Mikayla Schumacher .docx

Mikayla Schumacher
10039 Sleepy Hollow Lane
Port Richey, FL 34668
03/08/20
Daisy’s Pediatrician Office
Attn: Hiring Representative
1307 State Rd 69
New Glarus, WI 53574
Dear Hiring Representative:
I am contacting you in response to the Office Manager position
posted on Indeed.com for the Daisy’s Pediatrician Office. I will
be completing my associate degree shortly; and I was excited to
find an opportunity that matches my skill set. As you will see
from my resume, I have nursing aide, nursing assistant, and
management certifications.
Throughout my academic and professional careers, I have
proven my ability in:
· Electronic Medical Records including patient data entry and
retrieval from EHR.
· Patient Monitoring such as observing patient blood pressure
using wireless devices
· Communication skills needed to communicate with patients to
assess their health
· Charting and Documentation
These examples demonstrate just the beginning of what I can
offer to Daisy’s Pediatrician Office as the Office Manager. I
welcome the opportunity to interview with you, and demonstrate
my other capabilities to you. I can be reached at (727) 608-8563
or [email protected].
Thank you for your consideration, and I look forward to
speaking with you soon.
Respectfully,
Mikayla Schumacher

Resume (enclosed)
10/16/2008
1
HOW CHILDREN HOW CHILDREN HOW CHILDREN HOW
CHILDREN
EXPERIENCE ABUSEEXPERIENCE ABUSE
Dynamics of VictimizationDynamics of Victimization
DYNAMICS OFDYNAMICS OF
CHILD SEXUAL ABUSECHILD SEXUAL ABUSE
Help us understand the Help us understand the
child’s perspective and child’s perspective and child s
perspective and child s perspective and
coping strategiescoping strategies
Adapted from © CornerHouse 2002
Child Sexual Abuse Child Sexual Abuse
Accommodation SyndromeAccommodation Syndrome
Roland Summit, MDRoland Summit, MD
S S -- SecrecySecrecy
HH H lpl ssn ssH lpl ssn ssH H -- HelplessnessHelplessness
E E -- Entrapment and AccommodationEntrapment and
Accommodation

D D -- Delayed or Unconvincing DisclosureDelayed or
Unconvincing Disclosure
R R -- RetractionRetraction
© Finding Words New Jersey
10/16/2008
2
SecrecySecrecy
Summit, 1983Summit, 1983
Terrifying reality of child Terrifying reality of child
sexual abuse: sexual abuse:
Child is alone with the offenderChild is alone with the offender
Threats/promises to keep secretThreats/promises to keep secret
Sh m nd iltSh m nd iltShame and guiltShame and guilt
Nondisclosure RatesNondisclosure Rates (Lyon, 2002)(Lyon,
2002)
Women: 33Women: 33--92%92%
Men: 42Men: 42--85% 85%
86% of sexual assaults to 86% of sexual assaults to
adolescents unreportedadolescents unreported (NIJ, 2003)(NIJ,
2003)
70% of sample told to keep 70% of sample told to keep
abuse secretabuse secret (Berliner & Conte, 1990)(Berliner &
Conte, 1990) © Finding Words New Jersey
HelplessnessHelplessness

Children are subordinate to older Children are subordinate to
older
people, especially those in people, especially those in
authority authority
Perpetrators groom children in Perpetrators groom children in
nonnon--sexual ways firstsexual ways firstyy
Typical response of small Typical response of small
creatures to terror is to freezecreatures to terror is to freeze
Child’s guilt about not protesting Child’s guilt about not
protesting
leads to more silenceleads to more silence
Victims report saying “no” would Victims report saying “no”
would
have only resulted in continued have only resulted in continued
abuse and perhaps further harm abuse and perhaps further harm
(Berliner & Conte, 1990)(Berliner & Conte, 1990)
Entrapment & AccommodationEntrapment & Accommodation
Typically occurs repeatedly; child Typically occurs repeatedly;
child
must survivemust survive
Child must accommodate to Child must accommodate to
increasing sexual demands increasing sexual demands
increasing sexual demands increasing sexual demands
Child must accommodate to Child must accommodate to
increasing awareness of betrayal by increasing awareness of
betrayal by
caretakerscaretakers--problems in relationship problems in
relationship
with nonwith non--offending parentoffending parent

Feel responsible for the wellFeel responsible for the well--being
being
of the entire familyof the entire family
Special problems of male victimsSpecial problems of male
victims
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Entrapment & AccommodationEntrapment & Accommodation
(cont’d…)(cont’d…)
Behavioral Strategies: sexualized Behavioral Strategies:
sexualized
behavior, lying, difficulty concentrating, behavior, lying,
difficulty concentrating,
substance abuse, running awaysubstance abuse, running away
Psychological Strategies:Psychological Strategies:y g gy g g
FragmentingFragmenting
DissociationDissociation
Dissociative Identity DisorderDissociative Identity Disorder
Delayed or Unconvincing Delayed or Unconvincing
DisclosureDisclosure
“Most on“Most on--going sexual abuse is going sexual abuse is
nevernever

disclosed outside the family.”disclosed outside the family.”
Disclosure in bits and piecesDisclosure in bits and piecespp
Disclosed almost incidentally in state Disclosed almost
incidentally in state
of turmoilof turmoil
Disclosed without evident feelingDisclosed without evident
feeling
In a sample of sexually abused In a sample of sexually abused
children (N=248), 75% did not children (N=248), 75% did not
disclose within a year of onset (Elliot disclose within a year of
onset (Elliot
& Briere, 1994).& Briere, 1994).
Delayed or Unconvincing Delayed or Unconvincing
DisclosureDisclosure
Triggers for disclosure:Triggers for disclosure:
Family conflictFamily conflict
Incidental discovery by 3Incidental discovery by 3rdrd
partypartyIncidental discovery by 3Incidental discovery by 3
partyparty
Outreach educationOutreach education
Protection of younger childrenProtection of younger children
Medical problemsMedical problems
Close friendshipClose friendship
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RetractionRetraction

Chaotic Aftermath of DisclosureChaotic Aftermath of
Disclosure
Family stress and disbeliefFamily stress and disbelief
Potential family disintegration and guiltPotential family
disintegration and guilt
After disclosure child discovers the threats After disclosure
child discovers the threats After disclosure, child discovers the
threats After disclosure, child discovers the threats
underlying the secrecy are trueunderlying the secrecy are true
Unsupportive interactions with larger Unsupportive interactions
with larger
systems.systems.
RetractionRetraction
Recantation rates across studies range from Recantation rates
across studies range from
44--50% 50% (Lyon, 2002)(Lyon, 2002)
Recantation rates from 4Recantation rates from 4--27% 27%
(London, Bruck, (London, Bruck,
Ceci & Shuman, 2005)Ceci & Shuman, 2005)
Recantations most likely to occur in Recantations most likely to
occur in
intrafamilial abuse cases where significant intrafamilial abuse
cases where significant
family members are disbelieving, nonfamily members are
disbelieving, non--
supportive, blaming, and stressed.supportive, blaming, and
stressed.
The Traumagenic ModelThe Traumagenic Model
Finkelhor & Browne, 1985Finkelhor & Browne, 1985

1.1. BetrayalBetrayal
2.2. Traumatic Traumatic
SexualizationSexualization
3.3. PowerlessnessPowerlessness
4.4. StigmatizationStigmatization
Adapted from © CornerHouse 2002
10/16/2008
5
BetrayalBetrayal
Perpetrator in position of trust/authorityPerpetrator in position
of trust/authority
Child discovers that someone he/she Child discovers that
someone he/she
depended upon caused harmdepended upon caused harmp pp p
Grief reactions and depression over the Grief reactions and
depression over the
loss of a trusted figureloss of a trusted figure
Higher levels of posttraumatic and Higher levels of
posttraumatic and
dissociative symptoms dissociative symptoms (Leahy, Pretty, &
(Leahy, Pretty, &
Tenenbaum, 2004)Tenenbaum, 2004)
Can lead to avoidance of close Can lead to avoidance of close
relationships or to indiscriminate choicesrelationships or to

indiscriminate choices
Traumatic SexualizationTraumatic Sexualization
Inappropriate conditioning of child’s Inappropriate conditioning
of child’s
sexual responsivenesssexual responsiveness
Problematic beliefs and feelings Problematic beliefs and
feelings
associated with sexuality as well as associated with sexuality as
well as
dysfunctional arousal patterns can dysfunctional arousal
patterns can
developdevelop
Traumatic Sexualization (cont’d..)Traumatic Sexualization
(cont’d..)
Examples:Examples:
Sexual preoccupations and repetitive sexual behavior Sexual
preoccupations and repetitive sexual behavior
of young child victims, such as masturbation or of young child
victims, such as masturbation or
compulsive sex play.compulsive sex play.
Display of sexual knowledge and interests that are Display of
sexual knowledge and interests that are p y gp y g
inappropriate to their age.inappropriate to their age.
Confusion of sexuality with nurturance or power.Confusion of
sexuality with nurturance or power.
Promiscuity in adolescence, aversion to sex, Promiscuity in

adolescence, aversion to sex,
flashbacks to the molestation experience, difficulty flashbacks
to the molestation experience, difficulty
with arousal and orgasm, with arousal and orgasm,
vaginismusvaginismus, negative , negative
attitudes toward their sexuality and their bodies.attitudes toward
their sexuality and their bodies.
10/16/2008
6
PowerlessnessPowerlessness
Finkehlor & Browne, 1985Finkehlor & Browne, 1985
Child cannot control noxious eventsChild cannot control
noxious events
Child’s attempts to halt the abuse are Child’s attempts to halt
the abuse are
frustrated; e.g., when they unsuccessfully frustrated; e.g., when
they unsuccessfully
attempt to report abuseattempt to report abusep pp p
Force & threat are not necessary to instill Force & threat are not
necessary to instill
powerlessnesspowerlessness
Narratives of victims analyzed for themes of Narratives of
victims analyzed for themes of
perpetrator methods perpetrator methods (Leahy, Pretty, &
Tenenbaum, 2004)(Leahy, Pretty, & Tenenbaum, 2004)
Created powerless victim (deception and force)Created
powerless victim (deception and force)
Created omnipotent perpetrator (reality Created omnipotent
perpetrator (reality

definition/control & manipulation)definition/control &
manipulation)
Powerlessness Powerlessness
(cont’d…)(cont’d…)
Fear and anxiety symptoms: nightmares, Fear and anxiety
symptoms: nightmares,
phobias, hypervigilance, clinging behavior, and phobias,
hypervigilance, clinging behavior, and
l l
p yp g g gp yp g g g
somatic complaintssomatic complaints
Sense of impotence: despair, depression, Sense of impotence:
despair, depression,
suicidal behavior, learning problems, inability to suicidal
behavior, learning problems, inability to
cope with environments that continues on into cope with
environments that continues on into
adolescence and adulthood, revictimizationadolescence and
adulthood, revictimization
Compensating for powerlessness: needs to Compensating for
powerlessness: needs to
control and dominatecontrol and dominate
StigmatizationStigmatization
Child’s knows that the activity is deviant and taboo and Child’s
knows that the activity is deviant and taboo and
abuser may convey negative statementsabuser may convey

negative statements
Negative connotations (badness, shame, & guilt) are Negative
connotations (badness, shame, & guilt) are
communicated to the child, especially after
disclosurecommunicated to the child, especially after
disclosure--
b i t d i t th hild’ lfb i t d i t th hild’ lf i C lt l i C lt l
become incorporated into the child’s selfbecome incorporated
into the child’s self--image. Cultural image. Cultural
meaning plays a big role.meaning plays a big role.
Risk of revictimization Risk of revictimization (Classen, Palesh
& Aggarwal, 2005)(Classen, Palesh & Aggarwal, 2005)
2/3 revictimization rate2/3 revictimization rate
Predictors: childhood sexual abuse & severityPredictors:
childhood sexual abuse & severity
Associated with multiple difficulties including selfAssociated
with multiple difficulties including self--blame and blame and
shameshame
10/16/2008
7
How Children Experience How Children Experience
AbuseAbuse
Interview ExamplesInterview ExamplesInterview
ExamplesInterview Examples
Victim Responses to AbuseVictim Responses to Abuse
Twaite & RodriguezTwaite & Rodriguez--Srednicki,

2004Srednicki, 2004
Whiffen & MacIntosh, 2005Whiffen & MacIntosh, 2005
KendallKendall--Tackett, Meyer & Finkelhor, 1993Tackett,
Meyer & Finkelhor, 1993
Swanstone, Tebbutt, O’Toole & Oates, 1997Swanstone, Tebbutt,
O’Toole & Oates, 1997
DepressionDepression
Anxiety DisordersAnxiety Disorders
Di i ti /di i ti di dDi i ti /di i ti di dDissociation/dissociative
disordersDissociation/dissociative disorders
Post traumatic stress symptomsPost traumatic stress symptoms
Attachment issuesAttachment issues
Fears and somatic complaintsFears and somatic complaints
Sexual behavior problemsSexual behavior problems
Generalized behavior problemsGeneralized behavior problems
SelfSelf--esteem issuesesteem issues
Ketring & Feinauer, 1999Ketring & Feinauer, 1999
Victim Impact ContinuumVictim Impact Continuum
DurationDuration
FrequencyFrequency
ForceForce
Invasiveness of abuseInvasiveness of abuse
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8
Jonzon & Lindblad, 2005 Jonzon & Lindblad, 2005
Other maltreatment (physical abuse)Other maltreatment
(physical abuse)p yp y
SupportSupport
Support from partners and friends in adulthoodSupport from
partners and friends in adulthood
Maternal support in childhoodMaternal support in childhood
Coping/outlookCoping/outlook
KKendallendall--Tackett, Meyer & Finkelhor, 1993Tackett,
?? AgeAge
•• Age at time of assessment Age at time of assessment
appearsappears relatedrelatedAge at time of assessment Age at
time of assessment appearsappears relatedrelated
•• Difficult to assess due to intervening variablesDifficult to
assess due to intervening variables
?? GenderGender
•• Studies inconsistent; recommended for further Studies

inconsistent; recommended for further
researchresearch
Ketring & Feinauer, 1999Ketring & Feinauer, 1999
Leahy, Pretty & Tenenbaum, 2004Leahy, Pretty & Tenenbaum,
2004
Vi timVi tim P p t t R l ti nship P p t t R l ti nship
VictimVictim--Perpetrator Relationship Perpetrator
Relationship
Range: Father figure..other Range: Father figure..other
family/acquaintance..strangerfamily/acquaintance..stranger
“Closeness” of relationship“Closeness” of relationship
High levels of authority/trust associated with High levels of
authority/trust associated with
emotional manipulation and increased symptomsemotional
manipulation and increased symptoms
10/16/2008
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VictimVictim--Perpetrator Perpetrator
RelationshipRelationship

TargetTarget
Sees self as victimSees self as victim
“Why me?”“Why me?”
May be more frightened May be more frightened
but less guilt riddentbut less guilt riddent
VictimVictim--Perpetrator RelationshipPerpetrator Relationship
FriendFriend
Begins as one of companionshipBegins as one of companionship
May fill a parental gapMay fill a parental gap
Possibility of protectiveness by victim Possibility of
protectiveness by victim
toward perpetratortoward perpetrator
SibliSibliSiblingSibling
Enmeshed system in Enmeshed system in
familyfamily
Age or power difference Age or power difference
may not be perceived by may not be perceived by
victimvictim
10/16/2008
10

VictimVictim--Perpetrator RelationshipPerpetrator Relationship
CaretakerCaretaker
Vigilant of perpetrator’s needsVigilant of perpetrator’s needs
Protective of perpetratorProtective of perpetrator
May also be concerned about impact on May also be concerned
about impact on
rest of familyrest of family
LoverLover
A d A d Age and power Age and power
difference not difference not
perceived by victimperceived by victim
Feelings of specialnessFeelings of specialness
Protective of Protective of
perpetratorperpetrator
“What it was “What it was
like to be an like to be an
incest incest
victim”victim”
10/16/2008
11
Some day maybe there

will exist a well
informed, well
considered and yet
fervent public
conviction that theconviction, that the
most deadly of all
possible sins is the
mutilation of a child’s
spirit.
- Erik Erickson
© CornerHouse 2002
27W i n t e r 2 0 0 6 • J u v e n i l e a n d F a m i l y C o u r
t J o u r n a l
II N T R O D U C T I O N
Cases involving child sexual
abuse (CSA) are among the
most heartbreaking cases a
judge hears, for both emo-
tional and legal reasons.
How does the court evalu-
ate the testimony of the
young child who says it

never happened, the child
who discloses months
after the alleged event,
the girl who recants after
visitation with family mem-
bers, or the boy with an IQ of 51 who cannot
clearly articulate how the alleged abuse occurred?
Proving child sexual abuse in the absence of physi-
cal evidence or testimony of an eyewitness is difficult.
Children recant, child development issues intervene,
and cognitive limitations raise questions, while the testi-
mony of the adult perpetrator does not waiver. Indeed,
although errors in either direction can have devastating
consequences, finding the truth in CSA cases seems too
often impossible. Decision makers confront the twin
specters of leaving inarticulate children unprotected
from further traumatic sexual abuse on the one hand,
and subjecting innocent caregivers to criminal prosecu-

tion or the loss of parental
rights on the other.
Science can be a tre-
mendous asset to judges in
understanding and interpret-
ing the behavior of victims
of child sexual abuse, since
their behavior can often
seem counterintuitive. It is
essential that judges consider
children’s disclosure patterns
in light of current research in
order to have the greatest
chance to evaluate the facts
and find the truth. Children’s disclosure patterns are
crucial because physical findings are diagnostic of child
sexual abuse in 10% or fewer cases (Frasier & Makaroff,
this issue). Sexual abuse, especially when there is no

penetration, rarely results in physical trauma. Even when
there has been sexual penetration, the capacity for rapid
healing of the genital anatomy inhibits the detection of
evidence (The National Research Council, 1993, p. 72).
Therefore, children’s statements are central both to the
prosecution of the crime of child sexual abuse and the
protection of children from further abuse.
This review is intended to update criminal, juve-
nile, and domestic relations court judges who preside
The State of the Debate
About Children’s Disclosure Patterns
in Child Sexual Abuse Cases
BY ERNA OLAFSON AND JUDGE CINDY S. LEDERMAN
A B S T R A C T
In current research studies about the disclosure patterns of
sexually
abused children, experts agree that most victims delay
disclosure
for years, often until adulthood. Researchers disagree about dis-
closure rates and recantation rates among children during
formal
interviews. Studies of children who had not previously
disclosed but
are known through corroborative evidence to have been sexually
abused show lower rates of disclosure than do studies of

children
who had disclosed prior to the formal interview. Gradual
disclosures
among children are common, and more than a single interview
may
be necessary in some cases. Prior disclosure, level of support by
non-offending parents, developmental level, and relationship to
perpetrator affect children’s rates of disclosure and their
disclosure
patterns. More research is necessary to clarify children’s post-
disclo-
sure recantation rates and predictors.
Erna Olafson, Ph.D., Psy.D., is Associate Professor of Clinical
Psychiatry and Pediatrics at Cincinnati Children’s Hospital
Medical Center and the
University of Cincinnati College of Medicine. She is Director of
the Program on Child Abuse Forensic and Treatment Training at
Cincinnati Children’s Hospital
Childhood Trust. Her presentations and publications focus on
domestic violence, sexual assault, and child abuse.
Judge Cindy S. Lederman is the Presiding Judge of the Juvenile
Court in Miami-Dade County, Florida. A member of the
NCJFCJ’s Board of Trustees,
she was instrumental in creating the Dade County Domestic
Violence Court and served as the court’s first Administrative
Judge. In 1999, Judge Lederman was
awarded a Fellowship from Zero to Three: The National Center
for Infants, Toddlers and Families in their Leaders of the 21st
Century Initiative.
C h i l d r e n ' s D i s c l o s u r e P a t t e r n s i n S e x u a l
A b u s e C a s e s

28 J u v e n i l e a n d F a m i l y C o u r t J o u r n a l • W i
n t e r 2 0 0 6
over CSA cases about current areas of agreement and
disagreement among scientific researchers about the
disclosure patterns of CSA victims. A major volume on
abuse disclosure patterns is scheduled for publication
in 2006 (Pipe, Lamb, Orbach, & Cederborg, in press).
It contains chapters by researchers from differing
perspectives that we have drawn upon for this article
(London, Bruck, Ceci, & Shuman, in press; Lyon, in press).
Unfortunately for those charged with making decisions
about children’s welfare, no single school of researchers
has the last word on these controversial issues.
Brief History
Many scholarly papers about children’s disclosure
patterns either begin with a discussion of Roland
Summit’s Child Sexual Abuse Accommodation Syndrome
(CSAAS) or structure their arguments around his model
of children’s behavior in these cases (London, Bruck,

Ceci, & Shuman, 2005; Lyon, 2002; Lyon, in press;
Summit, 1983). Summit argued that children often deny
being sexually abused, even when they are directly
asked, and that disclosing children often subsequently
recant their allegations. He based the accommodation
syndrome primarily on cases of intrafamilial child
sexual abuse (incest) rather than extrafamilial child
sexual abuse.
Although Summit’s “syndrome” has been litigated
with a variety of outcomes in many courts, it may have
become so controversial that it obscures rather than
clarifies the issues at hand. Judges should bear in mind
that for almost a century before Summit published his
influential paper, there was statistical evidence that
children often delay disclosure or remain completely
silent about sexual victimization. Indeed, this prior
literature was so extensive that a major psychological
journal rejected Summit’s accommodation syndrome

paper before it found publication elsewhere because,
the reviewers argued, it contributed nothing new
(Lyon, in press; Olafson, 2002). There have also been a
number of studies documenting children’s disclosure
patterns in otherwise corroborated child sexual abuse
cases since the 1983 publication of Summit’s paper
(Lyon, in press). Examining children’s disclosure pat-
terns one category at a time, without organizing them
around Summit’s now-controversial accommodation
syndrome, may clarify and simplify the issues.
The Issues
What are the disclosure and non-disclosure patterns
among children known to have been sexually abused?
There are several issues:
■ Do most child victims delay reporting sexual abuse,
sometimes until adulthood?
■ If directly asked, do most child victims disclose
sexual abuse?
■ If directly asked, do some CSA victims initially fail
to disclose or deny being abused, so that more than
one formal interview becomes necessary?

■ How common is incremental abuse disclosure, from
partial and fragmentary accounts to full disclosure
over time?
■ Once children have disclosed sexual abuse, do a
high percentage of known victims subsequently
recant or retract their disclosures?
■ Are there factors such as gender, developmental
level, culture, degree of abuse severity, parental sup-
port, and relationship to perpetrator that influence
disclosure patterns among CSA victims?
Sources of Information
The two most reliable sources of information about
disclosure patterns in CSA victims are:
■ Retrospective surveys of adults who report
having been sexually abused during childhood;
and
■ Research about children’s statements during
evaluation and treatment in cases with cor-
roborative evidence that is independent of
children’s statements, such as videotapes of the
actual abuse, physical findings, sexually trans-
mitted diseases, and offender confession.
Both sources are imperfect. Cases that have indepen-
dent corroboration may be unrepresentative of sexual
abuse cases in general. Retrospective surveys depend on

human memory over time, so that under-reporting, over-
reporting, and inaccurate reporting may occur.
Nevertheless, cases with independent corrobora-
tion and retrospective surveys are superior to the
other sources sometimes used in literature reviews. For
example, studies that claim substantiation or conviction
rates as “independent” corroboration may significantly
inflate the percentages of actually abused children who
disclose their victimization during formal question-
ing. This is because substantiation, prosecution, and
E r n a O l a f s o n a n d J u d g e C i n d y S . L e d e r m a
n
t J o u r n a l
conviction depend so heavily at all decision stages on
children’s statements. To argue that substantiation rates
that depend upon children’s disclosures proves that
most children make disclosures when interviewed is to

argue in a circle (Lyon, in press).
The definitions of key terms also affect research out-
comes, but researchers do not always specify their oper-
ational definitions. “Child sexual abuse” can include a
wide variety of behaviors, from non-contact exposure to
genital fondling to violent genital, oral, and anal rape. In
this article, we focus primarily on contact child sexual
abuse. “Disclosure” also has a variety of meanings. We
define disclosure to mean a clear verbal statement that
at least one abusive act took place, although a disclosure
need not be a complete report of everything that hap-
pened. Our definition does not include suggestive doll
play and other fragmentary “partial disclosures” that,
when included in research studies, artificially inflate
children’s “disclosure” rates (e.g. Dubowitz, Black, &
Harrington, 1992).
“Non-disclosure” can also vary in meaning depend-
ing on whether it refers to a child’s non-disclosure dur-

ing a single or initial interview or a child’s non-disclo-
sure maintained over six or more interviews. Children
questioned only once show higher “non-disclosure”
rates than do children questioned several times, so that
studies such as that by Sorenson & Snow (1991) that
show very high initial non-disclosure rates have an even-
tual disclosure rate of over 90%.
Child Sexual Abuse Disclosures Delayed
Until Adulthood
There appears to be a consensus among research-
ers that most child sexual abuse victims delay disclos-
ing, often until adulthood. A number of well-designed
retrospective surveys now show that the great majority
of victims delay disclosing contact child sexual abuse
during childhood (Finkelhor, Hotaling, Lewis, & Smith,
1990; Smith et al., 2000). These surveys also indicate
that even when adults recall having told someone
about the abuse, the majority of these cases were not

then reported to the authorities. In one survey, 28% of
respondents stated that they had disclosed to no one
before telling the telephone interviewer about the child
sexual abuse (Smith et al., 2000); another survey found
that 42% of men and 33% of women first told anyone
about having been sexually abused as children when
asked during the retrospective telephone interview
(Finkelhor et al., 1990).
London and colleagues (2005) summarize the ret-
rospective literature by noting that the results of 10
retrospective surveys indicate that only one-third of
adults who suffered child sexual abuse revealed the
abuse to anyone during childhood. The study concludes
that “approximately 60%-70% of adults do not recall
ever disclosing their abuse as children, and only a small
minority of participants (10%-18%) recalled that their
cases were reported to the authorities” (London et al.,
2005, p. 203). Although London and colleagues note the

research limitations inherent in adult retrospective liter-
ature, they also write, “Given the differences in method-
ology, definitions of abuse, and sample characteristics,
the general consistency of these findings across these
studies is noteworthy” (London et al., 2005, p. 201; but
see Poole & Dickinson, 2005).
Judges and other fact finders can only adjudicate
those cases that come to their attention, and a child’s
prior disclosure to a caregiver or friend constitutes
the most common means by which child sexual abuse
comes to the attention of the authorities and thus to the
courts (Lyon, in press). Therefore, because it appears
that most people delay disclosing until adulthood, chil-
dren who decide to tell someone about being sexually
abused and whose cases therefore come to court are
not representative of sexually abused children in gen-
eral. In other words, child protection authorities and
the judiciary are likely to see only a minority of those

children who are actually being sexually abused. There
are, of course, some sexual abuse cases that are report-
ed for reasons other than a child’s prior disclosure, such
as children’s sexualized behaviors, physical findings,
and other external evidence. This review article focuses
on the disclosure patterns and behaviors among both
groups of sexually abused children, those who had pre-
viously disclosed and a smaller number of those who
came into the system in some other way.
Child Sexual Abuse Disclosures Delayed
within Childhood
There appears to be agreement among researchers
from diverse perspectives that “when children do dis-
close, it often takes them a long time to do so” (London
A b u s e C a s e s
n t e r 2 0 0 6
et al., 2005, p. 204). In a study of 399 children aged 8

to 15, Elliott and Briere (1994) find that of 248 subjects
assessed as having been sexually abused, 74.9% did not
disclose their abuse to anyone within the year that it first
occurred, and 17.8% had waited more than five years to
tell anyone. The courts are likely to see many such cases
in which children delayed reporting for months or even
years before telling someone about the abuse. It is also
not unusual for children to disclose the abuse long after
adjudication when they are in a safe environment and
the litigation is finished. Delays in telling anyone about
the abuse for several months, a year, or even longer
occur in a significant percentage of child sexual abuse
cases (Henry, 1997; Sas & Cunningham, 1995).
In weighing the evidence in child sexual
abuse cases, judges and other fact finders
should be aware that, in a high percentage
of actual CSA cases, there will be delays of
months or even years between the onset
of the abuse and a child first disclosing to
another person.
Children’s Gradual Disclosures during

Formal Interviews
Many prosecutors are familiar with the problem of
incremental disclosure, in which a child may disclose
only aspects of an abusive event, such as genital fon-
dling, during the initial interview. Shortly before trial
is scheduled to begin, the child, perhaps during court
preparation with the prosecutor, describes new details,
such as penetrating oral sex, that necessitate postpone-
ments, the filing of new criminal charges, and concerns
about the child’s credibility and competence. In one
such case, a young incest victim, when asked why she
had not mentioned crucial additional information dur-
ing her initial advocacy center interviews responded,
“I just didn’t think of it.” This pattern of partial disclo-
sure can be explained by Summit’s classic child sexual
abuse accommodation syndrome, but it may also simply
reflect the usual patterns of recall in the very young.
In an experimental study, Dr. Robyn Fivush asked non-

abused children aged 3-6 about a known event on
two subsequent occasions (Fivush, 1994). On the two
recall occasions, children reported different but still
accurate information about the events, with an overlap
of details between the two retellings of only 20%. This
research about children’s normal patterns of recollec-
tion and reporting could in itself justify recommending
that children be given more than a single interview to
tell the authorities about the events in their lives.
In a summary of 21 studies from 1965 to 1993 of
children diagnosed with gonorrhea, Lyon finds gradual
disclosure by children to be very common (Lyon, in
press). In 118 CSA cases studied by Elliott and Briere
(1994), there was external evidence for the abuse,
including, for example, medical evidence diagnostic of
child sexual abuse, perpetrator confession, a witness
to the abuse, or pornographic pictures of the child.
In a number of these 118 cases, victims disclosed par-

tially in the first interview by mentioning fondling, but
when investigators confronted them with the external
evidence for more severe abuse (penetration), the chil-
dren then made more complete disclosures.
Thus, when questioned during formal interviews,
children may only partially disclose during the initial
interview. Because evidentiary studies show that trau-
matic medical evidence (such as a ruptured hymen) is
lacking in a significant number of cases in which per-
petrators have confessed to penile penetration, judges
should not prematurely regard children’s statements
as complete after a single interview (Muram, Speck, &
Gold, 1991). As Elliott and Briere (1994) write, “Forensic
evaluations that consist of a single interview may result
in incomplete disclosure and less accurate determina-
tions, especially in cases where medical or other exter-
nal data are lacking or inconclusive” (p. 274).
This recommendation does not contradict the long-

held principle in the child protection fields to avoid
subjecting children to repeated interviews by multiple
investigators from social services, law enforcement, and
the court system. The National Children’s Advocacy
Center has developed and tested guidelines for extend-
ed forensic evaluations with reticent children. If several
interviews become necessary, it is recommended that a
single interviewer conduct them and that the question-
ing be sensitively structured to build rapport over time
and avoid repetitive questioning and suggestiveness
(Carnes, Wilson, & Nelson-Gardell, 1999; Carnes, Nelson-
Gardell, Wilson, & Orgassa, 2001).
E r n a O l a f s o n a n d J u d g e C i n d y S . L e d e r m a
n
t J o u r n a l
Because many sexually abused children in
externally corroborated cases are known to
disclose only gradually, more than a single
interview may become necessary to serve

children’s safety and justice. See the guide-
lines by the National Children’s Advocacy
Center (Carnes et al., 1999; 2001).
Non-Disclosure or Denial by Children When
Interviewed about Child Sexual Abuse
The most troubling cases for the courts are those in
which there are red flags indicating a strong possibility of
child sexual abuse: The case is reported, the child inter-
viewed, and the child discloses no sexual abuse. There are
two classes of children to consider here:
■ Children who previously disclosed partially or fully
to another person and thus precipitated entry into
the system; and
■ Children who came into the system through other
means, such as diagnosis of a sexually transmitted
disease during routine medical care, extreme sexual-
ized behaviors, or the discovery of videotapes docu-
menting the abuse.
It is about children’s disclosure patterns once they
are in the system that the experts disagree, and these
cases are the most troubling to those responsible for
protecting children from abuse and protecting adults
from false allegations.

London et al. (2005) state that “the data clearly demon-
strate that most children who are interviewed about sexual
abuse do disclose and do not later recant…” (p. 217).
Lyon (in press) responds with a critique that reveals
problems with two kinds of case selection bias in many
of the samples upon which London and colleagues
based the above conclusion. Lyon argues that:
■ To avoid suspicion bias, one must examine cases
that did not come to the attention of the authorities
because a child disclosed to someone prior to the
formal interview; and
■ To avoid substantiation bias, one must examine
cases in which substantiation was completely inde-
pendent of the child’s statements.
To understand how both forms of selection bias
artificially inflate the actual rates of children’s sexual
abuse disclosures, consider the following extreme case.
If we suspect sexual abuse only when a child has previ-
ously disclosed, then 100% of children in a sample of
children suspected of being sexually abused will have

disclosed at some point. If we substantiate child sexual
abuse only if a child discloses, then 100% of children
in a sample of substantiated cases will have disclosed.
The reality is only somewhat less extreme. The great
majority of suspected CSA cases come to our attention
only because a child has previously disclosed. Child
sexual abuse substantiation also depends most heavily
on children’s disclosures, because external evidence of
child sexual abuse (such as physical findings or offender
confession) is rare and generally detected only after
sexual abuse has been suspected.
London et al. (2005) seem to agree with Lyon about
suspicion bias by writing, “Prior disclosure of abuse pre-
dicts disclosure during formal assessment” (p. 209), but
they do not then systematically deal with the problem of
suspicion bias. London and colleagues also acknowledge
but do not fully address the substantiation bias problem
by writing, “In many of the cited studies, classification of

abuse was often based in part on children’s disclosures;
consequently, the conclusion that abused children do
disclose abuse during formal interviews may be circular”
(p. 217). They then base their conclusion that “the evi-
dence fails to support the notion that denials, tentative
disclosures, and recantations characterize the disclosure
patterns of children with validated histories of sexual
abuse” (p. 194) on their review of research studies that
are in many cases flawed by both suspicion and substan-
tiation bias. What do studies that avoid both biases tell
us about this area of contention?
Studies of Disclosure Patterns in Cases without
Selection Bias
Nine boys and one girl were interviewed by police
after Swedish law enforcement discovered videotapes of
102 incidents of child sexual abuse, ranging from expo-
sure of the child’s genitals to oral/anal/vaginal intercourse
(Sjoberg & Lindblad, 2002). The perpetrator was either
related to the children or knew them through his work

at a day care center. Abuse severity was coded both from
the videotapes and from children’s statements. No child
had previously disclosed abuse nor had it been suspected.
Five children reported no abuse during police interviews,
for a disclosure rate of 50%. The child who had suffered
A b u s e C a s e s
n t e r 2 0 0 6
the greatest number (60 incidents) and most severe
sexual assaults according to the videotaped evidence did
not disclose during the police interview. Two of the five
children who did disclose did so only in response to lead-
ing questions. No child reported any sexual behavior not
documented on the videotape.
Cases with children not suspected to be sexual abuse
victims who are diagnosed with sexually transmitted dis-
eases, who are too old to have acquired the diseases con-

genitally and too young to have acquired them through
consensual sex with peers, also avoid both suspicion
and substantiation bias. Confining this review to STD
diagnosis deals with the problem raised by London et al.
(2005) that “medical evidence” is not always a “reliable
benchmark” because, for example, genital redness may be
caused by many things besides sexual abuse.
Lawson and Chaffin (1992) found that among 28 chil-
dren in which STDs were medically diagnosed without
prior suspicion of abuse, only 12 children (43%) made
an allegation of sexual abuse during the initial formal
interview, and 16 children did not. Almost half of these
children had shown no physical or behavioral symptoms
of sexual abuse, so that there were no “red flags” that
would have otherwise brought these children into the
system as possible CSA victims. Maternal attitude influ-
enced disclosure patterns greatly. Among those children
whose parents were supportive, 63% disclosed abuse

during these initial interviews, whereas when caregivers
expressed skepticism, only 17% disclosed.
Of the 16 false negatives in the original Lawson
and Chaffin study, five were subsequently located and
consented to be interviewed. Four of these five had a
supportive parent and one a non-supportive parent.
Researchers presented the study to parents and chil-
dren as an evaluation of responses to prior emergency
room visits, and they never mentioned child abuse.
Nevertheless, four of the five parents spontaneously
told the researchers that their children had disclosed
sexual abuse some time after the initial hospital inter-
view, a finding that supports the idea that CSA disclo-
sure is often an incremental process that may require
more than a single interview (Chaffin, Lawson, Selby,
& Wherry, 1997). Upon psychological testing, the four
non-disclosing children whose parents had been sup-
portive at the time of the initial interview tested three

times higher on dissociative symptoms than did the dis-
closing children and nine times higher on dissociative
symptoms than non-abused control children. Because of
the nature of this study and the very small numbers of
children involved, these results are far from conclusive,
but they do suggest a possible link between dissociative
symptoms and non-disclosure among CSA victims.
London et al. explain the Lawson and Chaffin
results by describing this sample as “unusual” and as
representing “the small hard core of children who do
not disclose abuse when directly asked” (2005, p. 215).
Lyon argues in response that the Lawson and Chaffin
sample avoids the problems of suspicion and substan-
tiation bias that characterize many other samples. Lyon
then raises a concern about the many cases that are
closed as unsubstantiated after a single interview during
which a possibly sexually abused child without medical
evidence fails to disclose when formally questioned.

A number of other samples document similarly
low rates of disclosure in STD cases. Lyon examined 21
studies published between 1965 and 1993 of children
diagnosed with gonorrhea. In nine of these papers, the
authors referred to a “history” of sexual contact or sexual
abuse for some of the children with gonorrhea, without
clarifying whether this history came from children’s dis-
closures or from other sources (Lyon, in press). In most
of the remaining studies, the authors used words such as
“admitted” or “denied” sexual contact or referred even
more directly to children’s statements. Even when all
the cases of “history” were counted as actual child dis-
closures, Lyon finds that the average rate of “disclosure”
among the 579 children in these studies was 43%, or 250
children. Given the broad definition of “disclosure” that
he applies here, Lyon argues that this may actually be an
overestimate of disclosure rates. Most of these studies
indicated that the medical professionals questioned the

children, but the precise nature of these questions is not
known. When Lyon omits studies with children younger
than three years of age to control for developmental
limitations on narrative skill, he finds that 185 of 437
children, or 42%, disclosed.
To summarize this sample of disclosure studies that
avoid both suspicion and substantiation bias, Sjoberg
and Lindblad find a disclosure rate of 50%, Lawson and
Chaffin find a disclosure rate of 43%, and in a review of
21 studies of children diagnosed with gonorrhea, Lyon
finds a disclosure rate of 43%. London et al. (2005) assert
E r …
REDACTED STATEMENT: JANE DOE
OCTOBER 2008
AGGRAVATED SEXUAL ASSAULT
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08/83/2007 14:30 3367737994
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08/03/2007
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DATE: 0-05-#7 STARTING TIME: M stg 411 ENDING TIME:
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VICTIM IMPACT STATEMENT
Prosecutor's File #: (;) — Defendant's Name: ftf...tnala
Indictment*:
In the space below, please write about how you and your lam*
were affected by this incident.
Please do not talk about the facts of the case or anything you
might think of as testimony The
judge and the prosecutor would like to know:
a. Your feelings about the incident

b. How your life is different because of the incident
c. What you think the defendant's sentence should be
Your Name:
WAS -itn-4,1e, (mei r ,1,; 41/4 .54.,nutt1/4. /xi-ye -In
tzi.nA, UM*,
5Jt e-;nas.
1- WS itdel APA t ka5 matt f. tvi.e 4' +yre o-P rersnn
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„arks , es no 4- hnotre The •-in
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012 a%
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1 S 01/4 (1,r. irsive . rE" 1411.1 rny Pespnns ;hi la
.4eiLS.LLGese
#11

L- , ,
*-ib t -in ti4N and m artkirii I r -knelt,/ riel 44.p. eras?,
ths *X
Please return this form and all documents within 5 business
days to:
If you have any questions, please call the County Office of
Victim Witness Advocacy at
~OTF36BP000F.PDF.pdfPage 1Page 2Page 3Page 4Page 5Page
6~OT8486P000F.PDF.pdfPage 1Page 2Page 3Page 4Page 5Page
6Page 7Page 8Page 9Page 10Page 11Page 12Page 13Page
14Page 15Page 16Page 17Page 18Page 19Page 20Page 21Page
22Page 23Page 24
MiKayla Schumacher
10039 Sleepy Hollow Lane 7276088563
Port Richey, FL 34668 [email protected]
Profile
Certified Nursing Aide with over 10 years of experience
working in hospitals and long-term care facilities. Familiar
working in a variety of departments and care units throughout
career, providing a comprehensive background which can easily
be adapted to new challenges. Dependable employee with a
demonstrated commitment to providing compassionate,
professional care to patients.
Core Competencies
--Patient Monitoring

-Mobility Assistance
-Electronic Medical Records
-Charting and Documentation
-Diagnostics
-Communication Skills
-Medication Administration
-Patient Hygiene Care
-HIPAA Compliance
-
Training And Certifications
East Bay Rehabilitation 2018 – Present
Certified Nursing Aide
-License Number: 292492
Brightstar 2010-2018
Certified Nursing Assistant
-License Number: 292492
Setv LLC 2010 – 2016
Management and Supervisory
Work History
East Bay Rehabilitation Clearwater, FL 2018 – Present
-Served as a nursing aide in a 50-bed hospice for patients
needing long-term care. Focused on fulfilling core patient
needs, such as medication administration, feeding, hygiene, and
mobility around campus. Often interacted with patient families
and answered questions.

BrightstarClearwater, FL 2010 – 2018
-Worked in the intermediate care unit providing monitoring and
basic care services to patients. Maintained thorough records of
care tasks completed throughout day and updated electronic
patient records accordingly.
Setv LLC New Port Richey, FL 2010 – 2016
Management
Dynamic and performance-driven administrative professional
with strong organizational, customer service, and
communication skills. Multi-disciplinary with emphasis in
records management, payroll processing, accounts payable and
receivable.

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