Age Estimation in the Living: The Practitioner's Guide

Foreword xiii

Preface xv

Glossary of Abbreviations xvii

1 An Introduction to the History of Age Estimation in the Living 1
Andreas Schmeling and Sue Black

1.1 Introduction 1

1.2 Dental Development 3

1.3 Skeletal Maturation 5

1.4 Secondary Sexual Development 8

1.5 Conclusion 10

References 12

2 Immigration, Asylum Seekers and Undocumented Identity 19
Heather Law, Lorraine Mensah, Sue Bailey and Julia Nelki

2.1 Asylum Seeker to Refugee 26

References 28

3 Clinical and Legal Requirements for Age Determination in the Living 30
Philip Beh and Jason Payne-James

3.1 Introduction 30

3.2 Contrasts between Age Assessment in the Living and the Deceased 31

3.3 Reasons for Age Estimation of Bodies and Human Remains 32

3.4 Reasons for Age Estimation of Living Individuals 32

3.5 Assessment Techniques 37

3.6 How Age May Be Specifically Documented 37

3.7 Birth Certificates 38

3.8 Identity Cards 38

3.9 Driving Licence 38

3.10 Passports 39

3.11 Age Verification Cards 40

3.12 Other Documents 40

3.13 Medical Issues 40

3.13.1 Duties to Examinee 40

3.14 Communication 41

3.15 Summary and Conclusions 41

References 42

4 Legal Implications of Age Determination: Consent and Other Issues 43
George Fernie and Jason Payne-James

4.1 Introduction 43

4.2 Principles of Practice 44

4.3 Duties of the Examining Practitioner 47

4.4 Criminal Issues in Age Determination in the Living 48

4.5 Practical Implications 51

4.6 Summary 53

References 54

5 The Challenges of Psychological Assessments of Maturity 55
Julia Nelki, Pete Grady, Sue Bailey and Heather Law

5.1 Introduction 55

5.1.1 Current Status in the UK 57

5.2 Need for Determination of Maturity 58

5.3 Psychological Maturity as a Concept 59

5.3.1 Child Development 60

5.3.2 Middle Childhood 61

5.3.3 Adolescence 62

5.3.4 Ethical Framework 63

5.4 Current Practice 65

5.5 Suggestions for a Framework for Good Practice 67

5.5.1 Setting 68

5.6 Summary and Conclusion 69

Appendix 5.A Proposed Framework, Based on Common Assessment Framework (Department of Schools Families and Children, 2007) 69

References 74

6 Principles of Physical Age Estimation 77
Sue Black and George Maat

6.1 Intra-uterine Growth and Development 79

6.2 Birth and Infancy 82

6.3 Childhood 83

6.4 Juvenile 85

6.5 Adolescence 85

6.6 Adult 86

6.7 Senescence 87

6.8 Summary 88

6.9 Growth Studies 89

References 91

7 Growth, Maturation and Age 95
Noël Cameron and Laura L. Jones

7.1 Growth, Maturation and Age 95

7.1.1 The Concept of Time 95

7.1.2 Maturity Indicators 98

7.1.3 Maturational Variation 99

7.1.4 Uneven Maturation 99

7.1.5 Sexual Dimorphism 100

7.1.6 Maturity and Size 100

7.2 Assessment of Maturation 101

7.2.1 Skeletal Maturity 101

7.2.2 Dental Maturity 101

7.2.3 Secondary Sexual Development 102

7.2.4 Independence of Methods 102

7.3 Secular Trends 102

7.4 Worldwide Variation in the Timing of Maturation 104

7.4.1 Secondary Sexual Development 104

7.4.2 Dental Development 109

7.4.3 Skeletal Development 109

7.5 Factors Associated with the Timing of Maturation 112

7.5.1 Genetic Variability 112

7.5.2 Demographic Factors 113

7.5.3 Biological Factors 114

7.5.4 Environmental Factors 116

7.6 Summary 120

References 120

8 Practical Imaging Techniques for Age Evaluation 130
Andreas Schmeling, Sven Schmidt, Ronald Schulz, Andreas Olze, Walter Reisinger and Volker Vieth

8.1 Introduction 130

8.2 Radiation Exposure in X-ray Examinations for the Purpose of Age Estimation 131

8.3 Radiological Examination of the Hand 133

8.4 Radiological Examination of the Teeth 138

8.5 Radiological Examination of the Clavicles 142

8.6 Summary and Conclusions 144

References 145

9 External Soft Tissue Indicators of Age from Birth to Adulthood 150
Anil Aggrawal, Puneet Setia, Avneesh Gupta, and Anthony Busuttil

9.1 Growth Patterns 151

9.2 Anthropometric Parameters in Children 151

9.2.1 Growth Charts 152

9.2.2 Developmental Milestones 159

9.2.2.1 Head Control 159

9.2.2.2 Rolling 159

9.2.2.3 Sitting 160

9.2.2.4 Gross Motor 160

9.2.2.5 Fine Motor 161

9.2.2.6 Social and cognitive 161

9.2.2.7 Speech and language 162

9.3 Pubertal Changes 162

9.3.1 Stages of Pubic Hair Development Derived from Tanner (1962) 163

9.3.1.1 Pubic Hair Development in Males 164

9.3.1.2 Pubic Hair Development in Females 164

9.3.2 Stages of Axillary Hair Development Derived from Tanner (1962) 164

9.3.3 Stages of Development of Male Genitalia Derived from Tanner (1962) 166

9.3.3.1 Testicular Volume 166

9.3.3.2 Age of First Erection and Ejaculation 167

9.3.4 Stages of breast development as derived from Tanner (1962) 168

9.3.5 Age of Menarche 168

9.4 Areas of New Research 170

9.5 Conclusion 170

References 171

10 Age Evaluation and Odontology in the Living 176
Jane Taylor and Matthew Blenkin

10.1 Introduction 176

10.2 Overview of the Development of the Dentition 177

10.3 Techniques of Dental Age Estimation 179

10.4 The Sub-adult Dentition 180

10.4.1 Sub-adult: Physical/Anatomical 180

10.4.1.1 Tooth Counts 180

10.4.2 Sub-adult: Radiographic 182

10.4.2.1 Atlas Style Techniques 182

10.4.2.2 Techniques Employing Measurement 184

10.4.3 Sub-adult: Destructive 187

10.4.3.1 Histological Techniques 187

10.4.3.2 Aspartic Acid Racemization 187

10.5 The Adult Dentition 187

10.5.1 Adult: Physical 188

10.5.1.1 Tooth Wear 188

10.5.2 Adult: Radiographic 188

10.5.2.1 Third Molars 189

10.5.2.2 Secondary Dentine Apposition 190

10.5.3 Adult: Destructive 191

10.5.3.1 The Gustafson Method 191

10.5.3.2 Root Transparency 191

10.5.3.3 Amino Acid Racemization and Histological Techniques 191

10.6 Summary 191

References 193

11 Age Evaluation from the Skeleton 202
S. Lucina Hackman, Alanah Buck and S. Black

11.1 Background 202

11.2 Fetal Age 204

11.3 Birth 208

11.4 Juvenile/Child 210

11.5 Age Estimation from the Skeleton in Living Adults 221

11.6 Medial Clavicle 222

11.7 Sternal Ribs and Costal Cartilages 223

11.8 Pelvis 224

11.9 Skull Sutural Closure 224

11.10 Laryngeal Cartilages 225

11.11 Other General Ageing Features 226

11.12 Summary 226

References 226

12 Age Evaluation after Growth Cessation 236
Anil Aggrawal, Puneet Setia, Avneesh Gupta and Anthony Busuttil

12.1 Background 236

12.2 Consent 237

12.3 Radiology 237

12.3.1 Pubic Bones 239

12.3.2 Long Bones 242

12.3.3 Skull Sutures 243

12.3.4 Costal Cartilages 246

12.3.4.1 Sternum 246

12.3.5 Vertebrae 247

12.3.6 Laryngeal Cartilages 250

12.4 Odontology 250

12.5 Soft Tissues of Face 251

12.6 Genetics in Age Estimation 252

12.7 Physiological and Biochemical Parameters for Age Estimation 253

12.8 Areas of Future Research 254

12.8.1 Small Long Bones 254

12.8.2 Scapula 254

12.8.3 Others 254

12.8.4 Histology 256

12.9 Conclusion 257

References 257

13 The Presentation of Results and Statistics for Legal Purposes 267
David Lucy

13.1 Introduction 267

13.2 Evidence and Intelligence 269

13.3 Statistical Methods in Age Estimation 270

13.4 Classical, or Frequentist, Approaches 271

13.5 Bayesian Approaches 271

13.6 The Relevance to Age Estimation 272

13.7 Likelihood Ratio Approaches 274

13.8 Errors of Interpretation 279

13.9 Concluding Comments 280

Appendix 13.A Age-Related Data from Gustafson (1950) 281

References 282

14 Key Practical Elements for Age Estimation in the Living 284
Sue Black, Jason Payne-James and Anil Aggrawal

14.1 The Four Pillars of Age Estimation 286

14.1.1 Pillar 1: Social and Psychological Evaluation 286

14.1.2 Pillar 2: External Estimation of Age 286

14.1.3 Pillar 3: Skeletal Estimation of Age 288

14.1.4 Pillar 4: Dental Estimation of Age 289

14.2 Conclusion 290

Index 291