Child on Child Sexual Abuse: A Research Literature Summary

Child on Child Sexual Abuse: A Research Literature Summary Gregory A. Hand, Project Manager Justice Research Center August 25, 2009 Primary Sources: • Righthand, S. & Welch, C. (2001). Juveniles Who Have Sexually Offended.Washington, DC: Office of Juvenile Justice and Delinquency Prevention (OJJDP). • Saunders, B.E., Berliner, L., & Hanson, R.F. (Eds.). (2004). Child Physical and Sexual Abuse: Guidelines for Treatment (Revised Report: April 26, 2004). Charleston, SC: National Crime Victims Research and Treatment Center.

Statistics • It is estimated that at least two out of every ten girls and one out of every ten boys are sexually abused by the end of their 13th year. • 50% of all adult sex offenders began their sexually abusive behavior as a juvenile. • In Florida, 12% of all juvenile sex offenders were 12 years or younger, the largest percentage (39%) were 16 or 17.

Characteristics of Juveniles Who Have Committed Sex Offenses • Children who committed sex offenses vary in characteristics • They differ according to types of offending behaviors, histories of child maltreatment, sexual knowledge and experiences, academic and cognitive functioning, and mental health issues.

Characteristics of Juveniles Who Have Committed Sex Offenses • Juvenile sex offenders frequently engage in nonsexual criminal and antisocial behavior • A national survey found that most of the 80 juveniles who disclosed sexually assaultive behavior had previously committed a nonsexual aggravated assault.

Characteristics of Juveniles Who Have Committed Sex Offenses • Childhood experiences of being sexually or physically abused, being neglected, and witnessing family violence have been independently associated with sexual violence in juvenile offenders • While past sexual victimization can increase the likelihood of sexually aggressive behavior, most children who are sexually abused will not commit further abuse.

Characteristics of Juveniles Who Have Committed Sex Offenses • A study of 1,600 juvenile sex offenders from 30 states found that only about one-third of the juveniles perceived sex as a way to demonstrate love or caring for another person; others perceived sex as a way to feel power and control (23.5 percent), to dissipate anger (9.4 percent), or to hurt, degrade, or punish (8.4 percent). • Studies of male college students and adult sex offenders have shown that deviant sexual arousal is strongly associated with sexually coercive behavior

Characteristics of Juveniles Who Have Committed Sex Offenses • One study found that 89 percent of the juvenile sex offenders studied said they use pornographic materials. • Another study found that 42 percent of juvenile sex offenders, compared with 29 percent of juvenile violent offenders (whose offenses were nonsexual) and status offenders, had been exposed to hardcore, sexually explicit magazines.

Characteristics of Juveniles Who Have Committed Sex Offenses • Studies typically report that as a group, juveniles who sexually offended experienced academic difficulties. • Some cognitive distortions observed in abused children like reduced empathy, inability to recognize appropriate emotions in others, blaming the victim and inability to take another person’s perspective are also associated with juvenile sex offenders who have been maltreated.

Characteristics of Juveniles Who Have Committed Sex Offenses • Conduct disorder diagnoses and antisocial traits frequently have been observed in populations of juveniles who have sexually offended. • Studies also have described other behavioral and personality characteristics: • Impulse control problems and lifestyle impulsivity • Higher scores on the Schizoid, Avoidant, and Dependent scales of the MCMI • Higher rates of depression, anxiety, aggression, narcissism, pessimism, and sexual dysfunction

Characteristics of Juveniles Who Have Committed Sex Offenses • Rates at which juvenile sex offenders were found to be under the influence of drugs or alcohol at the time they committed their offenses ranges from 3.4 percent to 72 percent. • The evidence is insufficient to identify substance abuse as a causative factor in the development of sexually abusive behavior, although substance abuse has a disinhibiting potential and, if present, may require intervention.

Types and Classifications • Although a variety of characteristics have been identified among juveniles who have sexually offended, few studies have attempted to classify these juveniles according to their similarities and differences. • Naive experimenters, undersocialized child exploiters, sexual aggressives, sexual compulsives, disturbed impulsives, group influenced, and pseudosocialized • Pedophilic, sexual assault, and undifferentiated • Child molesters, rapists, sexually reactive children, fondlers, paraphilic offenders, and unclassifiable • Adolescent sex offenders who assault younger victims (3-5 years or more difference in age) vs. peer offenders (offending within 3-5 years difference in age)

Types and Classifications • Preadolescent Children • Available studies have reported sexual aggression in children as young as 3 and 4; the most common age of onset appears to be between 6 and 9. • Girls were represented in much greater numbers among these children than among adolescents who have abused, and these girls often engaged in behaviors that were just as aggressive as the boys’ actions. • Victims of preadolescents tended to be very young (averaging between ages 4 and 7), most often were female, and typically were siblings, friends, or acquaintances. • Preadolescents have also been found to have frequent academic and learning difficulties and impaired peer relationships.

Types and Classifications • Preadolescent Children • Families of preadolescents who have sexually abused tended to be dysfunctional. In fact, the researchers concluded, “The evidence . . . points to family interactions as a primary source of the problem.” • The families of these children tended to be characterized by high levels of poverty, single parenting, sexual abuse, domestic violence, and parenting stress. • Compared to adolescent children, the preadolescent children’s families…evidenced significantly more problems, and the younger children also had significantly higher levels of social isolation and current life stresses.

Assessments • Comprehensive assessments of individuals are needed to facilitate treatment and intervention strategies. These include assessment of each juvenile’s needs (psychological, social, cognitive, and medical), family relationships, risk factors, and risk management possibilities. • Parents or guardians of juveniles should be involved in the assessment and in the treatment process. Their informed consent should be obtained, and they should be clearly informed of the limits of confidentiality.

Assessments • Four primary domains require assessment: • intellectual and neurological, • personality functioning and psychopathology, • behavioral, • and sexual deviance. • The special issues surrounding abuse cases such as risk assessment, safety planning, and the complicated familial and parent-child relationship issues that exist should be a part of the assessment process. • Assessment should result in an accurate portrayal of the functioning of the offender or abused child and their family within their cultural context.

Assessments • Child Sexual Behavior Inventory (William N. Friedrich, Ph.D., ABPP ): • Completed by the mother or primary female caregiver, the CSBI contains 38 items covering 9 content domains: Boundary Issues Sexual Anxiety, Sexual Intrusiveness, Self-Stimulation, Sexual Interest, Voyeuristic Behavior, Exhibitionism, Sexual Knowledge, and Gender Role Behavior. • The assessment is useful clinically both in screening for possible sexual abuse experiences and in assessing the progress of recovery in known victims. • The Total Scale Score indicates overall level of sexual behavior exhibited by the child; the Developmentally Related Sexual Behavior Score indicates sexual behaviors that can be considered normal for the child's age and gender; and the Sexual Abuse Specific Items Score indicates sexual behaviors that can be viewed as atypical for the child's age and gender. This last score alerts you to the possibility of sexual abuse. • LONGSCAN Version: Shortened to 25 Questions, modified for lower SES clients and includes a Sexual Aggression component.

Assessments • Abel Assessment for Sexual Interest(Gene Abel): • An objective test that can reliably differentiate between child molesters and non-molesters. Designed for adult men, the AASI answers a 389-item questionnaire about their sexual behavior, beliefs and willingness to admit common social problems. • The first portion of the Abel Assessment consists of a questionnaire that gathers information regarding the client’s sexual preferences and behaviors, legal history, and self-reported ability to control their sexual behaviors. • The questionnaire also contains items that are analyzed to assess whether the client is feigning test results, has cognitive distortions about having sex with children, or fits a statistical profile of individuals (known offenders) who have sexually abused children. • The second part of the test is a measure of visual reaction time beyond the client’s awareness while viewing 160 slides (in 22 categories) depicting clothed children, teens, and adults. During this portion of the test, the client is also asked to rate his or her degree of sexual arousal to the visual stimuli. Data obtained from the testing is sent to Abel Screening, Inc. for processing and analysis; a detailed report of the client’s response patterns is then provided to the testing site. • The results from these procedures are used to derive three scores that allegedly reveal the probability of the subject being a sexual molester of pre-adolescent girls or boys, or lying when denying an act of molestation.

Assessments • Other Assessments to Consider • Child Abuse Potential Inventory (Milner, 1986) • Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR) • Minnesota Sex Offender Screening Tool • Multiphasic Sex Inventory • Rosenberg Sexual Deviance Deception Assessment • Sexual Interest and Deviancy Assessment • Sex Offense and Development Assessment • Sexual Violence Risk-20 (SVR-20)

Assessments • The assessment is the cornerstone of the treatment process. • Without accurate, comprehensive, and sophisticated assessment, followed by reasonable treatment planning, interventions are likely to be misguided and ultimately ineffective.

Treatment • Following a full assessment of the juvenile’s risk factors and needs, individualized and developmentally sensitive interventions are required. • Feedback and discussion of the results with family members are important ingredients of the assessment process. • Individualized treatment plans should be designed and periodically reassessed and revised. • Plans should specify treatment needs, treatment objectives, and required interventions.

Treatment • Treatments should be respectful of the families particular circumstances, background, and values. • Treatment plans should be practical. Plans that call for services that are unavailable, require many sessions per week, or are beyond the financial means of the family are not useful because it is unlikely they will be followed. • Plans should specify treatment needs, treatment objectives, and required interventions. • Feedback and discussion of the results with family members are important ingredients of the assessment process.

Treatment Saunders, B.E., Berliner, L., & Hanson, R.F. (Eds.). (2003). Child Physical and Sexual Abuse: Guidelines for Treatment (Final Report: January 15, 2003). Charleston, SC: National Crime Victims Research and Treatment Center.

Treatment • Trauma-focused Cognitive-Behavioral Therapy (CBT) • The treatment focuses on conditioned emotional associations to memories and reminders of the trauma, distorted cognitions about the events, and negative attributions about self, others and the world. • Non-offending parents are included in the treatment process to enhance support for the child, reduce parental distress, and teach appropriate strategies to manage child behavioral reactions. • Duration of Treatment: 12-16 sessions

Treatment • Adult Child Molester Treatment • Adult child molester treatment uses cognitive behavioral and adjunctive therapies to help child sexual offenders develop the motivation and skills to stop sexual offending by replacing harmful thinking and behaviors with healthy thoughts and the skills to make choices that will reduce risk. • Specialized treatment typically includes individual or group therapy with additional intervention through education of, and monitoring by, collaterals in offenders’ environment. • Duration of Treatment: 1-2 years of active treatment; weekly individual and/or group sessions.

Treatment • Family Focused, Child Centered Treatment Interventions in Child Maltreatment • This model focuses on specific factors that created risk to the child and family and identifies the required behavioral outcome to reduce that risk. • Rather than providing a menu of services that require participation to be considered successful, the FTI focuses on identifying risk factors and required behavioral change, and uses input from the caregiver regarding what will be needed to make the required change. • Duration of Treatment: 6 to 12 months

Questions/Comments? Greg Hand Justice Research Center www.thejrc.com 850-521-9900 ghand@thejrc.com

Child on Child Sexual Abuse: A Research Literature Summary