explanation is correct, introduction of drawings earlier in the interview is obviously not defensible in the field, where the risk of contamination might jeopardize fact-finding and intervention. The developmental effects reported in this article were also extremely interesting. As in numerous other laboratory and fieldbased studies (Baker-Ward et al., 1993; Lamb, Sternberg, & Esplin, 1998; Lamb et al., 2003; Orbach et al., 2000; Ornstein et al., 1992; Sternberg, Lamb, Orbach, et al., 2001; see Schneider & Bjorklund, 1998, for a review), there were steady increases with age in the total amounts of information provided by the children as well as in the total amounts retrieved using recall prompts. Interestingly, however, both the absolute number of (new) details and the proportion of the total retrieval obtained after introduction of the drawings decreased with age. This may suggest that the oldest children, having better developed retrieval strategies, provided more complete accounts of their experiences in the standard part of the interview, whereas focused and concrete retrieval cues helped the younger children to access details that they did not otherwise report. The recognition memory prompts were not disproportionately helpful for younger children in the standard part of the interview, either in this study or in several other field studies (Lamb et al., 2000, 2003; Orbach et al., 2000; Sternberg, Lamb, Orbach, et al., 2001), however, suggesting that systematic references to a concrete cue, the human figure drawing, were particularly helpful for the younger children. The findings reported here have implications for both researchers and clinicians. First, awareness of developmentally appropriate techniques for facilitating the retrieval of information even from preschoolers may help clinicians to avoid reliance on contaminating prompts and to delay risky (i.e., error-inducing) recognition prompts as much as possible when eliciting information from their younger clients. Second, an understanding of both age differences in childrens responsiveness to a human figure drawing and its potential for enhancing information retrieval may help clinicians make their interviewing strategies more developmentally appropriate. Third, our demonstration that a human figure drawing can help preschoolers retrieve additional allegation-related details should be of great value, not only to clinicians conducting forensic interviews but also to those attempting to determine whether and what types of therapeutic intervention might be most helpful. Fourth, we illustrate the fine differences between prompts associated with very different levels of possible error and describe

simple but superior alternatives that can be (and have been) used by mental health professionals as well as investigative interviewers. Although these results suggest that a human figure drawing can be helpful, it is important to remember that the accuracy of the information elicited was unknown. Generalizing from previous laboratory and field studies (Dale et al., 1978; Dent, 1986; Dent & Stephenson, 1979; Goodman et al., 1991; Goodman & Aman, 1990; Hutcheson et al., 1995; Lamb & Fauchier, 2001; Oates & Shrimpton, 1991; Orbach & Lamb, 2001; Ornstein et al., 1992), we know that the information elicited using recognition memory prompts (like most of the information elicited after the drawing was introduced) is more likely to be inaccurate than information elicited using open-ended prompts, although most of it is likely to be accurate. At minimum, therefore, the additional information prompted by introduction of the drawing in the careful manner described here should be of value to investigators as they seek investigative leads to a more complete definition of the allegation and a broader understanding of the alleged events.

References
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USING HUMAN FIGURE DRAWING Goodman, G. S., & Reed, R. S. (1986). Age differences in eyewitness testimony. Law and Human Behavior, 10, 317332. Hutcheson, G. D., Baxter, J. S., Telfer, K., & Warden, D. (1995). Child witness statement quality: Question type and errors of omission. Law and Human Behavior, 19, 631 648. Johnson, M. K., & Foley, M. A. (1984). Differentiating fact from fantasy: The reliability of childrens memory. Journal of Social Issues, 40, 3350. Jones, D. P. H. (1992). Interviewing the sexually abused child: Investigation of suspected abuse (4th ed.). London: Gaskell. Lamb, M. E., & Fauchier, A. (2001). The effects of question type on self-contradiction by children in the course of forensic interviews. Applied Cognitive Psychology, 15, 483 491. Lamb, M. E., Hershkowitz, I., Sternberg, K. J., Boat, B., & Everson, M. D. (1996). Investigative interviews of alleged sexual abuse victims with and without anatomical dolls. Child Abuse and Neglect, 20, 12511259. Lamb, M. E, Hershkowitz, I., Sternberg, K. J., Esplin, P. W., Hovav, M., Manor, T., et al. (1996). Effects of investigative utterance types on Israeli childrens responses. International Journal of Behavioral Development, 19, 627 637. Lamb, M. E., Sternberg, K. J., & Esplin, P. W. (1998). Conducting investigative interviews of alleged sexual abuse victims. Child Abuse and Neglect, 22, 813 823. Lamb, M. E., Sternberg, K. J., & Esplin, P. W. (2000). Effects of age and delay on the amount of information provided by alleged sex abuse victims in investigative interviews. Child Development, 71, 1586 1596. Lamb, M. E., Sternberg, K. J., Orbach, Y., Esplin, P. W., Stewart, H. L., & Mitchell, S. (2003). Age differences in young childrens responses to open-ended invitations in the course of forensic interviews. Journal of Consulting and Clinical Psychology, 71, 926 934. Lyon, T. D. (1999). The new wave of suggestibility research: A critique. Cornell Law Review, 84, 1004 1087. Marin, B. V., Holmes, D. L., Guth, M., & Kovac, P. (1979). The potential of children as eyewitnesses: A comparison of children and adults on eyewitness tasks. Law and Human Behavior, 3, 295306. Memorandum of Good Practice. (1992). London: Her Majestys Stationery Office. Oates, K., & Shrimpton, S. (1991). Childrens memories for stressful and non-stressful events. Medical Science and the Law, 31, 4 10. OCallaghan, G., & DArcy, H. (1989). Use of props in questioning preschool witnesses. Australian Journal of Psychology, 41, 187195. Orbach, Y., Hershkowitz, I., Lamb, M. E., Sternberg, K. J., Esplin, P. W., & Horowitz, D. (2000). Assessing the value of structured protocols for forensic interviews of alleged child abuse victims. Child Abuse and Neglect, 24, 733752.

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Orbach, Y., & Lamb, M. E. (2000). Enhancing childrens narratives in investigative interviews. Child Abuse and Neglect, 24, 16311648. Orbach, Y., & Lamb, M. E. (2001). The relationship between withininterview contradictions and eliciting interviewer utterances. Child Abuse and Neglect, 25, 323333. Ornstein, P. A., Gordon, B. N., & Larus, D. M. (1992). Childrens memory for a personally experienced event: Implications for testimony. Applied Cognitive Psychology, 6, 49 60. Peterson, C., & Biggs, M. (1997). Interviewing children about trauma: Problems with specific questions. Journal of Traumatic Stress, 10, 279 290. Poole, D. A., & Lamb, M. E. (1998). Investigative interviews of children: A guide for helping professionals. Washington, DC: American Psychological Association. Poole, D. A., & Lindsay, D. S. (1998). Assessing the accuracy of childrens reports: Lessons from the investigation of child sexual abuse. Applied & Preventive Psychology, 7, 126. Price, D. W., & Goodman, G. S. (1990). Visiting the wizard: Childrens memory for a recurring event. Child Development, 61, 664 680. Saywitz, K. J., & Goodman, G. S. (1996). Interviewing children in and out of court: Current research and practice implications. In J. Briere, L. Berliner, J. A. Bulkley, C. Jenny, & T. Reid (Eds.), The APSAC handbook on child maltreatment (pp. 297318). Thousand Oaks, CA: Sage. Saywitz, K. J., Goodman, G. S., Nicholas, E., & Moan, S. F. (1991). Childrens memories of physical examination involving genital touch: Implications for reports of child sexual abuse. Journal of Consulting and Clinical Psychology, 59, 682 691. Schneider, W., & Bjorklund, D. F. (1998). Memory. In W. Damon, D. Kuhn, & R. S. Siegler (Eds.), Handbook of child psychology: Cognition, perception, and language (5th ed., Vol. 2, pp. 467521). New York: Wiley. Sternberg, K. J., Lamb, M. E., Davies, G. M., & Westcott, H. L. (2001). The Memorandum of Good Practice: Theory versus application. Child Abuse and Neglect, 25, 669 681. Sternberg, K. J., Lamb, M. E., Orbach, Y., Esplin, P. W., & Mitchell, S. (2001). Use of a structured investigative protocol enhances young childrens responses to free recall prompts in the course of forensic interviews. Journal of Applied Psychology, 86, 9971005. Walker, N., & Hunt, J. S. (1998). Interviewing child victim-witnesses: How you ask is what you get. In C. P. Thompson, D. J. Herrman, J. D. Read, D. Bruce, D. Payne, & M. P. Toglia (Eds.), Eyewitness memory: Theoretical and applied perspectives (pp. 55 87). Mahwah, NJ: Erlbaum.

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Appendix A Questions About Tactile Contact (Touching)

1. I want to be sure I understand everything you told me, so I need to ask you some more questions. I may ask you again about things youve already talked about. To begin, I want to show you a picture of a girl or boy like you. [Show the child the drawing (Appendix B).] [If child has mentioned a single incident but did not specifically describe tactile contact, proceed to question 3. If child has mentioned multiple incidents, use incident-defining cues to draw attention to each incident in turn, beginning the discussion of each incident by saying:] 2. You told me about a time when you and [name provided by child; if no-one was named, say s/he] were [use incident-defining cue]. [If child has clearly described tactile contact, skip question 3 and proceed to 4] 3. Did any part of [Name person as child did. If no name was provided say his/her] body touch any part of your body? [Wait for a response] [If child responds affirmatively, say:] Tell me everything about that. [Follow up with other open-ended prompts [such as Tell me more about that or And then what happened?] until the child provides no new information. Then, hand the child a pen and say:] 4. Show me on this picture where s/he touched you. [Wait for a response] 5. Did any part of [Name person as child did. If no name was provided say his/her] body touch any other part of your body? [Wait for a response] [If child responds affirmatively and the information is new, say:] Tell me everything about that. [Follow up with other open-ended prompts [such as Tell me about that or And then what happened?] until the child provides no new information. Then, hand the child a pen and say:] 6. Show me on this picture where s/he touched you. [Wait for a response] 7. Did s/he touch this part [point to mouth. For children under 8, add the part you eat with]? [Wait for a response] [If child responds affirmatively and the information is new, say:] Tell me everything about that. [Follow up with other open-ended prompts [such as Tell me about that touching] until the child provides no new information. Have him/her mark the mouth.] 8. Did s/he touch this part [point to breast/chest area. For children under 8, add the part your shirt covers]? [Wait for a response] [If child responds affirmatively and the information is new, say:] Tell me everything about that.

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[Follow up with other open-ended prompts [such as Tell me about that] until the child provides no new information. Have the child mark the chest area.] 9. Did s/he touch this part [point to genital area. For children under 8, add, the part you wee with]? [Wait for a response] [If child responds affirmatively and the information is new, say:] Tell me everything about that. [Follow up with other open-ended prompts such as Tell me about that until the child provides no new information. Have the child mark the genital area.] 10. Did s/he touch this part [point to arm. For children under 8, add, the part you draw with]? [Wait for a response] [If child responds affirmatively and the information is new, say:] Tell me everything about that. [Follow up with other open-ended prompts [such as Tell me about that] until the child provides no new information. Have the child mark the arm.] 11. Did s/he touch this part [point to bottom. For children under 8, add, the part you poo with]? [Wait for a response] [If child responds affirmatively and the information is new, say:] Tell me everything about that. [Follow up with other open-ended prompts [such as Tell me about that] until the child provides no new information. Have the child mark the bottom.] 12. Did s/he touch this part [point to lower leg. For children under 8, add, the part you walk with]? [Wait for a response] [If child responds affirmatively and the information is new, say:] Tell me everything about that. [Follow up with other open-ended prompts [such as Tell me about that] until the child provides no new information. Have the child mark the lower leg.] [If child has not indicated how the alleged perpetrator touched her or him, ask:] 13. You mentioned that [name] touched your [use childs word, if s/he used one, and point to part identified by child. If child did not name the body part, simply point and say touched you here]. Which part of her/his body touched you there? [Wait for a response] Tell me everything about that. [Follow up with other open-ended prompts [such as Tell me about that] until the child provides no further information.] 14. Is there any other touching you can tell me about? [Wait for a response. If the child says, No, move on to Question 15. If child says, Yes, say:]

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[Follow up with other open-ended prompts [such as Tell me about that] until the child provides no new information.] 15. Now I want to show you a picture of a [man/woman/boy/girl like him/her/name if provided by child]. [Show the child the drawing.] 16. Did you touch any part of [Name person as child did. If no name was provided say his/her] body? [Wait for a response] [If child responds affirmatively and the information is new, say:] Tell me everything about that. [Follow up with other open-ended prompts [such as Tell me about that] until the child provides no further information. If the child does not specify where touch occurred, say:] 17. Show me on this picture where you touched her/him. [Wait for a response. Have the child mark the location.] 18. Did you touch any other part of [Name person as child did. If no name was provided say his/her] body? [Wait for a response] [If child responds affirmatively and the information is new, say:] Tell me everything about that. [Follow up with other open-ended prompts [such as Tell me about that] until the child provides no new information. If the child does not specify where touch occurred, say:] 19. Show me on this picture where s/he touched you. 20. Did you touch this part [point to mouth. For children under 8, add the part s/he eats with]? [Wait for a response] [If child responds affirmatively and the information is new, say:] Tell me everything about that. [Follow up with other open-ended prompts [such as Tell me about that] until the child provides no further information. Have the child mark the mouth.] 21. Did you touch this part [point to breast/chest area. For children under 8, add the part her/his shirt covers]? [Wait for a response] [If child responds affirmatively and the information is new, say:] Tell me everything about that. [Follow up with other open-ended prompts [such as Tell me about that] until the child provides no further information. Have the child mark the chest area.] 22. Did you touch this part [point to genital area. For children under 8, add, the part s/he wees with]? [Wait for a response] [If child responds affirmatively and the information is new, say:] Tell me everything about that.

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[Follow up with other open-ended prompts [such as Tell me about that] until the child provides no further information. Have the child mark the genital area.] 23. Did you touch this part [point to arm. For children under 8, add, the part s/he writes with]? [Wait for a response] [If child responds affirmatively and the information is new, say:] Tell me everything about that. [Follow up with other open-ended prompts [such as Tell me about that] until the child provides no further information. Have the child mark the arm.] 24. Did you touch this part [point to bottom. For children under 8, add, the part s/he poos with]? [Wait for a response] [If child responds affirmatively and the information is new, say:] Tell me everything about that. [Follow up with other open-ended prompts [such as Tell me about that] until the child provides no further information. Have the child mark the bottom.] 25. Did you touch this part [point to lower leg. For children under 8, add, the part s/he walks with]? [If child responds affirmatively and the information is new, say:] Tell me everything about that. [Follow up with other open-ended prompts [such as Tell me about that] until the child provides no further information. Have the child mark the lower leg.] [If child has not indicated how s/he touched the alleged perpetrator, ask:] 26. You mentioned that you touched her/his [use childs word, if s/he used one, and point to part identified by child. If child did not name the body part, simply point and say touched you here]. Which part of your body touched that [pointing to part identified by child] part of her/his body? [Wait for a response] Tell me everything about that. [Follow up as necessary with other open-ended prompts [such as Tell me about that] until the child provides no further information.] 27. Is there any other touching you can tell me about? [Wait for a response. If the child says Yes and the information is new, say:] Tell me everything about that. [Follow up with other open-ended prompts [such as Tell me about that] until the child provides no further information.]

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Appendix B Gender-Neutral Drawing

Figure B1.

Unclothed (frontal and dorsal), gender-neutral outline drawing.

Received October 23, 2002 Revision received July 12, 2003 Accepted July 14, 2003