130 N.J. 554 (1993) 617 A.2d 1196

STATE OF NEW JERSEY, PLAINTIFF-APPELLANT AND CROSS-RESPONDENT,
v.
J.Q., DEFENDANT-RESPONDENT AND CROSS-APPELLANT.

The Supreme Court of New Jersey.

Argued September 30, 1992. Decided January 6, 1993.

*555 Linda K. Danielson, Deputy Attorney General, argued the cause for appellant and cross-respondent (Robert J. Del Tufo, Attorney General of New Jersey, attorney).

Amy Gershenfeld Donnella, Designated Counsel, and Marcia Blum, Assistant Deputy Public Defender, argued the cause for respondent and cross-appellant (Zulima v. Farber, Public Defender, attorney).

*556 H. Todd Hess submitted a brief on behalf of amicus curiae, New Jersey Council of Child and Adolescent Psychiatry (Hayden, Perle & Silber, attorneys).

The opinion of the Court was delivered by O'HERN, J.

This appeal concerns the use of expert opinion testimony to aid jurors in the criminal trial of a child-sexual-abuse case. The specific issue concerns expert-opinion evidence premised on the Child Sexual Abuse Accommodation Syndrome (CSAAS), and whether there is a reliable scientific explanation for certain exhibited characteristics of an abused child, such as acceptance of the abuse or delayed reporting, that would help jurors understand why a child victim would not complain to a parent or other authority figure about the abuse. We hold that CSAAS has a sufficiently reliable scientific basis to allow an expert witness to describe traits found in victims of such abuse to aid jurors in evaluating specific defenses. In this case, the expert's opinion went beyond that limited scope and included opinions on commonplace issues, such as credibility assessments derived from conflicting versions of an event and not-yet scientifically established opinions on the ultimate issues that are for jury resolution. Although the evidentiary questions arise as a matter of plain error, we agree with the Appellate Division that the introduction of such evidence was clearly capable of producing an unjust result and we thus affirm the Appellate Division's judgment ordering a new trial.

I

Facts and Procedural History

The background to the case is regrettably familiar, a story of childhoods unhinged by events so traumatic that even the participants cannot contemplate them. When first confronted with the possibility that defendant might have sexually abused his daughters, their mother was incredulous. After the girls *557 first told their mother of the alleged abuse, she cautioned them that it was important to tell the truth about their father. The girls said that they were telling the truth. Their mother testified that she had warned her daughters never to let a stranger touch them but had never told them about sexual abuse from a father, because she never thought it could happen to her children. Defendant was equally insistent that committing sexual acts with children and, in particular, his daughters is unimaginable. He testified that anybody who engaged in sexual relations with his own children would have to be "sick" and that he did not believe he was sick. Whether defendant is sick or not, the jury has found that abuse occurred.

Rather than use the initials mandated by law, we shall use fictitious names to describe the parents and children involved. We shall refer to the mother as "Karen," the father as "John," and the two children as "Connie" and "Norma." The parents appear to be of different cultures — Karen is from the midwest and John is a recent arrival to the continental United States. They met in Indiana in 1973 or 1974 and started their life together there when Karen was thirteen and John was nineteen or twenty. John already had a child at that time. They soon moved to Brooklyn and later settled in Newark. Connie and Norma were born in 1977 and 1979, respectively. John and Karen never married. Although John worked as an auto mechanic and a golf-greens attendant during their years in New Jersey, he did not provide sufficient financial support for the household; thus, Karen received public assistance for the two children. Theirs was a tempestuous union marked by recriminations that each had been unfaithful. Their relationship deteriorated in late 1984 when John separated from Karen. During the separation, which lasted approximately four months, Karen became pregnant by another man. The breakup became final in late 1985 or early 1986 when John went to Brooklyn to live in an apartment with his brother. At the time of the breakup, Connie and Norma were approximately eight and six years old, respectively.

*558 After the breakup, John customarily picked up the children and took them to Brooklyn for weekend visits. John was then living in a one-room apartment with another woman, whom he married in 1987. About two years after the separation, Karen learned that Norma, during play, had attempted to pull down her younger sister's underwear and touch her buttocks. Karen asked Norma where she had ever learned of such things and Norma reluctantly identified the person who had initiated her into such conduct by spelling out the word "D-A-D".

Although at first disbelieving, Karen consulted a family counsellor and eventually reported the incident to the police. Both Connie and Norma reported that they had been the victims of repeated acts of sexual abuse by their father in the Newark apartment in 1984 as well as during their visits to Brooklyn. An Essex County grand jury returned an indictment charging John with acts of criminal sexual abuse in New Jersey on his children between January 1, 1984, and December 31, 1984.

Before trial, the prosecutor moved, pursuant to N.J.S.A. 2A:84A-32.4, to have Connie's and Norma's testimony taken on closed-circuit television. In ruling on the motion, the trial court heard testimony from Madeline Milchman, a Ph.D. in psychology with a concentration in developmental or child psychology. Dr. Milchman had interviewed the children and had reviewed other information on them as well. The court first qualified Dr. Milchman, without objection, as an expert witness in the areas of child psychology and child sexual abuse. Dr. Milchman essentially testified that both infant witnesses would suffer severe emotional distress if forced to testify before spectators, jurors, and especially their father in the courtroom setting. The trial court granted the motion, ordering that Norma and Connie testify through a closed-circuit system outside the presence of jurors, spectators, and defendant.

At trial, both Connie and Norma described, in graphic detail, the abuses committed on them involving sexual penetration and *559 oral sexual contact. (Presumably, the instances in Brooklyn were testified to under an Evidence Rule 55 analysis.) A pediatric resident who conducted a genital examination of Norma testified that she found that the child had a stretched hymenal opening, an abnormal condition for a seven-year-old girl. The medical evidence relating to Connie, entered by way of stipulation, also revealed a stretched hymen. Karen described discharges that she had observed on Norma's underwear but said that she had attributed them to Norma's not changing her underwear.

Dr. Milchman was called to the stand again at trial and qualified, without objection, as an expert witness on child sexual abuse. She identified the child sexual abuse accommodation syndrome "as a pattern of behavior that is found to occur again and again in children who are victims of incest." She described the various aspects of CSAAS and related them to behavior she had observed in Connie and Norma. Dr. Milchman also testified about how she assesses the veracity of an alleged victim of child sexual abuse. At the conclusion of her direct testimony, Dr. Milchman stated that in her expert opinion, Connie and Norma had been sexually abused.

The theory of the defense was that Karen had put the children up to this story to avenge her loss of John. Defendant offered evidence that the Newark apartment housed eight people and that there was no isolated occasion during which such abuse could have occurred.

The jury convicted defendant of multiple counts of first-degree aggravated sexual assault on Connie and Norma for various acts of penetration and oral sex, and of two counts of endangering the welfare of a child. The court sentenced defendant to thirty years' imprisonment, with ten years of parole ineligibility. The Appellate Division reversed the convictions, finding that the trial court had committed plain error in permitting the use of the CSAAS testimony to establish the credibility of the witnesses rather than for other limited purposes for *560 which it is generally reliable, i.e., to explain secrecy, belated disclosure, and recantation by a child-sexual-abuse victim. State v. J.Q., 252 N.J. Super. 11, 599 A.2d 172 (1991). The Appellate Division specifically held that

syndrome evidence, including CSAAS, is not reliable to prove the occurrence of sexual abuse, and that absent a question of capacity, a social science expert lacks the qualifications to render an opinion as to the truthfulness of a statement by another witness. Because the expert in this case testified before the jury as to syndrome evidence to prove that sex abuse occurred; opined as to the truthfulness of the children (and their mother), and rendered the opinion that the children were abused based in great measure upon these two interdicted classes of evidence, we are satisfied that the admission of her testimony was error clearly capable of producing an unjust result. [Id. at 15, 599 A.2d 172.]

One member of the panel dissented, believing that a case could be made in an Evidence Rule 8 [hereinafter Rule 8] hearing for the scientific reliability of CSAAS evidence as substantive evidence of abuse, thus obviating the need for a reversal of the judgment. The dissent impliedly requires consideration of categories of expert opinion evidence other than CSAAS testimony in child-sexual-abuse cases.

We granted the State's petition and defendant's cross-petition for certification, 127 N.J. 562, 606 A.2d 372 (1992). The State's petition exceeded the scope of an appeal as of right under Rule 2:2-1(a)(2) on those issues as to which there is a dissent in the Appellate Division. Rather, the State requested us to review "all issues relating to psychological and social science expert testimony regarding familial child sexual abuse complainants." Defendant's cross-petition argues against admission of expert testimony based on behavioral science theories.

II

Types of Expert Testimony in Child-Sexual-Abuse Prosecutions

In recent terms of Court we have had to consider various evidentiary problems in criminal prosecutions of child-sexual-abuse cases. See State v. Crandall, 120 N.J. 649, 577 A.2d 483 *561 (1990) (finding constitutional N.J.S.A. 2A:84A-32.4, which permits closed-circuit television testimony outside physical presence of alleged abusers); State v. D.R., 109 N.J. 348, 537 A.2d 667 (1988) (proposing new hearsay exception for child's out-of-court statement concerning acts of sexual abuse); State v. R.W., 104 N.J. 14, 514 A.2d 1287 (1986) (setting forth standards for use of expert psychological evaluation of child victim witnesses). Whether society has changed or whether society is finally confronting its deepest flaws is something that we cannot answer. Freud mistakenly believed that his female patients' experiences of sexual abuse as children were merely fantasies and attributed their complaints to hysteria. Chandra Lorraine Holmes, Child Sexual Abuse Accommodation Syndrome: Curing the Effects of a Misdiagnosis in the Law of Evidence, 25 Tulsa L.J. 143, 144 (1989) [hereinafter Holmes]. We know now, from the many accounts, that such abuse in the home is regrettably all too real. "Since the 1970s * * *, there has been a growing awareness of child sexual abuse and reports of it have skyrocketed." Diana Younts, Evaluating and Admitting Expert Opinion Testimony in Child Sexual Abuse Prosecutions, 41 Duke L.J. 691, 693 (1991) [hereinafter Younts] (citing L.B. Suski, Child Sexual Abuse: An Increasingly Important Part of Child Protective Service Practice, 3 Protecting Children 3 (1986), which shows an increase to 200,000 reports nationwide in 1986, from 7,559 reports in 1976). At the same time, we know that moving from the child's world into the courtroom presents legal issues of varying dimension. For example, in State v. D.R., supra, 109 N.J. 348, 537 A.2d 667, we recommended that the Legislature adopt an exception to the hearsay rule for the admission of out-of-court statements by a child witness provided that the child, if available, testify at trial (either through closed-circuit television or in the courtroom) or that there is other corroboration if the child is unavailable.^[1]*562 We believed that the availability of the child for questioning would afford the jury the opportunity to assess the child's credibility while safeguarding the defendant's right of confrontation and cross-examination. Id. at 370-71, 537 A.2d 667. Society must tread a measured path that avoids ignoring the reality of child sexual abuse and avoids as well the possibility of unjust conviction of this most shameful of crimes. In Maryland v. Craig, 497 U.S. 836, 110 S.Ct. 3157, 111 L.Ed.2d 666 (1990), four members of the Supreme Court cautioned that courts should be particularly insistent in protecting innocent defendants in child-sexual-abuse cases because of the reliability problems created by children's suggestibility in child-sexual-abuse prosecutions. Id., 497 U.S. at 868, 110 S.Ct. at 3175-76, 111 L.Ed.2d at 693-94 (Scalia, Brennan, Marshall & Stevens, JJ., dissenting).

A.

At the outset, we must carefully distinguish the issues presented in this case from those that are not presented. There are various categories of expert testimony on child sexual abuse. For purposes of this analysis, we draw on the survey of issues by John E.B. Myers et al., Expert Testimony in Child Sexual Abuse Litigation, 68 Neb.L.Rev. 1 (1989) [hereinafter Myers].^[2]

*563 The authors point out that some expert testimony is routinely accepted and presents no genuine evidentiary problem. For example, expert medical testimony plays an important role in child-sexual-abuse litigation. Such testimony is based on a physician's clinical diagnostic examination and the child's medical history. Courts have permitted expert medical witnesses to describe the results of the examination and to offer opinions as to the cause of any injuries, to establish penetration, and to answer questions whether injuries could have been inflicted in a particular way or whether a caretaker's explanation for an injury is reasonable. Myers, supra, 68 Neb.L.Rev. at 48-49.

In the behavioral-science field, the authors identify one type of expert testimony that describes behaviors commonly observed in sexually-abused children. Id. at 51-69. By way of background, the authors describe a wealth of literature that documents general patterns of behavioral and emotional reactions found in clinical samples of sexually-abused children, typically victims of incest. Id. at 52-62. The authors' review of the literature, however, leads them to conclude that the effects of sexual abuse vary among children. Id. at 61. Furthermore, children who exhibit symptoms of fear, anxiety, or avoidance are probably suffering the effects of some traumatic experience, of which sexual abuse is only one of many possible causes. Nevertheless, some behaviors, such as age-inappropriate sexualized responses, are more associated with sexual abuse than others. Ibid. Thus, the authors assert that situations in which sexual abuse is likely can be identified.

Given the prevalence of sexual abuse, and its documented association with anxiety symptoms, however, abuse should be considered and evaluated through direct inquiry. When symptoms of fear, anxiety, or avoidance accompany a credible report of sexual abuse, sexual abuse must be seriously considered.

While no symptom or set of symptoms is conclusive proof of sexual abuse, when symptoms evidencing abuse are present in conjunction with a report that bears indicia of reliability, the clinician is justified in forming a clinical opinion that a child has been sexually abused. [Myers, supra, 68 Neb.L.Rev. at 61-62.]

Despite the considerable basis for this behavioral-science evidence, "most courts do not approve such testimony as substantive *564 evidence of abuse." Myers, supra, 68 Neb.L.Rev. at 65, 68 (citing People v. Bowker, 203 Cal. App.3d 385, 249 Cal. Rptr. 886, 890-92 (1988), Lantrip v. Commonwealth, 713 S.W.2d 816, 817 (Ky. 1986), State v. Black, 537 A.2d 1154, 1156-57 (Me. 1988)). However, this type of testimony has an important nonsubstantive purpose of which the majority of courts approve. It can be used on rebuttal "to rehabilitate" the victim's testimony when the defense asserts that the child's delay in reporting the abuse and recanting of the story indicate that the child is unworthy of belief. Myers, supra, 68 Neb.L.Rev. at 51, 86-92.

Another area of behavioral-science testimony seeks to address the ultimate question of whether a child was in fact sexually abused. Myers, supra, 68 Neb.L.Rev. at 69-86. Such testimony would be based on the clinical observations of a professional "trained in the patterns, effects, and dynamics of child sexual abuse." Id. at 73. The authors say that many experts now believe that the study of child sexual abuse has advanced to such a point as to enable "qualified professionals" to "determine whether a child's symptoms and behavior are consistent with sexual abuse." Id. at 73-75. For example, in 1985 the Council on Scientific Affairs of the American Medical Association published a set of guidelines that listed, in particular, physical and behavioral signs identified with child sexual abuse. Id. at 74 (citing AMA Diagnostic and Treatment Guidelines Concerning Child Abuse and Neglect, 254 J.A.M.A. 796 (1985) [hereinafter Guidelines]). The behavioral signs listed include:

— Overt or subtle and indirect disclosures to a relative, friend or teacher

— Highly sexualized play

— Withdrawal and excessive daydreaming

— Low self esteem, feelings of shame or guilt

— Falling grades

— Pseudomature personality development

— Sexual promiscuity

— Poor peer relationships

— Suicide attempt

*565 — Positive relationship exhibited toward the offender

— Frightened or phobic, especially towards adults [Guidelines, supra, 254 J.A.M.A. at 798.]

Although the Myers article points to only two instances in which courts have approved the actual use of such testimony at a criminal trial for the purpose of establishing that sexual abuse had occurred, Myers, supra, 68 Neb.L.Rev. at 80-85 (citing Glendening v. State, 536 So.2d 212 (Fla. 1988), cert. denied, 492 U.S. 907, 109 S.Ct. 3219, 106 L.Ed.2d 569 (1989), and Townsend v. State, 103 Nev. 113, 734 P.2d 705 (1987)), we do not rule out the possibility that a qualified behavioral-science expert could demonstrate a sufficiently reliable scientific opinion to aid a jury in determining the ultimate issue that the abuse had occurred. This record does not support the conclusion.

The scientific community does not yet exhibit a consensus that the requisite degree of scientific reliability has been shown. Although some argue that "`under no circumstances should a court admit the opinion of an expert about whether a particular child has been abused * * * [,]' [t]he majority of professionals believe qualified mental health professionals can determine whether abuse occurred; not in all cases, but in some." 1 John E.B. Myers, Evidence in Child Abuse and Neglect Cases § 4.31, at 283-84 (2d ed. 1992) [hereinafter Myers, Evidence in Child Abuse and Neglect Cases] (footnote omitted) (quoting Melton & Limber, Psychologists' Involvement in Cases of Child Maltreatment, 44 Am. Psychol. 1225, 1230 (1989)). In evaluating the qualifications of a witness who seeks to offer substantive evidence of sexual abuse, the trial court may wish to consider the criteria suggested in Myers, supra, Evidence in Child Abuse and Neglect Cases § 4.31, at 284-85.

Assessing children for possible sexual abuse is a complex task requiring skill and experience. The expert must possess specialized knowledge of child development, individual and family dynamics, patterns of child sexual abuse, the disclosure process, signs and symptoms of abuse, and the use and limits of psychological tests. The expert is familiar with the literature on child abuse, *566 and understands the significance of developmentally inappropriate sexual knowledge. The expert is able to interpret medical reports and laboratory tests. The expert also is trained in the art of interviewing children, and is aware of the literature on coached and fabricated allegations of abuse. Of tremendous importance is the expert's clinical experience with sexually abused children. [Ibid. (footnotes omitted).]

Obviously, the more limited the purpose for which the evidence is to be used, e.g., were it not for a substantive but for a rehabilitative purpose, the less demanding need be the qualifications of the witness.

Still another category of expert testimony, not presented in this case, concerns inferences to be drawn from a child's interaction with anatomically-detailed dolls during the investigative interview. In many child-sexual-abuse trials, the expert's testimony is wholly or partially based on this methodology. Younts, supra, 41 Duke L.J. at 706. However, the social-science literature questions whether proponents of doll use have yet demonstrated that the dolls are a valid assessment tool for diagnosing abuse. Id. at 708-20. Younts suggests that before the reliability of this methodology can be established, researchers must show at least that children can be accurately categorized as abused or nonabused based on their interaction with the dolls. Id. at 719. Obviously, the use of the anatomical dolls may help a child in reciting the history of the event and that demonstration may be of aid to jurors.

B.

We must examine the scientific premises supporting the expert's testimony and the purpose for which the testimony was used. We note first that testimony on the child sexual abuse accommodation syndrome has been placed within the category of behavioral-science testimony that describes behaviors commonly observed in sexually-abused children. Courts rarely permit the testimony for the purpose of establishing substantive evidence of abuse, but allow it to rehabilitate the victim's testimony. See Myers, supra, 68 Neb.L.Rev. at 51, 66-69, 86-92. Roland C. Summit, M.D., has authored the most *567 concise and seemingly most authoritative statement of CSAAS. Roland C. Summit, The Child Sexual Abuse Accommodation Syndrome, 7 Child Abuse & Neglect 177 (1983) [hereinafter Summit].^[3] Dr. Summit explained in 1983 that although "[c]hild sexual abuse has exploded into public awareness during a span of less than five years," the awakening of interest creates new hazards for the child victim because it increases the likelihood of discovery "but fails to protect the victim against the secondary assaults of an inconsistent intervention system." Id. at 178 (emphasis omitted). Dr. Summit believed that most adults who hear a distraught child accuse a "respectable" adult of sexual abuse will fault the child. Ibid. The "[d]isbelief and rejection by potential adult caretakers," which in Dr. Summit's view were the too-frequent responses to reports of child sexual abuse, "increase the helplessness, hopelessness, isolation and self-blame that make up the most damaging aspects of child sexual victimization."^[4]Ibid.

To remedy the systemic injury to the child that results from disbelief, Dr. Summit undertook a scientific study of child-sexual-abuse victims.^[5] In publishing his results, Dr. Summit *568 hoped "to provide a vehicle for a more sensitive, more therapeutic response to legitimate victims of child sexual abuse and to invite more active, more effective clinical advocacy for the child within the family and within the systems of child protection and criminal justice." Summit, supra, 7 Child Abuse & Neglect at 179-80. In other words, the purpose of his study was to improve the health of the child, ensure that children receive adequate treatment for what they had suffered, and guarantee that society's response be not flawed by misperceptions.

Dr. Summit's study drew upon correlations and observations that "emerged as self-evident within an extended network of child abuse treatment programs and self-help organizations" and he tested the validity of his theory over a four-year period of his own practice. Summit, supra, 7 Child Abuse & Neglect at 180. The child sexual abuse accommodation syndrome, or CSAAS, "represents a common denominator of the most frequently observed victim behaviors." Ibid. CSAAS includes five categories of behavior, each of which contradicts "the most common assumptions of adults." Summit, supra, 7 Child Abuse & Neglect at 181. Of the five categories, he described two as "preconditions" to the occurrence of sexual abuse and the remaining three as "sequential contingencies" to the abuse "which take on increasing variability and complexity." Ibid. Obviously, the "preconditions" continue into and characterize the period of abuse.

The first of the preconditions is secrecy: child abuse happens only when the child is alone with the offending adult, and the experience must never be disclosed. That secrecy is frequently accompanied by threats: "`This is our secret; nobody else will understand.'" "`Don't tell anybody.'" "`Nobody will believe you.'" "`Don't tell your mother; (a) she will hate you, * * * (c) she will kill you,'" and the like. Summit, supra, 7 Child Abuse & Neglect at 181. From the secrecy, the child gets the impression of danger and fearful outcome. Ibid. In this case, Norma and Connie testified that they had not reported the alleged abuse because defendant had told them that if they did, *569 he would hit them and they would get into more trouble than he.

The second precondition is helplessness. Dr. Summit explains that the abused child's sense of helplessness is an outgrowth of the child's subordinate role in an authoritarian relationship in which the adult is entrusted with the child's care, such as the parent-child relationship. Summit, supra, 7 Child Abuse & Neglect at 182. The prevailing reality for the most frequent victim of child sexual abuse is a sense of total dependence on this powerful adult in the face of which the child's normal reaction is to "play possum." Id. at 182-83.

The third aspect of the syndrome, also the first of what Dr. Summit identifies as a sequential contingency, is a combination: the child feels trapped by the situation (entrapment), and that perception results in the behavior of accommodating the abuse (accommodation). Because of the child's helplessness, the only healthy option left is to survive by accepting the situation. "There is no way out, no place to run." Summit, supra, 7 Child Abuse & Neglect at 184. Adults find that hard to believe because they lack the child's perspective, but "[t]he child cannot safely conceptualize that a parent might be ruthless and self-serving; such a conclusion is tantamount to abandonment and annihilation." Ibid. The roles of parent and child become reversed: it is the child who must protect the family. The abuser warns, "`If you ever tell, they could send me to jail and put all you kids in an orphanage.'" Summit, supra, 7 Child Abuse & Neglect at 185.

The fourth aspect, then, is delayed, conflicted and unconvincing disclosure. Id. at 186. Most victims never disclose the sexual abuse — at least not outside the immediate family. Dr. Summit found that family conflict triggers disclosure, if ever, "only after some years of continuing sexual abuse and an eventual breakdown of accommodation mechanisms." Ibid.

Allegations of sexual abuse seem so unbelievable to most that the natural reaction is to assume the claim is false, *570 especially because the victim did not complain years ago when the alleged abuse was ongoing. Ibid. Dr. Summit surmises that

[u]nless specifically trained and sensitized, average adults, including mothers, relatives, teachers, counselors, doctors, psychotherapists, investigators, prosecutors, defense attorneys, judges and jurors, cannot believe that a normal, truthful child would tolerate incest without immediately reporting or that an apparently normal father could be capable of repeated, unchallenged sexual molestation of his own daughter. [Ibid.]

There are very few clues to such abuse. Most women (indeed, even this mother) do not believe it possible that a man whom she loved would ever be capable of molesting his or her own children. Summit, supra, 7 Child Abuse & Neglect at 187.

The fifth and final aspect is retraction. Although this case does not involve retraction, that "[w]hatever a child says about sexual abuse, she is likely to reverse it" appears to be a fact. Summit, supra, 7 Child Abuse & Neglect at 188 (emphasis omitted). The post-disclosure family situation tends to confirm the victim's worst fears, which encouraged her secrecy in the first place, i.e., her mother is disbelieving or hysterical, her father threatened with removal from the home, and the blame for this state of affairs placed squarely on the victim. Ibid. Once again, because of the reversed roles, the child feels obligated to preserve the family, even at the expense of his or her own well being. The only "good" choice, then, is to "capitulate" and restore a lie for the family's sake. Ibid.

Dr. Summit analogizes the gradual acceptance of the reality of child sexual abuse to society's changing attitude towards adult rape with the emergence of the rape trauma syndrome theory (RTS). Summit, supra, 7 Child Abuse & Neglect at 189 (citing Ann W. Burgess & Linda L. Holmstrom, Rape Trauma Syndrome, 131 Am.J. of Psychiatry 981 (1974) [hereinafter Burgess & Holstrom]). Women were assumed to cause rape, in the absence of a consistent clinical understanding of the "psychological climate," and reactions to such sexual attacks. Summit, supra, 7 Child Abuse & Neglect at 189. Thus, "Those who reported often regretted their decision as they found *571 themselves subjected to repeated attacks on their character and credibility." Ibid. The gradual departure from the mythology of women and rape so recently outlined by our Court in In re M.T.S., 129 N.J. 422, 432-33, 443-45, 609 A.2d 1266 (1992) (dispelling myth that victim's silence in response to sexual assault equals consent), and State v. Hill, 121 N.J. 150, 157-66, 578 A.2d 370 (1990) (dispelling myth that victim's failure immediately to report an alleged sexual assault tends to show that she was not assaulted at all), has slowly been extended to child-abuse victims.

Hence, the behavioral studies of CSAAS are designed not to provide certain evidence of guilt or innocence but rather to insure that all agencies, including the clinician, the offender, the family, and the criminal justice system, offer "the child a right to parity with adults in the struggle for credibility and advocacy." Summit, supra, 7 Child Abuse & Neglect at 191. CSAAS achieves that by providing a "common language" for analysis and a more "recognizable map" to the understanding of child abuse. Ibid.

III

Standards Governing the Admission of Expert Opinion Evidence of CSAAS in Criminal Trials

We need not retrace the development of these standards in any extensive detail. In a long series of cases, we have outlined the general standards that govern the admissibility of such evidence. See State v. Spann, 130 N.J. 484, 617 A.2d 247 (1992); State v. Zola, 112 N.J. 384, 548 A.2d 1022 (1988), cert. denied, 489 U.S. 1022, 109 S.Ct. 1146, 103 L.Ed.2d 205 (1989); State v. R.W., supra, 104 N.J. 14, 514 A.2d 1287; State v. Kelly, 97 N.J. 178, 478 A.2d 364 (1984); State v. Cavallo, 88 N.J. 508, 443 A.2d 1020 (1982). A summary may be found in State v. R.W., supra, describing the accepted grounds for admitting expert testimony:

*572 As provided in the Rules of Evidence, Evid.R. 56, and reiterated by many cases, the testimony of an expert is allowed when it relates to a subject-matter beyond the understanding of persons of ordinary experience, intelligence, and knowledge. E.g., State v. Kelly, supra, 97 N.J. 178 [478 A.2d 364] Evers v. Dollinger, 95 N.J. 399 [471 A.2d 405] (1984). This applies as well to the field of child sex-abuse offenses. As we have seen, such testimony may be allowed to explain generally the behavior, feelings, and attitudes of such victims when it is shown that their condition is not readily understood by persons of average intelligence and ordinary experience; an expert or scientific explanation of their condition, one accepted as reliable by the scientific community that is involved in the diagnosis, treatment, and care of such individuals, can assist a jury in understanding the evidence. [104 N.J. at 30-31, 514 A.2d 1287.]

Acceptance within a scientific community can sometimes be an elusive premise to prove. There will always be some detractors to any theory or clinical approach. State v. Kelly, supra, 97 N.J. 178, 208-14, 478 A.2d 364, illustrates the kind of inquiry that must be made concerning the definition of the scientific community, the degree of acceptance within that community, and the method of proof of that acceptance.^[6]See also Rubanick v. Witco Chemical Corp., 125 N.J. 421, 593 A.2d 733 (1991) (discussing special difficulties encountered in certain forms of scientific analysis). Some courts have admitted expert testimony that a child has been sexually abused without any reference to scientific reliability. In re Cheryl H., 153 Cal. App.3d 1098, 200 Cal. Rptr. 789 (Ct.App. 1984). However, even a qualified expert's opinion must have a reliable basis. Landrigan v. Celotex Corp., 127 N.J. 404, 417, 420, 605 A.2d 1079 (1992) (stating that whether an expert may testify to cancer causation depends on degree of acceptance within relevant scientific community of the methodology of analysis). Certainly, we *573 should be even more hesitant to depart from the general-acceptance requirement in a criminal case. State v. Spann, supra, 130 N.J. at 510, 617 A.2d at 259-260.

Finally, we have consistently recognized that juries have exclusive responsibility in the determination of criminal guilt or innocence. State v. Simon, 79 N.J. 191, 398 A.2d 861 (1979). Hence, in State v. Odom, 116 N.J. 65, 560 A.2d 1198 (1989), we permitted a State's expert witness to testify that, in his opinion, based on his experience and specialized knowledge, the quantity of drugs was there possessed with the intent to distribute them. We therefore concluded that "as long as the expert does not express his opinion of defendant's guilt but simply characterizes defendant's conduct based on the facts in evidence in light of his specialized knowledge, the opinion is not objectionable." Id. at 79, 560 A.2d 1198. We realize that the line drawn in Odom may be thin at times but believe that properly charged juries can see the distinction.

There does not appear to be a dispute about acceptance within the scientific community of the clinical theory that CSAAS identifies or describes behavioral traits commonly found in child-abuse victims. See, e.g., Myers, supra, 68 Neb. L.Rev. at 66-69; Holmes, supra, 25 Tulsa L.J. at 158-59. The most pointed criticism of the theory is that the same traits may equally appear as the result of oth