Studies have also examined the effects of stress on memory in children. Three- to 4-year-old children interviewed after Hurricane Andrew were assessed for memory of the storm (Bahrick, Parker, Fivush, & Levitt, 1998). The authors found an inverted U curve, with best memory at intermediate levels of storm damage and a decrease in memory at the highest levels of storm damage.
Studies of healthy children 4 to 6 years of age who went to the doctor and had blood draws, injections, and genital and anal exams showed that children have reliable memories of the events and are resistant to suggestion (Goodman, Hirschman, Hepps, & Rudy, 1991; Saywitz, Goodman, Nicholas, & Moan, 1991). With decreases in age children became more susceptible to suggestion and had a decrease in reliability; they were also more susceptible to suggestion when interviewed by an adult than by a child, suggesting an eagerness to please authority (Ceci & Bruck, 1993; Ceci, Ross, & Toglia, 1987). Children have been shown to be resistant to abuse-related suggestions, such as "He took your clothes off, didn't he?"(Goodman & Aman, 1990; Rudy & Goodman, 1991). Reliability about genital exams was actually higher than for other parts of the physical exam (Saywitz et al., 1991). Children did not report the genital exam unless asked directly (Ceci et al., 1987). Children age 3 to 13 asked about a voiding cystourethrogram fluoroscopy they received at 2 to 6 years of age were less likely to recall information if the procedure had been stressful, and were less likely to recall information the younger they were at the time of the procedure (Quas et al., 1999). In another study children ages 3 to 18 with leukemia who underwent a painful lumbar puncture were assessed 1 week after the procedure (Chen, Zeltzer, Craske, & Katz, 2000). Children of all ages showed a high accuracy of recall, and accuracy increased with age.
Children with a history of abuse have also been shown to be accurate in remembering details of doctor's genital and anal exams. In a study of 189 3- to 17-year-olds, all children showed >70% accuracy in recalling details of the exam (Eisen, Qin, Goodman, & Davis, 2002). There were no differences in accuracy of recall between abused and nonabused children, and there was no relation with dissociative tendencies or other measures of psychopathol-ogy. Older age was the only factor that predicted accuracy of recall.
In summary, the empirical literature suggests that children can have accurate recall of stressful events. These studies, however, have primarily been conducted in normal children. We cannot assume that studies in normal children can be generalized to all children, including abused children. The few studies that were conducted on abused children did not specifically look at those with PTSD or other stress-related mental disorders. Since, as reviewed below, memory and stress responsive systems are altered in patients with stress-related mental disorders, extrapolation of findings from healthy subjects to abuse victims with mental disorders, which is the group of primary interest in the debate about delayed recall of childhood abuse, has limitations.
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