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Inaccuracy of age assessment from images of

postpubescent subjects in cases of alleged child
pornography

ARTICLE in DEUTSCHE ZEITSCHRIFT FÜR DIE GESAMTE GERICHTLICHE MEDIZIN · SEPTEMBER 2012
Impact Factor: 2.71 · DOI: 10.1007/s00414-012-0765-8 · Source: PubMed

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Int J Legal Med
DOI 10.1007/s00414-012-0765-8

ORIGINAL ARTICLE

Inaccuracy of age assessment from images of postpubescent

subjects in cases of alleged child pornography
Arlan L Rosenbloom

Received: 1 April 2012 / Accepted: 16 August 2012

# Springer-Verlag 2012

Abstract Despite frequent medical expert testimony au- Keywords Child pornography . Tanner stage . Medical
thoritatively stating that images of individuals who are expert testimony . Sexual maturation . Forensic anthropology
postpubescent indicate age less than 18 and therefore,
child pornography, developmental experts have noted
that a scientific basis for such estimation is lacking. In
Background
fact, recent studies have demonstrated a high degree of
inaccuracy in such estimates, and that the stage of
In 1996, the author agreed to review evidence in a case of
breast development often used as indicative of age un-
alleged child pornography [1] because the reports of two
der 18 years is present in a substantial percentage of
government expert physicians appeared unsupportable. The
adult women. Ten images of adult women from legiti-
reports included such statements as, “Three of those females
mate pornographic sites promoting youthful images
had Tanner stage 4 sexual characteristics, which again is
were shown to 16 pediatric endocrinologists expert in
consistent with a young girl of 13 to 15 years of age … 1
evaluating maturation, who determined whether or not
young Asian girl appeared to be late Tanner stage 4 and
the individuals represented were under 18 years of age.
within reasonable medical probability, she is 15 or 16 years
They also provided information about what features
of age.” Slender Asian women may have relatively small
were most important in their evaluations. Sixty-nine
breasts which appear more immature than they are, Tanner
percent of the 160 estimates were that the images rep-
stage 4 breast development is entirely consistent with full
resented females under 18 years of age. There was wide
maturity [2, 3], and once full maturation is reached, it is not
variability in the designation of importance of the var-
possible to say that an individual is under 18 years of age.
ious features of maturation in reaching conclusions, with
Indeed, when the video materials were reviewed, they were
breast development and facial appearance considered
found to be of poor quality, with participants who could not
most important. This study confirms that medical testi-
be identified as younger than 18 years of age.
mony, even by experts in adolescent development, can
Subsequently, the late Professor James Tanner in England
deem images of adult women selected for their youthful
was contacted by an attorney for two educators in the USA
appearance to be under age 18 two thirds of the time.
who, as in the above case, had been arrested in a federal
Thus, important as prosecuting users of child porno-
sting operation (where the government was in the pornog-
graphic material may be, justice requires the avoidance
raphy business for the purpose of entrapping potential sus-
of testimony that is not scientifically based,
pects) for having, despite documented protestations that
they were not interested in underage material, pictures of
underage males, as determined by a government medical
A. L. Rosenbloom (*) expert using Tanner staging [4]. Tanner suggested that the
Division of Endocrinology, Department of Pediatrics, University accused contact the author, as an expert closer to home. In
of Florida College of Medicine, Children’s Medical Services his correspondence (July 21, 1997), Tanner noted that, “…
Center,
the Tanner scales were not designed to be used for estimat-
1701 SW 16th Ave,
Gainesville, FL 32608, USA ing chronological age, forensically or otherwise.” He also
e-mail: rosenal@peds.ufl.edu noted that the government expert’s report stating, “Tanner

stage IV late, giving them a chronological age of 16–17”,
showed both inconsistency with the earlier detailed descrip-
tion by the expert of what could be considered full maturation
and a lack of knowledge of how to use the scales, and he
deplored such forensic use of the Tanner scale which would
“periodically lead to miscarriages of justice”. In later corre-
spondence, Tanner referred to use of the staging for estimating
probable chronologic age as “wholly illegitimate,” and that no
equations existed to estimate age from stage and even if they
did the degree of unreliability in the staging, the independent
variable, would introduce large errors into the estimation-the
dependent variable. He noted further that the unreliability of
the stage rating would be increased to an unknown degree by
improperly performed staging through nonstandardized
images, rather than clinical examination. He described Tanner
staging as designed for estimating development or physiologic
age for medical, educational, and sports purposes where chro-
nologic age is known [5].
In the case of United States of America versus Arnold
Katz in the Western District of Louisiana, the court held a
Daubert hearing to determine if the use of Tanner staging
was a scientifically based means of determining if a model
in a video tape was under the age of 18 years. The court
found that it was and allowed for the admission of the expert
testimony using the Tanner scale. Subsequently, the pub-
lished letter co-authored by Doctor Tanner, based on the
experience noted above called into question the previous
Daubert ruling on the credibility and admissibility of expert
testimony based on the Tanner scale [5]. Therefore, the USA
attorney petitioned the court, in November 1999, stating: “In
this particular case, based upon the recent published report
by Dr Tanner, the government cannot prove beyond a rea-
sonable doubt the age of the female, an essential element of
the crime charged. As a result, the interest of justice
demands that the United States dismiss the Indictment
against the defendant.” The court complied.
Despite this precedent, a judicial expert noted in 2005
that, “Many prosecutors have used medical experts familiar
with Tanner staging to testify in their child pornography
cases” [6]. She went on to note, regarding the Katz case
that “Ultimately, the trial court allowed the government’s
experts to testify using the Tanner scale in the Katz case”.
As noted above, this misrepresents what actually transpired
“ultimately”. Recognizing the problem presented by Tan-
ner’s opposition to the forensic use of Tanner staging, a
frequent expert for government prosecutors advises, after
providing a detailed description of Tanner staging including
full-page illustrations, “the medical expert should avoid the
use of Tanner stage language in reports and testimony,
except to explain the role of this well-known and accepted
method of determining the sequence of sexual maturation”
[7]. It is unclear how an expert could coherently follow this
internally contradictory advice.
Int J Legal Med
Only one study is available which objectively assessed
experts’ ability to determine whether images depict individ-
uals younger than 18 years. The research material consisted
of 11 images of 11 adult females who were professional
participants in authorized pornographic websites. The
images were studied by 5 forensic pathologists, 5 pediatri-
cians, 5 gynecologists, and 13 laypersons in Italy and a
comparable number in Germany who were asked to deter-
mine whether the images represented individuals over or
under 18 years of age. The rate of underestimation of age
ranged from half of the images by Italian forensic patholo-
gists to 95 % for German pediatricians [8]. The authors
concluded that they had shown, “the inadequacy of the use
of visual and other morphological parameters as criteria for
aging suspect juvenile pornographic material in the postpu-
bertal stage and the enormous risks judges and ‘experts’
may take in applying them—a phenomenon which is occur-
ring in many courts of law across Europe.” They concluded
that, “forensic and medical experts should avoid such un-
scientific behavior which may have drastic consequences in
a court of law,” echoing Tanner’s warning from a decade
earlier.
Material and methods
Ten erotic images of adult females from legitimate porno-
graphic internet sites that declare models ages and follow
the Title 18>Part One>Chapter 110>§ 2257 of the US code
requiring producers of sexually explicit material to obtain
proof of age for every model they shoot were supplied by
Professor Cattaneo (images and verification data available
upon request). The images were not those used in the
published study by Cattaneo et al. [8], which were no longer
available. They were, however, similar images used for
courses given to forensic pathology and anthropology stu-
dents to demonstrate the difficulties of age determination
from images. The images were chosen from sites promoting
young-looking females.
The images were individually projected to a conference
of 16 pediatric endocrinologists in March 2012. The eval-
uators were told that the images were from litigation evi-
dence and that they were to consider themselves experts
testifying whether the individuals depicted were over or
under 18 years of age. Because these images all permitted
evaluation of breasts, facies, body contours, and pubic area,
they were all considered appropriate for decision making;
the author’s experience is that the only images for which
experts will not provide an opinion are those that might not
have some or most of these features. In the report of Catta-
neo et al. [8], only 5 % of Italian and none of German
pediatricians’ and gynecologists’ responses were “not eval-
uated”. Thus, inability to interpret was not offered as an
Int J Legal Med
option to the evaluators. Interpretations were recorded on a
tabular form which included demographic information of
type of practice, gender, and years out of medical school.
Also requested was an indication of the importance in their
determinations of each of the features of facial maturation,
breast development, body contours, and pubic hair/genital
maturation on a scale of 1, very important to 4, not
important.
Results
Thirteen of the 16 evaluators were females. Three were in
private practice and all the rest were either academicians or
trainees; experience as a physician ranged from 5 to
34 years. Sixty-nine percent of the 160 estimates were that
the images represented females <18 years of age. One
individual found three of the ten images to be of
females <18 years, but all others found at least six of
the images to be of females <18 years of age. This
included 4 examiners rating six images as underage, 2
examiners thus rating seven images, 3 examiners con-
sidering eight images underage, and 5 examiners thusly
interpreting all but one image. There were no images
interpreted by all examiners to be either under or over
18 years of age. One image was interpreted by 2 eval-
uators as of an individual <18 years and another image
thusly interpreted by 5 evaluators; the remaining eight images
were interpreted as representing subjects <18 years by 13–15
evaluators. The nine evaluators with 10 years or less experi-
ence were compared to those with greater than 10 years ex-
perience; there was no difference in percentage of images
interpreted as representing subjects <18 years of age.
There was wide variability in the designation of impor-
tance of the various features of maturation in reaching con-
clusions, despite the subspecialty uniformity of the
evaluators (Table 1). Breast development was rated 1 or 2
by 81 %, facial maturation, body contours, and genitalia/
pubic hair thusly rated by 69, 56, and 50 %, respectively.
Table 1 Features considered important in the age estimation from
erotic images of females by 16 pediatric endocrinologists
Feature 1 2 3 4
Breast development 7 (44) 6 (37.5) 2 (12.5) 1 (6)
Facial maturation 9 (56) 2 (12.5) 0 5 (31)
Body contours 2 (12.5) 6 (37.5) 4 (25) 4 (25)
Pubic hair/genital 6 (37.5) 3 (19) 4 (25) 3 (19)
Each feature was rated from 1 (very important) to 4 (not important).
Numbers given indicate numbers of evaluators assigning this value
with percentages in parentheses
Discussion
This study supports the observations of Cattaneo et al. [8] in
what might be considered a more expert group of profes-
sionals, pediatric endocrinologists who are routinely in-
volved in evaluating growth and maturation in individuals
of known age. That such experts could deem more than two
thirds of images of females over 18 years of age to be
indicative of individuals younger than 18 years emphasizes
the magnitude of unreliability of expert opinion in such
cases. Determining that an individual is prepubertal is usu-
ally possible from the available images. After puberty is
underway, however, “science has very few solutions, re-
gardless of the fact that some experts still recklessly pro-
nounce ages” [8].
There are no studies indicating that it is possible to
reliably determine age from degree of maturation, even
using the Tanner scale when pubic hair, breast stage or, in
males, genital maturation, are accurately assessed by expert
physical examination [5, 9]. There are no studies because of
the wide variation in the age of pubertal onset of approxi-
mately 6 years, and of progression, such that the duration
from the start to completion of maturation can vary from 3
to 7 years [2]. Once such maturity is attained, of course, it
remains impossible to accurately estimate the age of the
mature individual on the basis of their development, just
as it was not possible during the various stages of
maturation.
Tanner stage 4 breast development is often considered by
experts in child pornography cases to indicate age less than
18 years. A recent study has addressed the difficulty of
distinguishing Tanner 4 from Tanner 5 breast development
in women who were not selected for their youthful appear-
ance and were known to be over 18 years of age. The study
concluded that individual experts might consider an adult
female to be under age 18 on the basis of persistence of
stage 4 breast development for one fourth of images of such
unquestionably adult women [3].
Expert testimony often includes remarkable underestima-
tion of developmental level, as noted in the examples above,
and even when there is no tendency to opine other than
objectively, as in the study of Cattaneo et al. [8] and in the
present study, underestimation is typical.
The problem of misuse of Tanner staging and other
maturational features that are not included in the Tanner
criteria for age estimation and judgments that cannot be
justified by the evidence from images has been pervasive.
In one case, the State of Maryland was in possession of
certified documents identifying that the eight models in 34
photos purporting to be child pornography were adults at the
time of production, while the state’s expert insisted they were
minors no older than 13 years of age, including the 27-year-
old who was sitting in the courtroom [10]. In another case, a

man returning from South America through Puerto Rico was
arrested at the airport for possessing a video portrayal of child
pornography that in fact involved a 23-year-old actress, data
which could have been confirmed online, but government
medical expert insistence required that the actress come to
Puerto Rico to exonerate the accused [11].
As in the study of Cattaneo et al. [8], expert testimony
has included consideration of a number of developmental
features beyond those that go into Tanner staging which, as
the European investigators have shown, combine to achieve
erroneous results. Following are examples from medical
expert testimony;
& “This depicted a female who was Tanner stage 4 based
on review of the genitals mostly and was estimated the
girl to be approximately 15 years old. Of note, in this
case in particular with little pubic hair development, the
child could be in the range for Tanner stage 4–5, which
could place her anywhere from 10–15 years old.” [12]
There are no Tanner stages for female genital devel-
opment. Indeed, the individual had fully mature genita-
lia, body proportions, and facies. The absence of most or
all female pubic hair in artistic, erotic, and pornographic
materials is consistent with contemporary style and of no
use for maturational staging.
& “… her sexual maturity rating was at Tanner stage 4
based upon her breasts. I gave her an age estimate of
12.9 years plus or minus approximately a year, which
would have been 1 standard deviation and if you use 2
standard deviations it would put her out to 15.3 years.”
[13]
Tanner stage 4 breast development is consistent with
full maturation, in which case it is not possible to say
that an individual is <18 years of age. [3]
& “There is neither visible axillary hair nor even hyperpig-
mentation of the axilla noted… absence of axillary hair
[is] consistent with a youth who has not reached her full
pubertal development.” [14]
The individual had fully mature breast development.
Obviously, few girls who have developed axillary hair
have left it unshaven. The notion of hyperpigmentation
of the axilla being a maturational feature is egregious
fabrication
& “See the male better in this picture and again Tanner
stage 3–4, closer to the Tanner stage 3 range.” [12]
This image provides a good view of the male genita-
lia which are fully mature, with pubic hair extending up
the abdomen. There is absolutely no way this could be
interpreted as less than full maturation.
The report of Cattaneo et al. [8], the study of persistent
Tanner 4 breast development in adults [3], and the present
study should contribute to the judicial skepticism about
medical expert opinion regarding age of postpubescent
Int J Legal Med
subjects in images that was initially raised in 1998 [3].
Indeed, on the basis of available information [3, 5, 8, 9],
medical expert opinion that images of five females indicated
age <18 years based on, “Tanner rating, in addition to the
body habitus, body hair patterns, musculature, dentition,
head to body ratio, overall size, maturity of facial fea-
tures,…” was recently rejected by the court and the
plaintiff acquitted [15].
Conclusions
Purveying images of children in sexually provocative or
pornographic images is unquestionably a deviant practice
that requires all available legal intervention. However, when
the suspected illegal material involves images of postpubes-
cent individuals, medical expert testimony has often been
provided that subjects of the images are underage without a
scientific basis. Recent studies have confirmed that breast
development criteria have been misused in this regard [3]
and that expert physicians not employed by either prosecu-
tors or defense attorneys consistently underestimate the age
of adult women from typical pornographic images used in
litigation [8]. The present study confirms that experts in
adolescent development can deem images of adult women
appearing in pornographic sites promoting the youthful
appearance of the actresses/models to be under age 18 two
thirds of the time. Thus, important as prosecuting users of
child pornographic material may be, justice requires the
avoidance of testimony that is not scientifically based.
Acknowledgment I thank Professor Cristina Cattaneo of the Labo-
ratorio di Antropologia e Odontologia Forense, Istituto di Medicina
Legale, Universita degli Studi di Milano, for supplying the images
used in this study and their validation data.
References
1. United States of America v. Robert W Parker; In the US District Court
for the Southern District of Texas-Houston division; Cr. No. N-96-72
2. Brook CGD, Stanhope R (1989) Normal puberty: physical char-
acteristics. In: Brook CGD (ed) Clinical paediatric endocrinology,
2nd edn. Blackwell Scientific, Oxford, pp 169–188
3. Rosenbloom AL, Rohrs HJ, Haller MJ, Malasanos TH (2012)
Tanner stage 4 breast development in adults: forensic implications.
Pediatrics. doi:10.1542/peds.2011-3122
4. United States of America v. Lonnie A Young & Stephen
Carruthers. In the US District Court for the Middle District
of Georgia-Macon
5. Rosenbloom AL, Tanner JM (1998) Misuse of the Tanner puberty
stages to estimate chronologic age. Pediatrics 102:1494
6. Kreston SS (2005) Prosecutorial issues in the child pornography
arena. In: Cooper SW, Estes RJ, Giardino AP, Kellogg NB, Vieth VI
(eds) Medical, legal, & social science aspects of child sexual exploi-
tation, vol 2. GW Medical Publishing Inc, St. Louis, pp 662–663
Int J Legal Med
7. Cooper SW (2005) The medical expert and child sexual
exploitation. In: Cooper SW, Estes RJ, Giardino AP, Kellogg
NB, Vieth VI (eds) Medical, legal, & social science aspects of
child sexual exploitation, vol 2. GW Medical Publishing Inc,
St. Louis, p 830
8. Cattaneo C, Ritz-Timme S, Gabriel P, Gibelli D, Giudici E, Poppa
P, Nohrden D, Assmann S, Schmitt R, Grandi M (2009) The
difficult issue of age assessment on pedo-pornographic material.
Forensic Sci Int 183:e21–e24
9. Rosenbloom AL (1999) Tanner staging and pornography. Pediat-
rics 104:996–997
10. http://amjur.wordpress.com/2007/09/29/alleged-child-porn-victims-
identified%E2%80%94as-adults-prosecutor-ignores-evidence-
insists-they-are-pre-teens-and-proceeds-with-prosecution/. Accessed
August 21, 2011
11. http://www.crimeandfederalism.com/2010/04/porn-actress-saves-
wrongfully-accused-.html. Accessed March 30, 2012
12. United States vs Ted H Grauer. Report of January 21, 2011
13. State of Iowa vs Arthur Pixler. Deposition of October 29, 2001
14. State of Illinois vs Robert Kelly. Report of June 24, 2005
15. Court-martial of SSgt Swearingen, San Diego California, February
2012