Although the sexually anatomical dolls, SAC Dolls, are widely used in the assessment of cases of alleged child sexual abuse, they are controversial and they have been severely criticized in the scientific community. There is no evidence that the dolls can be used to gain reliable information about prior events. These dolls are, in fact, teaching aids and are easily used to influence or instruct a child.

Children's statements can be initiated and guided by adult questioning, and shaped by adult instruction when the child has not experienced any real event. This vulnerability to suggestion is enhanced when props such as dolls are used. The claim that children can accurately demonstrate something they cannot talk about by using dolls is not supported by research.

White and her colleagues (White, Strom, & Santilli, 1986; White, Strom, Santilli, & Halpin 1986) developed a structured protocol for the use of the dolls, but this has not been validated or accepted in clinical practice. Realmuto, Jensen, and Wescoe (1990) used this protocol and found that their raters were unable to correctly classify the children as abused or nonabused. Few researchers, however, attempt to use any kind of protocol.

Following the report of the American Psychological Association's Special Task Force on the use of Anatomical Dolls, on February 8, 1991, the APA issued a statement concluding that there are no normative data for the dolls and their use, and that there are no uniform standards for conducting interviews with the dolls. Unfortunately, the persons actually using the dolls are often untrained, unsophisticated, and vary widely in their interpretation of children's behavior with the dolls (Boat & Everson, 1988; Kendall-Tackett & Watson, 1992). Skinner, Berry, and Giles (1992a, 1992b) observe that doll users are likely to develop personal norms based on their own experience and caution practitioners against equating their own experience with scientific evidence.

The use of the dolls can be a modeling and learning experience for a child. Interviewers model handling the dolls, suggest that they be undressed (or undress them for the child) and label them for the child. They ask the child to show with the dolls what the accused did and may even place the dolls in sexually explicit positions for the child. This is a teaching experience for the child. Several studies suggest that some nonabused children engage the dolls in sexual play (Dawson & Geddie, 1991; Dawson, Vaughan, & Wagner, 1992; Everson & Boat, 1990; McIver, Wakefield, & Underwager, 1989).

The rationale given for using the dolls is that it enables young children who have difficulty verbalizing their abuse to demonstrate it. But there are no data supporting the belief that a child who is unable to talk about what happened can then accurately demonstrate the event using a doll. In fact, a series of studies found decreased accuracy when young children were asked to show on a doll where they were touched compared to being asked to show on their own bodies. This is because very young children cannot understand the basic self-doll relation assumed by interviewers who use the dolls. They cannot use dolls as symbols or representations for themselves and therefore cannot use the dolls to enact their own experiences (DeLoache, 1995). Ceci (1993) also reports that the use of dolls can increase error. These credible and solid research programs show that the dolls cannot be used as a demonstrative aid without introducing large but indeterminate amounts of error into the accounts. As suggestive as they are, the dolls may also be destructive. If a young, innocent child has not been abused but is questioned with the dolls and asked about behaviors such as anal intercourse, this may well teach a young child about deviant sexual behaviors that they had no knowledge of previously. Young children do not need and cannot benefit from such knowledge.

Another rationalization offered is that the dolls enable an interviewer to go through a body parts naming procedure and learn the child's idiosyncratic terms for the genitals. This is often done early in the interview. When the questioning about body parts ends with the identification of the genitalia, as it often does, the child has likely been taught that the purpose of the interview is to talk about sexuality. There is no evidence to support the efficacy of this procedure. An interviewer does not need dolls to talk to children about sexuality or to learn the child's vocabulary. If there is a desire to know the child's names for body parts, all you have to do is ask. They will tell you what they call them.

Specific research studies in the use of the dolls with children have failed to produce evidence for any validity or reliability of their use. It is not possible to use the dolls to tell the difference between abused and non-abused children. Several studies, including McIver, Wakefield, & Underwager, 1989, demonstrate that some non-abused children will produce behaviors that are supposed to show abuse and some abused children do not produce such behaviors.

In summary, there is no evidence that doll interviews are a reliable method for getting accurate information about sexual abuse. The studies that claim to show differences between the responses of sexually abused and nonabused children have major methodological shortcomings which limit any conclusions that can be drawn from them (Ceci & Bruck, 1993; Underwager & Wakefield, 1990, Wakefield & Underwager, 1991, 1994; Wolfner, Faust, & Dawes, 1993). In a recent review of the empirical research, Skinner, et al. (1992) conclude that distinct patterns of play of abused versus nonabused children have not been identified and that the lack of norms calls into question the forensic use of the dolls. Wolfner et al. (1993) assert that there is no scientific evidence to justify clinical or forensic diagnosis of sexual abuse on the basis of doll play and maintain that their use violates the ethical principles for psychologists. They demonstrate that the use of the dolls has no incremental validity, that is, they do not produce any knowledge not already available. Levy (1989) argues in a legal analysis that any statement by a child that is the product of a doll-aided evaluation should be inadmissible as evidence.

The probability that the use of the dolls may produce false and unreliable information is so high as to make their acceptance as evidence likely to introduce error, bias, and confusion into the deliberations. At the same time finders of fact in the justice system who are not knowledgeable about the scientific status of the dolls are likely to be susceptible to an erroneous presentation of them as valid and reliable instruments and thus be unduly influenced by information based upon the use of the dolls.

The use of the dolls as assessment or investigatory techniques is not accepted within the scientific community (Levy, 1989; Ceci & Bruck, 1993). The September 30, 1986 Federal Registry called for research proposals on the use of the dolls, saying that although their use has widely proliferated, there is no evidence, no research to support their efficacy. The most recent scientific literature describes the use of the dolls as potentially suggestive and non-supported by empirical research. Skinner & Berry (1993) and Skinner, Berry, & Giles (1992a, 1992b) demonstrate that there is no acceptable validity or reliability for their use, no acceptable standardization, and no appropriate norms. They also show there is no scientific data showing acceptable support for either construct or criterion validity. Lewis (1992) describes the sources of invalidity and shows they lead to false positive (concluding there is abuse when there is no abuse) conclusions in four types of legal proceedings.

The California Appeals court, in the case of Amber B, ruled that the use of the dolls did not meet the Frye standard for admissibility. The Iowa (1983) Appeals court ruled that admitting the testimony of a psychologist interpreting a child's behavior with dolls as showing sexual abuse had occurred was reversible error. The Kansas Supreme Court (Kansas v. Bratt) analyzed a case on the basis of the U.S. Supreme Court Idaho v. Wright ruling and concluded the use of the dolls was inadmissible. The Supreme Court of Utah (Utah v. Rimmasch, 1989) included the use of the dolls in techniques not accepted in the scientific community which cannot be used to bolster the truth of a witness's testimony. The U.S. Court of Appeals, Ninth Circuit (United States of America v. Gillespie, 1988), held it was reversible error to admit expert testimony based on the use of the dolls without evidence for their scientific reliability. The highest court in Holland ruled that no testimony based upon the use of anatomical dolls is admissible unless the judge can demonstrate that their use meets the objections raised by our Dutch colleagues and us. Coolbear (1992) finds that although mental health professionals are aware that the dolls have no demonstrated reliability nor validity, the legal professions do not know or understand this. See

The use of the dolls as an assessment or investigatory technique is not generally accepted within the scientific community and would not meet the Frye test. Rather, their use remains highly controversial and the scientists quoted above who have carefully reviewed the body of research on the dolls recommend that they not be used. For the reasons discussed by Skinner and Berry (1993) and Wolfner et al. (1993) they also fail to meet Daubert. The use of the dolls has been falsified (Wolfner et al. 1993); there is no replication of any positive outcomes; the level of error is unacceptable; and their use has not been accepted in the scientific community.

Dolls should not be used in the courtroom or in the process of a child giving testimony. Such use risks introducing error, suggesting and leading a child to demonstrations that are highly prejudicial, lacks any probative value, and makes any cross-examination aimed at eliciting reliable statements impossible.

References in support include;

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