Shaken baby syndrome/abusive head trauma struggles to find a solid scientific foundation, largely because of a circularity confound, the same diagnostic features under study serve as the basis for categorising cases for research purposes. In an attempt to overcome this circularity, researchers have turned to confessions as a sorting criterion in the research, under the belief that confessions are independent of the diagnostic features and hence not subject to circularity. However, none of the research examines the nature and reliability of the confessions, or the interrogations that produce them; they simply accept the confessions as true, reliable, and independent. Research on interrogations and false confessions, however, along with extensive and wholly consistent anecdotal evidence, strongly suggest that SBS/AHT confessions are largely if not entirely produced by interrogator reliance on the diagnostic findings. That reliance undermines both the independence of the confessions, and hence their ability to break free from circularity, and the reliability of these confessions as a group. On the current state of knowledge, confessions cannot be relied upon to substitute for science to support the SBS/AHT hypothesis.

Doctors and prosecutors who defend the diagnosis of shaken baby syndrome (SBS) point, among other things, to the many confessions obtained from parents and other caregivers as evidence of the reality of the diagnosis. Drawing on the existing social science research, this chapter examines the questions of (1) how, if at all, interrogations of those suspected of injuring or killing a child are conducted differently than other interrogations, and (2) what, if anything, would render such suspects more or less vulnerable to confession (true or false). The chapter examines how interrogations are typically conducted, and the primary reasons suspects confess, keeping in mind that their confessions can be either true or false. In the end, this chapter concludes that suspects in alleged shaken baby cases are arguably more vulnerable to false confession than those suspected of other crimes, and accordingly one cannot assume the reliability or truthfulness of confessions in these cases.

This chapter discusses the common types of adaptive trial designs and their motivations and challenges. The common types covered in this chapter include: sequential designs, sample size re-assessment, adaptive randomisation, minimisation, response adaptive randomisation, enrichment design, and seamless design. Sequential designs that use interim analyses to allow for early stopping are the most common type of adaptive trial design. Sequential designs are often used with other types of adaptive trial designs. Other common types of adaptive trial designs include sample size re-assessment that uses blinded or unblinded data for re-estimation of sample size during the trial; response adaptive randomisation that preferentially increases allocation ratio in favour of treatment arm based on interim trial data; adaptive enrichment design that allows for modification of patient eligibility criteria; and seamless design that combines two phases of clinical trial research into one trial. Adaptive trial designs offer more flexibility in comparison to conventional fixed trial designs, but this comes with complexities that usually require more thorough and thoughtful planning in the design stage. Trade-offs for different design options should be carefully considered.