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ISTANBUL PROTOCOL VI. PSYCHOLOGICAL EVIDENCE OF TORTURE AND ILL-TREATMENT

recording confidential, with limited access given only of symptoms can be very different from adults and
to the assessment team and to protecting the child’s the clinician must rely more heavily on observations
identity. If there are any other local legal requirements of the child’s behaviour than on verbal expression,
regarding data protection, these should be adhered to. consider the child’s behaviour before the alleged
torture or ill-treatment and use developmental
580. It can be useful and provide additional support for the milestones to identify any potential impact on
evaluation’s conclusions to use assessment instruments. normal behaviour. 497 Collecting information from
It is recommended that clinicians use instruments the caregivers, teachers or other adults in the child’s
validity and reliability of which have been established environment is advised and might be necessary.
for the particular population that is assessed. When Research has delineated the effects of trauma on
such instruments are not available, great caution children’s mental and physical health. For example, it
should be taken in the interpretation of test results. has been found that trauma significantly compromises
Any adaptation in administration and interpretation cognitive development, 498 and that exposure to
procedures should be documented and the potential traumatic experiences increases the risk of learning
impact on the findings should be noted. 496 and behavioural problems, obesity 499 and psychotic
symptoms in childhood. 500 Neurobehavioural
(c) Clinical considerations development research shows that children’s brain
development is affected by the environment in which
581. An assessment of the psychological effects of torture they grow up. Although they may not be able to
and ill-treatment on children and young persons recall, the memory of torture can have a traumatic
should include information regarding the following: effect on babies and toddlers with potential long-
(a) the child’s age, developmental status, as well term impact on their attachment, regulation and
as current and past psychological and medical experience of trust. 501 The environment and trauma
functioning (including cognitive, communication and will influence an adolescent’s identity, brain maturation
language abilities, special needs, social and school and thought functions, such as abstract thought
functioning, behavioural adjustment and emotional and the ability to consider multiple perspectives, as
disorders); (b) chronological personal and family well as the regulation of emotions and emotional
history of life events, residences etc.; (c) description processing, which are still developing at this age. 502
of the alleged torture or ill-treatment, its frequency
and duration; (d) information regarding whether the 583. Symptoms of PTSD may appear in children. The
child witnessed the death and/or torture of others, symptoms can be similar to those observed in adults,
especially meaningful others, or learned that it had but the clinician must rely more heavily on observations
occurred to meaningful others; (e) the alleged torturer’s of the child’s behaviour than on verbal expression. 503
identity and what it represents for the child in their For example, the child may demonstrate symptoms of
particular social and political context; (f) protective re-experiencing as manifested by monotonous, repetitive
factors and indicators of resilience; (g) the availability play representing aspects of the traumatic event, visual
of family and other caregivers to provide psychosocial memories of the events in and out of play, repeated
support; (h) the legal status of the child; and (i) the questions or declarations about the traumatic event
provisions in place for treatment and support. and recurrent nightmares that for younger children in
particular (e.g. those aged 6 and less) may not have
582. While symptoms may appear in children and can be recognizable content. Children may also articulate
similar to those observed in adults, manifestation repetitive concerns that the torture will occur again or

496 Gerald P. Koocher, “Ethical issues in forensic assessment of children and adolescents”, in Forensic Mental Health Assessment of Children and Adolescents, Steven N. Sparta
and Gerald P. Koocher, eds. (New York, Oxford University Press, 2006), pp. 46–63.
497 See Lenore C. Terr, “Childhood traumas: an outline and overview”, American Journal of Psychiatry, vol. 148, No. 1 (1991), pp. 10–20; Zero to Three, DC:0–5: Diagnostic
Classification of Mental Health and Development Disorders of Infancy and Early Childhood, version 2.0 (Washington, D.C., 2021); Françoise Sironi, “‘On torture un enfant’,
ou les avatars de l’ethnocentrisme psychologique”, Sud/Nord – Folies et Cultures, No. 4 (Enfances) (1995), pp. 205–215; and Lionel Bailly, Les catastrophes et leurs
conséquences psychotraumatiques chez l’enfant (Paris, ESF, 1996).
498 Michelle Bosquet Enlow and others, “Interpersonal trauma exposure and cognitive development in children to age 8 years: a longitudinal study”, Journal of Epidemiology
and Community Health, vol. 66, No. 11 (2012), pp. 1005–1010.
499 Nadine J. Burke and others, “The impact of adverse childhood experiences on an urban paediatric population”, Child Abuse & Neglect, vol. 35, No. 6 (2011), pp. 408–413.
500 Louise Arseneault and others, “Childhood trauma and children’s emerging psychotic symptoms: a genetically sensitive longitudinal cohort study”, American Journal of
Psychiatry, vol. 168, No. 1 (2011), pp. 65–72.
501 Atilgan Erozkan, “The link between types of attachment and childhood trauma”, Universal Journal of Educational Research, vol. 4, No. 5 (2016), pp. 1071–1079.
502 UNHCR, The Heart of the Matter, pp. 58–60.
503 See Terr, “Childhood traumas”; Zero to Three, DC:0–5 Diagnostic Classification; Sironi, “‘On torture un enfant’”; and Bailly, Les catastrophes et leurs conséquences.

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