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Developmental and Etiological Characteristics of Children with Sexual Behaviour Problems: Treatment Implications
Abstract
Baseline data are reported on the demographics, psychological adjustment, victimization, and perpetration histories of 127 6- to 12-year-old children who have engaged in developmentally unexpected sexual behaviors. Information regarding the children's caregivers, and their extended families, is also presented. Data were collected during intake of the families into a longitudinal treatment outcome study.
A comprehensive battery of psychometric devices and a structured interview were completed with 127 children with sexual behavior problems and their primary caregivers at intake to a treatment outcome study.
More than half of the children engaging in developmentally unexpected sexual behaviors had been abused both sexually and physically by more than two different perpetrators. One-third of the people who had maltreated these children were less than 18 years old. These children had acted out against an average of two other children. High levels of distress in the children and their caregivers were evident across a number of psychometric and historical variables.
Children with sexual behavior problems exhibited a number of functional impairments commonly associated with maltreatment, including learning and psychiatric disorders. Their caregivers and families manifested several characteristics that deter children's recovery from maltreatment, including an impaired attachment between parent and child. The scope of the children's problems requires that treatment extend beyond the therapist's office to include schools and other agencies or individuals with whom the child and families have regular contact.
... Indeed, initial studies documented an increased frequency of PSB, including IPSB, among children with CSA histories (e.g., Friedrich, Urquiza, & Beilke, 1986;Johnson, 1988;Kendall-Tackett, Williams, & Finkelhor, 1993). Later research confirmed this link while suggesting that more frequent, chronic, incestuous, and coercive forms of CSA, as well as a greater number of perpetrators, yielded the greatest likelihood for the emergence of PSB (Friedrich et al., 2001;Gray, Pithers, Busconi, & Houchens, 1999;Hall et al., 2002). In other words, more severe forms of CSA confer an exponentially increased risk for the development of PSB. ...
... Children with more severe forms of IPSB (i.e., aggressive, coercive) in the Pithers et al. (1998a) sample were much less likely to be diagnosed with PTSD than children with less severe forms of IPSB. Gray et al. (1999) diagnosed PTSD in only 17% of their sample with IPSB. Similarly, Allen (2017) found no evidence that children with IPSB are more likely than other children to report PTSD symptoms. ...
... Clues that this understanding may be relevant to the display of PSB surfaced early in empirical investigations. While these studies established the cooccurrence of CSA with PSB, a less discussed finding was that childhood physical abuse (CPA) also was prevalent among PSB samples, with estimates ranging between 32% and 48% (Bonner et al., 1999;Gray et al., 1999;Hall, Mathews, & Pearce, 1998;Pithers et al., 1998a;Silovsky & Niec, 2002). More contemporary findings reflect these earlier studies, with Allen (2017) finding that 39% of children with PSB have a CPA history (for children with IPSB the prevalence of CPA was 43%), Smith et al. (2019) documented CPA in 31% of children with IPSB, and Lévesque, Bigras, and Pauzé (2010) established that children in their sample with CPA histories were 3.3 times more likely to display PSB. ...
Problematic sexual behavior (PSB) among preteen children is a poorly understood
clinical phenomenon that may leave even the most skilled and knowledgeable of clinicians at a loss when attempting to develop an evidence-based treatment approach. Much of this lack of practical direction can be credited to the relatively scarce clinical trial research examining this outcome. Nonetheless, the etiological research on PSB provides clearer directions and suggests the implementation of already well-established interventions may be effective. This paper reviews the current state of the etiological research pertaining to PSB and places these findings within developmental psychopathology, social learning theory, and posttraumatic stress disorder
symptomatology frameworks. Specific treatment directives derived from these three viewpoints are then reviewed, including a review of the current evidence base for the treatment of PSB. Finally, a treatment planning algorithm is specified to help clinicians identify the most beneficial approach to treating PSB in a given case.
... A data abstraction form was created for this study. Elements chosen to abstract were those deemed relevant based on a literature review (e.g., Bonner et al., 1992;Gray et al., 1999;Ryan et al., 1996) and on what would most likely be available in the medical records based on the types of information typically recorded by the examining physician. The finalized version of the abstraction form was created after testing several iterations. ...
... Our observations are supported by Ryan et al. (1996) who found that 5% of CIs did not admit being present when the sexual contact occurred, 13% denied participation, 33% accepted little or no responsibility for what happened, and only 19% accepted full responsibility for their actions. Additionally, Gray et al. (1999) noted that only 16% of the 127 children referred to them for SBPs admitted sexual misbehavior. ...
... In many ways, the findings of this study are similar to previous research findings: the majority of CIs in this study were male (Hackett et al., 2013;Ryan et al., 1996); CIs disproportionately experienced sexual abuse compared to children and youth not exhibiting SBPs (Bonner et al., 1992;Fox, 2017;Gray et al., 1999;Letourneau et al., 2004;Seto & Lalumiére, 2010;Sigurdsson et al., 2010); and they engaged other children in more than one type of sexual interaction (Hackett et al., 2013). Specific to gender differences, female CIs in this study also had similar characteristics described in previous research: female youth who exhibit SBPs tend to be younger (Finkelhor et al., 2009) and have higher rates of sexual abuse than males who exhibit SBPs (Hackett et al., 2013). ...
Background:
Over one-third of inappropriate sexual contact experienced by children is initiated by other children. Many studies examined child initiators (CIs) of interpersonal problematic sexual behaviors (IPSBs). This study uniquely links CI information with types of sexual contact as described by children they engaged in IPSBs.
Objective:
Describe CIs' characteristics and types of sexual acts they initiated.
Participants/setting:
Medical charts of CIs and children they engaged in IPSBs. Examinations occurred between 2002 and 2013.
Methods:
Retrospective chart review.
Results:
Most CIs were male (83%) and related to the child they engaged in IPSBs (75%); mean age was 10 years (range 4-17); 58% reported viewing sexually explicit media; 47% experienced sexual abuse. Most CIs (68%) engaged in multiple types of IPSBs. Children who experienced IPSBs initiated by males reported engagement in greater numbers of invasive acts (t(216) = 2.03, p = .043). Older CIs were more likely than younger CIs to report viewing sexually explicit media (χ2(1) = 7.81, p = .007) and those who did were more likely to initiate more invasive acts (t(169) = 2.52, p = .013) compared to CIs who did not.
Conclusions:
In this study, most CIs were young and experienced multiple adverse events; the most common types of IPSBs were invasive; and over half the CIs had been exposed to sexually explicit media, which was associated with initiating invasive sexual acts. These findings suggest aiming prevention efforts at young children to help them manage exposure to sexually explicit media and redress victimization experiences.
... Children with PSB are also likely to have other psychopathologies, including oppositional behaviors, conduct problems, inattention, hyperactivity and impulsivity, social difficulties, complex trauma histories, and/or severe trauma symptoms (Chaffin et al., 2008;Elkovitch et al., 2009). Results from numerous studies also have indicated that there is a strong positive relation between PSB and the Child Behavior Checklist (Achenbach & Rescorla, 2001) Internalizing, Externalizing, and Total scales (Baker, Gries, Schneiderman, Parker, Archer, & Friedrich, 2008;Bonner et al., 1999;Friedrich et al., 2001;L evesque, Bigras, & Pauz e, 2010;Gray, Busconi, Houchens, & Pithers, 1997;Gray, Pithers, Busconi, & Houchens, 1999). ...
... When specifically looking at school-aged children, approximately 50% of children referred for PSB treatment in one sample did not have a substantiated history of sexual abuse by child welfare services (Bonner et al., 1999). This finding was lower than another sample of school-aged children seeking treatment for PSB in which 84% of children had a sexual abuse history (Gray et al., 1999), although it is important to note that in that study sexual abuse was reported by parents, as opposed to cases that were substantiated by the child welfare system. A history of sexual abuse was found to be lower in a sample of preschoolers than samples of school-aged children. ...
... This finding is similar to the results of a study by Bonner et al. (1999), in which 32% of children referred for PSB treatment had substantiated physical abuse histories. In addition, 48% of children in a different sample referred for PSB treatment had parentreported histories of physical abuse (Gray et al., 1999). There appears to be less research specifically looking at the relation between PSB and domestic violence, but domestic violence was predictive of sexually intrusive behaviors in one study (Friedrich et al., 2003), and almost 60% of young children referred for PSB treatment had been exposed to domestic violence in a different sample (Silovsky & Niec, 2002). ...
It is important for health care professionals to have a strong knowledge base of childhood sexual development, to know how to differentiate between problematic and normative sexual behaviors, and counsel parents accordingly given their assessment of the behaviors. A review of the literature suggests that sexual behaviors are a common occurrence in childhood, though some behaviors are rare regardless of age. Frequency of the behavior, developmental considerations, and the level of harm may help health care professionals assess whether the sexual behavior is typical or problematic. Research suggests that the development of problematic sexual behavior is related to a variety of child, family, developmental, and social factors. Recommendations for clinical care for this population are offered, and a case study highlights a health care professional's appropriate assessment and decision making.
... In line with this, findings from a recent study point to parental histories of maltreatment, rather than child maltreatment, as a predictor of symptom change in children treated for sexualised behaviour [71]. At the same time, it is evident that sexual abuse is not a necessary or sufficient condition for SBP given that between 30 and 70% of children with SBP have not been sexually abused [31,38,39,64]. Furthermore, nearly 50% of sexually abused children do not present SBP [42]. ...
... With regard to gender and SBP, the findings are divergent with some studies suggesting that boys are more at risk of developing SBP [27,41,51], while others show the opposite [39,47,70] or report no gender differences [31,32]. However, given the lack of longitudinal studies, little is known about the association between SBP persistence and gender. ...
... Furthermore, future research is needed to replicate the results of this study with more ethnically and socio-demographically diverse samples. Further studies should also examine other risk factors that have been found to relate to SBP, but that were not examined here, such as other types of child maltreatment (e.g., physical abuse, [4]), disturbed parent-child relationships [39], parental conflict [33,38,64], incarceration of parents [33,38], parental support [18] and parent and child reflective functioning [22]. While the caregiver report of child SBP is the best measure of SBP available, the reliance only on caregiver report measures may be a source of common method variance [4]. ...
The aim of this longitudinal study was to examine the course of sexualized behavior problems (SBP) over 2 years in a sample comprised of 104 children aged 2–12, including 62 children with histories of child sexual abuse (CSA). Parents completed questionnaires assessing SBP, internalizing and externalizing difficulties at baseline, as well as 2 years later. In more than half (56.7%) of children with clinically significant SBP at baseline, sexualized behaviors persisted and remained at a clinically significant level over time. In children with CSA, 48.4% presented persistent SBP, 27.4% presented transitory SBP, while 19.4% did not present clinically significant SBP at either time. CSA increased the relative risk of persistent SBP 3.29 times, and for each one-unit increase in scores of externalizing difficulties, the odds of persistent SBP increased by 21%. The findings suggest that SBP consequent to CSA, especially when it co-occurs with externalizing difficulties, is likely to remain at levels warranting clinical intervention.
... Sexual abuse (Drach, Wientzen & Ricci, 2001;Epperson et al, 2005;Fritz, 2003;Kahn & Chambers, 1991;Rasmussen, 1999;Redlack, 2003;Rubenstein et al., 1993;Tarren-Sweeney, 2008;Underwood, Robinson, Mosholder & Warren, 2008) Physical abuse (Becker, 1998;Benoit & Kennedy, 1992;Epperson et. al., 2005;Friedrich, Davies, Feher & Wright, 2003;Gray, Pithers, Busconi & Houchens, 1999;Letourneau, Rombouts, 2005;Schoenwald & Sheidow, 2004;Silovsky & Niec, 2002) Exposure to domestic violence between parental figures (Caputo, Frick and Brodsky, 1999;Friedrich et al., 2003;Silovsky & Niec, 2002;Winstone, 2009) Early exposure to sexual material including parental sex and pornography (Friedrich, et al., 2003) Being in care (Baker, Kurland, Curtis, Alexander & Papa-Lentini, 2007;Farmer & Pollock, 2003;Friedrich et al., 2005;Smith & Howard, 1994) Family violence (Baker, Tabacoff, Tornusciolo & Eisenstadt, 2003 The perpetration of child molestation or rape (Caputo et al., 1999;Harris et al., 2003;Lakey, 1992) ...
... Kanbouropoulos et al. (2005) located only nine studies that reported on psychological characteristics of children engaging in sexually harmful behaviour, all suggesting that children experience the same risk factors as adolescents. Studies reported psychological problems such as lack of empathy, inadequate social skills, problematic affect, high levels of anxiety, anger, obsessional thoughts, and depression (Friedrich & Luecke, 1988;Hall, Matthews & Pearce, 1998, difficult peer relationships, poor social skills, inappropriate knowledge of their own sexuality, hyperactivity and substance use (Ray & English, 1995), conduct disorder (Gray et al., 1999, Pithers et al., 1998 ADHD (Gray et al., 1999, Hall et al., 2002 and high rates of fighting, aggression, property damage and disobedience (Pithers et al., 1998;Ray & English, 1995). Kanbouropoulos et al. (2005) noted that although many of these factors may not have been 'diagnosed' due to age, symptoms were evident. ...
... Kanbouropoulos et al. (2005) located only nine studies that reported on psychological characteristics of children engaging in sexually harmful behaviour, all suggesting that children experience the same risk factors as adolescents. Studies reported psychological problems such as lack of empathy, inadequate social skills, problematic affect, high levels of anxiety, anger, obsessional thoughts, and depression (Friedrich & Luecke, 1988;Hall, Matthews & Pearce, 1998, difficult peer relationships, poor social skills, inappropriate knowledge of their own sexuality, hyperactivity and substance use (Ray & English, 1995), conduct disorder (Gray et al., 1999, Pithers et al., 1998 ADHD (Gray et al., 1999, Hall et al., 2002 and high rates of fighting, aggression, property damage and disobedience (Pithers et al., 1998;Ray & English, 1995). Kanbouropoulos et al. (2005) noted that although many of these factors may not have been 'diagnosed' due to age, symptoms were evident. ...
... Some studies indicated a significant correlation between atypical sexual behavior and exposure of some form of child maltreatment (Baker et al., 2008;Bonner et al., 1999;Curwen et al., 2014;Gray, Busconi, Houchens, & Pithers, 1997;Silovsky & Niec, 2002;Tougas et al., 2016). These studies report that, as far as the child physical abuse is concerned, the prevalence rates of sexual behavior problems range from 32% to 48% (respectively for verified reports and parent reports; Bonner et al., 1999;Gray, Pithers, Busconi, & Houchens, 1999;Silovsky & Niec, 2002). In regard to neglect, they range from 16% to 18%, and, as for emotional abuse, they vary from 29% to 39% (Bonner et al., 1999;Gray et al., 1997). ...
... Regarding the frequency of sexual behaviors in the school context, in line with literature (Bonner et al., 1999(Bonner et al., , 2001Friedrich et al., 1991Friedrich et al., , 1992Gray et al., 1999;Pithers et al., 1998;Sandnabba & Santtila, 2003;Santtila et al., 2005;Silovsky & Niec, 2002) our data illustrates the significant effects of child's age and gender on the expression of sexual behaviors. Although this was not a longitudinal study, our results illustrate the tendency for children to progressively exhibit a lower number of sexual behaviors as they grow older. ...
The main purpose of the study was to explore the child sexual behaviors that Italian teachers have observed in the school context. A representative sample of 227 children, from 5 to 10 years old, was rated by their teachers through the Child Sexual Behavior Inventory. Frequencies of sexual behaviors among children aged 5 to 6, 7 to 8, and 9 to 10 are presented. Younger children showed a broader range of sexual behaviors that decrease with the growing age, such as males in comparison to females. Moreover, findings showed that child sexual behavior is not only related to age and gender but also to family characteristics. These results suggested that child sexual behaviors reported by teachers through the Child Sexual Behavior Inventory may provide useful information about the development of children’s sexuality. The knowledge of age appropriate sexual behaviors can help teachers discern normal sexual behaviors from problematic sexual behaviors.
... Children with sexual behavior problems have often been reported to present with histories of sexual abuse and, to a lesser extent, physical abuse (e.g., Friedrich, Beilke, & Urquiza, 1988;Friedrich, Urquiza, & Beilke, 1986;Gray, Pithers, Busconi, & Houchens, 1999;Hershkowitz, 2014;Silovsky & Niec, 2002). Tarren-Sweeney (2008) has further found that placement instability was an independent predictor of sexual behavior problems in children, noting that most of the children with sexual behavior problems evidenced ''psychopathology . . . ...
... Several studies have found placement instability to be associated with distal (i.e., long-term) as well as proximal (short-term) antisocial behavior. Ryan and Testa (2005) examined whether placement instability functioned behaviors (e.g., Alessandri, 1991;Cicchetti, Lynch, Shank, & Manly, 1992;Crittenden, Claussen, & Sugarman, 1994;Haskett & Kishner, 1991;Kaufman & Cicchetti, 1989;Williamson, Borduin, & Howe, 1991), Tarren-Sweeney (2008) noted that the most cited form of maltreatment (other than sexual abuse) associated with sexual behavior problems is physical abuse (e.g., Friedrich, Davies, Feher, & Wright, 2003;Gray et al., 1999;Silovsky & Niec, 2002). Burton and Schatz (2003) found that 38% of 7,261 from 30 studies had also been physically abused. ...
This study examined the relationship between childhood physical abuse, sexual abuse and placement instability, and sexually inappropriate and aggressive behaviors in a child welfare sample. Sexually Inappropriate Behavior was associated with all independent variables. Sexual Aggression and Child/Male Victims were both associated with Sexual Abuse and Placement Instability. Offense Persistence was associated with Placement Instability. All risk-mitigating factors (i.e., Self-Control, Global Adjustment, and Responsibility for Behavior) were associated only with Placement Instability. The broad and robust influence of placement instability on short-term outcomes of sexually inappropriate and aggressive behavior, as well as the risk mitigating factors, was the most notable finding. Findings underscore the importance of placement stability in the development of young children.
... Many early studies documented other correlates of PSB, including generalized externalizing problems and childhood physical abuse (e.g., Bonner et al., 1999;Gray, Pithers, Busconi, & Houchens, 1999) and more contemporary studies continue to find these relationships (Allen, 2017;Smith, Lindsey, Bohora, & Silovsky, 2019). In addition, environmental factors, such as parental stress and mental illness (Pithers, Gray, Busconi, & Houchens, 1998;Silovsky & Niec, 2002;Wamser-Nanney & Campbell, 2019), appear related to a child's display of PSB. ...
Background:
Preteen children with problematic sexual behavior (PSB) are increasingly coming to the attention of mental health professionals. However, efforts to provide clinical care to these children are hampered by the limited dissemination and implementation of effective screening procedures.
Objective:
A single-item screening tool designed for implementation in mental health settings was developed and tested for psychometric quality.
Participants:
Participants included caregivers of children receiving clinical services as a result of displaying PSB and/or subsequent to disclosure of child maltreatment (n = 341).
Methods:
Caregivers completed the single-item tool at the onset of services and approximately 15 days later. In addition, caregivers completed the Child Sexual Behavior Inventory, the Strengths and Difficulties Questionnaire, and the Child Stress Disorder Checklist-Short Form at the initial assessment.
Results:
Analyses demonstrated acceptable test-retest reliability of the tool (phi = 0.70-0.74, p < .001). Validity was established by showing that caregivers providing a positive response on the single-item tool scored children significantly higher on a full-length measure assessing PSB than caregivers denying such concerns on the single-item tool (t = 7.28-9.8, p < .001). However, scores on measures of internalizing concerns and posttraumatic stress symptoms were not distinguished by caregiver responses to the single item tool.
Conclusions:
The newly developed single-item tool appears to offer an efficient, reliable, and valid method of screening preteen children for the presence of PSB.
... Portanto quando as crianças sofrem ou testemunham violência, a partir da reprodução do modelo de educação recebido dos pais a violência é aprendida e posteriormente reproduzida, resultando na perpetuação transgeracional do ciclo da violência (Barreto et al., 2009). Ao aprenderem que a violência é uma reação apropriada em situações de conflito interpessoal, agem assim nos próprios relacionamentos na idade adulta (Franklin & Kercher, 2012 (Johnson, 1988), casos semelhantes são relatados em outros estudos (Cantwell, 1988;Gray et al., 1999;Sigurdsson et al., 2019). ...
Considering sexual violence as a complex, multifaceted, endemic and underreported public health problem, as well as its consequences for victims and society, in this review we look at the perpetrator of sexual violence in order to identify his characteristics based on national and international literature. The NCBI/PubMed, APA PsycInfo, CINAHL, Web of Science, Scopus and LILACS databases were used, including studies about perpetrators of sexual violence published in Portuguese, English and Spanish, without year of publication or methodological type restriction. Fourty-six studies were included. The results show the profile of the men and womenauthor in relation to life cycle, marital status, education, skin color/ethnicity, work, if they had suffered violence in childhood, if they had used alcohol and drugs, as well as behaviors related to violence. It is concluded that men are the main perpetrators of sexual violence against women in all life cycles, but children who suffer violence from family members of both sexes demand special attention.
... Portanto quando as crianças sofrem ou testemunham violência, a partir da reprodução do modelo de educação recebido dos pais a violência é aprendida e posteriormente reproduzida, resultando na perpetuação transgeracional do ciclo da violência (Barreto et al., 2009). Ao aprenderem que a violência é uma reação apropriada em situações de conflito interpessoal, agem assim nos próprios relacionamentos na idade adulta (Franklin & Kercher, 2012 (Johnson, 1988), casos semelhantes são relatados em outros estudos (Cantwell, 1988;Gray et al., 1999;Sigurdsson et al., 2019). ...
Tendo em vista a violência sexual como um problema de saúde pública complexo, multifacetado, endêmico e subnotificado, bem como suas consequências para as vítimas e para a sociedade, neste estudo lançamos um olhar para o autor de violência sexual com o objetivo de identificar suas características com base na literatura nacional e internacional. Utilizaram-se as bases NCBI/PubMed, APA PsycInfo, CINAHL, Web of Science, Scopus e LILACS, incluíram-se estudos que tratassem de autores de violência sexual publicados em português, inglês e espanhol, sem restrição de ano de publicação ou tipo metodológico. Foram incluídos 46 estudos na revisão. Os resultados mostram o perfil do homem e da mulher autora em relação ao ciclo de vida, estado civil, escolaridade, cor de pele/etnia, trabalho, se sofreu violência na infância, se fez uso de álcool e drogas, bem como comportamentos relacionados à violência. Merecem especial atenção os homens e mulheres autores de violência sexual contra crianças no âmbito familiar.
... Further evidence for the developmental psychopathology perspective comes from the multitude of studies showing a significant correlation between PSB and broader externalizing behavioral problems (e.g., Allen, 2017;Friedrich et al., 2003;Gray et al., 1999;Smith et al., 2019;Wamser-Nanney & Campbell, 2022). In addition, deficits in social competence also are well-established for children displaying PSB (e.g., Allen, 2017;Wamser-Nanney & Campbell, 2019), which may exacerbate anomalous developmental trajectories. ...
Studies examining the etiology of problematic sexual behavior (PSB) among pre-teen children often rely on identifying correlational relationships without examining potential causal mechanisms. This study describes an exploratory analysis of a potential mediational model where child sexual abuse (CSA) and child physical abuse (CPA) predict the onset of PSB through their impact on the emergence of posttraumatic stress (PTS) symptoms and self-dysregulation. The caregivers of 189 children between the ages of 3 and 11 years presenting for mental health treatment in the United States completed a battery of measures designed to assess each of the variables in the model. Cross-sectional, regression-based mediational analyses showed that the overall model performed adequately (R = .33, R2 = .11, F = 3.07, p = .004). CSA exerted a direct effect on PSB that was not mediated through either PTS or self-dysregulation. However, no direct effect for CPA was found. Rather, CPA exerted a significant effect on the display of self-dysregulation, which in turn was associated with PSB. These results are discussed in light of clinical implications and directions for further research.
... This finding led to questions about the nature and timing of developmental factors, such as the quality of a child's family environment and experiences of maltreatment. Various familial, contextual, and individual factors have been correlated with SBP in childhood and adolescence and numerous studies have shown that the lives of those with SBP are characterized by multiple instances of adversity (Bladon et al., 2005;Gray et al., 1999;Hall et al., 2018;Leon et al., 2008;Letourneau et al., 2004;Lussier et al., 2019;Merrick et al., 2008;Szanto et al., 2012;Wieckowski et al., 1998). For example, a study conducted by Vizard, Hickey, French, & McCrory, (2007) showed that various factors related to family environmentexposure to intimate partner violence, inconsistent parenting, lack of parental supervision, lax sexual boundaries, and physical neglect-were commonly observed among youth with SBP and most were correlated with SBP that developed early in childhood (i.e., before 10 years of age) and continued into adolescence. ...
Little is known about the development of childhood sexual behavior problems (SBP) in terms of continuity and discontinuity into adolescence. Prior studies have espoused a nondevelopmental approach focusing on the clinical profiles of these youths at the time of their referral. To address this gap, the current study proposes an examination of the developmental covariates involved in the continuity of SBP among a sample of 340 children and adolescents referred to Child Protection Services (CPS) in Quebec, Canada. Children’s CPS contacts from birth up to age 17 were inspected, allowing to recreate the life history of social and familial adversities during that period. Logistic regression models were performed and helped to identify developmental covariates of childhood-onset SBP and its persistence into adolescence. Findings suggest that children with childhood-onset SBP that persisted into adolescence have experienced various life adversities. The study findings provide some preliminary evidence of the developmental pathways of SBP.
... PSB may be more common in females in early childhood (Silovsky & Niec, 2002), yet by adolescence it is males who predominately come to the attention of treatment providers (Hackett, Phillips, Masson, & Balfe, 2013;Ryan, Miyoshi, Metzner, Krugman, & Fryer, 1996;Silovsky, Hunter, & Taylor, 2019). Risk factors associated with the development of PSB are multifaceted and involve exposure to inappropriate sexual material, traumatic experiences (e.g., sexual and other forms of abuse such as physical abuse and neglect), limited parental guidance, individual factors, and co-occurring disruptive behavior problems (Allen, 2017;Bonner, Walker, & Berliner, 1999;Gray, Pithers, Busconi, & Houchens, 1999;Hackett et al., 2013;Lévesque, Bigras, & Pauzé, 2012;Pithers, Gray, Busconi, & Houchens, 1998;Silovsky & Niec, 2002). Further, late childhood and early adolescence (i.e., 12-14 years old) is the developmental period of highest risk for youth to engage in PSB and come to the attention of law enforcement (Finkelhor et al., 2009). ...
Background:
Early intervention efforts designed for youth with problematic sexual behavior (PSB) have strong promise. Prompt identification of youth with PSB is critical to ensuring early intervention and effective response.
Objective:
The current study explored the complexities of how PSB of youth is identified in the community.
Setting:
A qualitative semi-structured interview approach was utilized to explore the perceptions and experiences of community members involved in cases of youth with PSB.
Participants:
Participants included 100 community members from eight geographically diverse locations in the United States.
Method:
Themes involving identification of PSB were classified by qualitative analyses, beginning with thematic analysis followed by focused coding.
Results:
Results indicated multiple pathways for the identification of youth with PSB involving a variety of professionals and agencies. Victim disclosure and witnessing the PSB were the most common identification pathways, with caregivers and school personnel the most common initial identifiers. Once identified, cases were reported to child welfare, law enforcement, and/or behavioral health agencies. Complications due to unclear response pathways and fears held by caregivers were notable.
Conclusions:
Developmentally appropriate, evidence-informed policies and procedures for the identification of and response to PSB in youth within and across professions would facilitate a public health response to for prevention and early responses to PSB of youth.
... In a sample of children with PSBs, a majority of the children (53%) had witnessed violence between the parents with whom they were currently living, including both biological and foster families (Pithers, Gray, Busconi, & Houchens, 1998). Direct maltreatment is also common among children of all ages referred to treatment for PSBs (e.g., Bonner et al., 1999; Gray, Pithers, Busconi, & SMITH, LINDSEY, BOHORA, AND SILOVSKY Houchens, 1999;Silovsky & Niec, 2002). In a longitudinal study done by Merrick, Litrownik, Everson, and Cox (2008) CPA at four years of age predicted greater sexual behavior in eight-year-old children. ...
Intrusive sexual behaviors (ISBs) are a specific type of problematic sexual behavior characterized by the invasive nature of the acts (e.g., touching others’ private parts, attempting intercourse; Friedrich, 1997). The limited amount of research on ISBs has focused on sexual abuse history as the primary predictor. However, Friedrich, Davies, Feher, and Wright (2003) found that ISBs in children up to age 12 were related to four broad conceptual factors: (a) exposure to sexual content, (b) exposure to violent behavior, (c) family adversity, and (d) child vulnerabilities. The current study sought to replicate Friedrich’s study using a clinical sample of 217 preschool-aged children (ages two to six). Results supported variables from within the child vulnerabilities construct (externalizing behaviors, βEXT = 0.032, p = 0.001), post-traumatic stress disorder (PTSD) criteria met (βPTSD = 0.177, p = 0.02), and an inverse relationship with age (βAGE = −0.206, p = 0.024). These results highlight the importance of considering childhood behavioral patterns and reactivity to traumatic events as correlates of ISBs in young children.
... The development and maintenance of PSB involves a complex and multifaceted matrix of potential contributing factors including: exposure to nudity, sexual acts or materials, parenting practices, child maltreatment and other trauma histories (e.g., family violence, sexual and physical abuse, neglect), and individual child factors like co-occurring disruptive behavior problems, developmental factors, and coping skills (Chaffin et al., 2008;Friedrich, Davis, Feher, & Wright, 2003;Gray, Pithers, Busconi, & Houchens, 1999). PSB is not a distinct psychiatric diagnosis (see American Psychiatric Association, 2013) but rather best conceptualized in terms of the co-occurring symptoms, antecedents, and protective factors at the individual, family, and community level (Elkovitch, Latzman, Hansen, & Flood, 2009). ...
Problematic Sexual Behavior (PSB) can be conceptualized as a distinct subset of externalizing behavior problems. Preschool children with PSB commonly have co-occurring nonsexual behavior problems, including disruptive behavior disorders (DBD). Behavioral parent training is the core component of effective treatments for DBD (Kaminski, Valle, Filene, & Boyle, 2008) and for PSB (St. Amand, Bard, & Silovsky, 2008). Parent-Child Interaction Therapy (PCIT) is an empirically supported evidence-based behavioral parent treatment program for young children ages 2 to 7 with disruptive behavior problems (California Evidence-Based Clearinghouse, 2017; Eyberg & Funderburk, 2011; Funderburk & Eyberg, 2011). However, due to the taboo nature of the topic and the potential impact and harm to other children, unique clinical issues can arise when behaviors are classified as “sexual.” Adaptations to PCIT are recommended to address safety, physical boundaries, commonly held myths about the population, and other related issues. Conceptual background of PSB and the fit of behavioral parent training as a core intervention is provided, followed by details regarding augmentations to embed approaches to address PSB within PCIT.
... In the present study, contrary to previous research, a history of sexual abuse only was not linked to the initiation of behavior patterns associated with an increased risk of acquiring HIV infection (Einbender & Friedrich, 1989;Gale, Thompson, Moran, & Sack, 1988). However, research is conflicted about whether sexual abuse only is a mechanism for engaging in HIV risk behavior or whether co-occurring abuse (Beitchman et al., 1992;Jones et al., 2010;Mian, Marton, & LeBaron, 1996) and family environment variables (Gray, Pithers, Busconi, & Houchens, 1999) moderate the negative effects of sexual abuse on HIV risk-taking behaviors (Cunningham, Stiffman, Dore, & Earls, 1994). Consistent with previous research showing that co-occurring forms of abuse (e.g., sexual and neglect) and a dysfunctional family environment increase adult vulnerability for HIV risk-taking above and beyond sexual abuse (Abramovich, 2005), the present study found that two high-risk profiles each with multiple risks (and the two highest CR scores) were significantly associated with HIV risk behavior. ...
Studies of adverse childhood experiences (ACEs) have gauged severity using a cumulative risk (CR) index. Few studies have focused on the nature of the context of adversity and their association with psychosocial outcomes. The objective of this study was to examine the patterning of ACEs and to explore the resultant patterns' association with HIV risk-taking, problem drinking, and depressive symptoms in adulthood. Latent class analysis (LCA) was used to identify homogeneous, mutually exclusive "classes" of 11 of the most commonly used ACEs. The LCA resulted in four high-risk profiles and one low-risk profile, which were labeled: (1) highly abusive and dysfunctional (3.3%; n ¼ 1,983), (2) emotionally abusive alcoholic with parental conflict (6%, n ¼ 3,303), (3) sexual abuse only (4.3%, n ¼ 2,260), (4) emotionally abusive and alcoholic (30.3%, n ¼ 17,460), and (5) normative, low risk (56.3%, n ¼ 32,950). Compared to the low-risk class, each high-risk profile was differentially associated with adult psychosocial outcomes even when the conditional CR within that class was similar. The results further our understanding about the pattern of ACEs and the unique pathways to poor health. Implications for child welfare systems when dealing with individuals who have experienced multiple forms of early childhood maltreatment and/or household dysfunction are discussed.
... However, 68% displayed subthreshold levels of symptoms, including impulsivity and trouble concentrating. In another non-juvenile justice sample of children who displayed problematic sexual behaviors, 53% of the boys and 38% of the girls ages 6 to 9, and 45% of the boys and 10% of the girls ages 10-12 met criteria for ADHD (Gray et al., 1999). ...
... These early reports, in fact, were clinical studies that virtually required that participants be involved in serious and/or frequent sexual offending, therefore providing a distorted view about all young persons involved in sexual offenses (e.g., see Lussier, 2017). Research, however, has shown that there is much heterogeneity in sexual development across children, and that only a small subgroup of children present evidence of SBPs with manifestations that are outside developmental and societal norms of what is considered to be sex play, curiosity, or exploration (e.g., Araji, 1997;Chaffin, 2008;Gray, Pithers, Busconi, & Houchens, 1999;Letourneau et al., 2004;Pithers, Gray, Busconi, & Houchens, 1998). Despite growing concerns over children showing atypical sexual development, there is surprisingly little research examining the origins and the developmental course of child SBPs over time. ...
There is little information about the onset and the developmental course of child sexual behavior problems (SBPs), including sexually intrusive behaviors (SIBs). Using data from the Vancouver Longitudinal Study on the Psychosocial Development of Children, the current study examined the presence of distinct patterns of sexual development among children. A normative sample of preschoolers (N = 354) with a small clinical subsample were followed from age 3 to 8 with repetitive measurements of sexual behaviors using a revised version of Child Sexual Behavior Inventory. Semiparametric group-based modeling identified four distinct sexual development trajectories: the very low (10.5%), the low declining (27.8%), the moderate stable (48.3%), and the high-rate increasing (13.4%). In contrast to the other developmental trajectories found, the high-rate-increasing pattern showed that sexual behaviors became increasingly extensive after school entry. Children characterized by this developmental pattern, especially boys, were more likely to be involved in SIBs after elementary school entry than those in the other groups. Findings highlight the presence of multiple developmental trajectories of sexual development with significantly different behavioral patterns after school entry.
... Ainsi, il y aurait un éventuel effet indirect de ces formes de maltraitance ou de violence sur le développement sexuel des enfants par la voie des séquelles encourues. Les enfants qui manifestent des CSP sont donc susceptibles d'avoir grandi dans un milieu familial comportant nombre de facteurs de risque : monoparentalité, conflits, violence, désorganisation, détresse psychologique, etc. (Friedrich, Davies, Feher et Wright, 2003;Gray, Pithers, Busconi et Houchens, 1999;Herskowitz, 2011;Lepage, 2008;Lepage et al., 2010;Silovsky et Niec, 2002;Szanto et al., 2012). Quoi qu'il en soit, les résultats pointent vers le rôle primordial des parents, en raison des modèles et de l'environnement qu'ils fournissent à leur enfant. ...
... Hands-off behaviors have been described as "nuisance" offenses and include behaviors such as peeping, exposing genitals, sexually explicit threats, sexual drawings, sex with animals, obscene phone calls, and obscene gestures. Although sex with animals is a hands-on behavior, it was included in hands-off behaviors because it involved contact with nonhuman animals (Burton, 2003;Fehrenbach et al., 1986;Gray, Busconi, Houchens, & Pithers, 1997;Gray, Pithers, Busconi, & Houchens, 1999;Johnson, 1988Johnson, , 1989Mathews et al., 1997;Ryan et al., 1996;Shaw et al., 1993;Veneziano, Veneziano, & LeGrand, 2000;Wieckowski et al., 1998). ...
Sex crimes against children and child sexual abuse are significant social and public health problems. Only within the last twenty-five years has attention been given to children and adolescents who victimize their peers. In the United States, these sexually reactive children and adolescents comprise considerable proportions of all arrests for sexual offenses; however, research about the role of pornography in their lives is virtually nonexistent. This descriptive, exploratory study of 160 sexually reactive children and adolescents describes the characteristics of those who use pornography and those who do not. In addition, this study examines the associations between pornography use and abuse history, psychiatric symptoms, nonsexual criminal, antisocial, and delinquent behaviors, and sexually aggressive behaviors among sexually reactive children and adolescents. This secondary analysis uses data from an ongoing study that is examining children and adolescents who have been removed from abusive homes and placed elsewhere, usually in foster care. These children and adolescents are currently at risk to sexually victimize other children. Chi-square and individual odds ratio analyses were employed to examine the associations between use of pornography with abuse history, psychiatric symptoms, nonsexual criminal, antisocial, and delinquent behaviors, and sexually aggressive behaviors. Several significant positive associations were found between pornography use and psychiatric symptoms, nonsexual criminal, antisocial, and delinquent behaviors, and sexually aggressive behaviors. Treatment recommendations for nurses and mental health professionals caring for children and adolescents in a variety of settings are offered. Moreover, findings from this investigation suggest assessment and preventive strategies that may inform future social policy, mental health, and criminal justice recommendations.
... Ainsi, il y aurait un éventuel effet indirect de ces formes de maltraitance ou de violence sur le développement sexuel des enfants par la voie des séquelles encourues. Les enfants qui manifestent des CSP sont donc susceptibles d'avoir grandi dans un milieu familial comportant nombre de facteurs de risque : monoparentalité, conflits, violence, désorganisation, détresse psychologique, etc. (Friedrich, Davies, Feher et Wright, 2003;Gray, Pithers, Busconi et Houchens, 1999;Herskowitz, 2011;Lepage, 2008;Lepage et al., 2010;Silovsky et Niec, 2002;Szanto et al., 2012). Quoi qu'il en soit, les résultats pointent vers le rôle primordial des parents, en raison des modèles et de l'environnement qu'ils fournissent à leur enfant. ...
Les mauvais traitements envers les enfants, dont les agressions sexuelles, figurent parmi les facteurs associes au developpement des comportements sexuels problematiques (CSP). De plus en plus, les connaissances theoriques et empiriques invitent a considerer ces facteurs pour mieux comprendre l’evolution des sequelles liees aux CSP en cours de traitement. La presente etude a pour but de verifier si la presence de mauvais traitements, vecus par l’enfant ou ses parents, permet de predire l’evolution des enfants participant au Programme d’intervention aupres d’enfants presentant des CSP (PI-ECSP) visant a reduire les CSP en favorisant l’acquisition d’habiletes personnelles, sociales et familiales. De facon generale, les resultats suggerent que la presence de mauvais traitements n’est pas liee a l’evolution des problemes de comportement des enfants en cours d’intervention. En revanche, l’etude revele la presence de facteurs predictifs sur certaines cibles d’intervention specifiques qui pointent vers une evolution plus positive lorsque des mauvais traitements ont ete subis par les enfants et une evolution plus mitigee lorsqu’ils ont ete vecus par un parent. Si le PI-ECSP parait tout a fait approprie pour la clientele a laquelle il est destine, les resultats de la presente etude indiquent que certains changements seraient a envisager afin de tenir davantage compte des besoins des parents participants. Tout comme c’est le cas pour bon nombre de travaux dans ce domaine de recherche, l’etude presente certaines limites, dont une taille d’echantillon restreinte et des donnees manquantes, qu’il importe de tenir compte dans l’interpretation des resultats.
... Ainsi, il y aurait un éventuel effet indirect de ces formes de maltraitance ou de violence sur le développement sexuel des enfants par la voie des séquelles encourues. Les enfants qui manifestent des CSP sont donc susceptibles d'avoir grandi dans un milieu familial comportant nombre de facteurs de risque : monoparentalité, conflits, violence, désorganisation, détresse psychologique, etc. (Friedrich, Davies, Feher et Wright, 2003;Gray, Pithers, Busconi et Houchens, 1999;Herskowitz, 2011;Lepage, 2008;Lepage et al., 2010;Silovsky et Niec, 2002;Szanto et al., 2012). Quoi qu'il en soit, les résultats pointent vers le rôle primordial des parents, en raison des modèles et de l'environnement qu'ils fournissent à leur enfant. ...
... For instance, in a small sample of young children ages 3-7 displaying ISBP (n = 37) Silovsky and Niec [39] found that 65 % of the sample was female. Studies utilizing older samples of preteen children displaying ISBP generally find a higher prevalence of males [7,29]. Unfortunately, many of the available studies use a range of children with ages spanning 6 or more years, yet often do not control for the impact of age on the outcomes. ...
Research examining children with sexual behavior problems (SBP) almost exclusively relies on caregiver reports. The current study, involving a sample of 1112 children drawn from a prospective study, utilizes child self-reports and teacher reports, as well caregiver-reports. First, analyses examined children displaying any SBP; a second set of analyses specifically examined children displaying interpersonal forms of SBP. Caregivers reported greater internalizing, externalizing, and social problems for children with general SBP and/or interpersonal SBP when compared to children without SBP. Caregiver concerns were rarely corroborated by teacher and child reports. Protective services records indicated that SBP was linked to childhood sexual abuse, but sexual abuse occurred in the minority of these cases. Physical abuse was more common among children with interpersonal forms of SBP. The data in the current study suggest the need for multiple reporters when assessing children presenting with SBP and that conventional views of these children may be misleading.
... Les études diffèrent notamment au niveau du moment et des mesures d'investigation. Certaines ont obtenu les bulletins scolaires de l'année précédant la période d'agression sexuelle (Gomes-Schwartz et al., 1985;Ligezinska et al., 1996;Paradise et al., 1994), la majorité ont interrogé les enseignants et les mères des enfants sur la période postdévoilement, d'autres (48 %) ont tenté de déterminer s'il y a eu détérioration de la performance depuis l'agression (Caffaro-Rouget et al., 1989;Calam et al., 1998;Conte & Schuerman, 1987;Eckenrode et al., 1993;Elwell & Ephross, 1987;Himelin, 1995;Mannarino et al., 1989;Mannarino et al., 1991;Rimsza et al., 1988;Rust & Troupe, 1991;Tong et al., 1987) et seulement quatre études ont effectué une relance afin d'évaluer le niveau d'adaptation à plus long terme (Calam et al.;Conte & Schuerman;Gray et al., 1999;Mannarino et al., 1989). Il importe de considérer que l'agression sexuelle peut avoir duré des mois, voire même des années, avant le dévoilement et que les chercheurs sont parfois peu spécifiques sur la période reflétée par leurs résultats. ...
The purpose of this literature review was to identify the gaps in the current knowledge concerning the school adaptation of sexually abused (SA) children. Since 1979, a total of 31 studies which evaluated at least one aspect of children's adaptation in the school context were identified. Only 10 studies were purposely conducted to assess how SA children function in educational settings. Although results are inconsistent, studies suggest that between 10 % and 58 % of these children show adjustment difficulties at school. Such problems may be expressed by poor school performance, poor academic achievement scores, conduct problems, lack of social skills, poor cognitive abilities, absenteeism, special class placement or grade repetition. Considering the diversity of the studies included in this review, results are categorized by outcome variables. For each variable examined, findings are often contradictory. The theoretical and methodological limitations of these studies are discussed in order to propose recommendations for future studies.
Youth problem sexual behaviors (PSBs), and particularly youth illegal sexual behaviors, have deleterious consequences for youth who engage in them, including removal from the home, perpetration of non-sexual offenses, and chronic involvement with the child welfare and juvenile legal systems (Lussier, Juvenile sex offending through a developmental life course criminology perspective: An agenda for policy and research). Further, individuals who are victims of youth PSBs also experience poor mental and physical health outcomes, resulting in a significant public health expenditure (Hailes et al., Long-term outcomes of childhood sexual abuse: An umbrella review). Researchers and policymakers alike have therefore placed considerable focus on efforts to develop effective evidence-based treatments for youth PSBs. To date, randomized controlled trials (RCTs) for interventions targeting PSBs have yielded positive outcomes for both school-age children and adolescents. Despite this, untested practices or practices with limited empirical support (i.e., those unsupported by data from RCTs) predominate service delivery with this vulnerable clinical population. In the present article, we discuss treatment de-implementation models in the context of PSB treatment. Then, we cover two treatment modalities focused on youth illegal sexual behavior specifically and for each describe: (a) the clinical interventions, (b) the available research, and (c) whether they should be considered de-implementation. We conclude with future research directions and practical recommendations for future de-implementation evaluation.
Problematic sexual behavior (PSB) are behaviors that involve sexual body parts and that are developmentally inappropriate or potentially harmful among children ages 12 and younger. PSB has been associated with different types of maltreatment as well as clinical difficulties, albeit inconsistently. The aim of this meta-analysis was to summarize the current research on correlates of PSB, specifically child demographic factors (i.e., gender, age), maltreatment history (i.e., childhood sexual abuse [CSA], childhood physical abuse [CPA]), and comorbid clinical symptoms (i.e., externalizing and internalizing problems). A total of 47 samples (n = 15,562 children) were included. Males and younger children were slightly more likely to exhibit PSB (g = .12 and -.21, respectively). CSA was associated with PSB (g = .71); however, the strength of this relationship differed by caregiver gender and publication year. CPA was also related to PSB (g = .32), but was more strongly associated when PSB was limited to the interpersonally intrusive subtype of PSB (g = .46). Externalizing (g = .95) and internalizing (g = .63) symptoms were also linked with PSB, with externalizing difficulties evincing the strongest association of all of the correlates. These results are discussed in the context of advancing research on PSB, specifically addressing several limitations in the current literature. These include inconsistent assessment of PSB and CSA, as well as the pressing need to develop a more robust measure of PSB. Finally, a more comprehensive assessment of the correlates of PSB is needed to address significant common method variance.
A real case of sexual child abuse is provided and analyzed. The chapter gives a brief description of the case and, in studying the case, presents some views about the prevention of sexual child abuse, as well as the precautions parents should take, and suggestions of actions that the government should take.
Background:
Exposure to sexual content, such as online pornography or live sexual content, has been posited in the literature as a risk factor for problematic sexual behaviors (PSBs) in children and adolescents, and has been identified as an important avenue for research and intervention, particularly given the ubiquitous access to technology among children.
Objective:
To examine the association between live/violent and non-violent sexual content exposure and PSB among children and adolescents. Objectives also include informing future research on sexual content exposure as a risk factor for PSB, and providing clinical recommendations related to prevention and intervention.
Participants and setting:
Results are based on 16,200 participants (28.65 % female; Mage = 14.26; range = 4.74-17.92) and 27 studies conducted in North America, Europe, Asia, and Africa.
Methods:
A systematic review was conducted of available literature published up to September 2021. Abstract and full-text review were conducted to assess whether studies met inclusion criteria. Random-effects meta-analyses were conducted on included studies.
Results:
Significant associations were found between exposure to non-violent sexual content and likelihood of engaging in PSB (OR = 1.82; p < .001; 95 % CI: 1.50-2.21), and between exposure to violent/live sexual content and PSB (OR = 2.52; p < .001; 95 % CI: 1.75-3.61). Sex emerged as a moderator of the association between exposure to non-violent sexual content and PSB, such that the association was stronger in studies with a greater proportion of females.
Conclusions:
Results support the need for future research on risk factors and mechanisms implicated in PSB. Prevention and intervention programs for children with PSB and their families could benefit from incorporating education on sexual content exposure.
Cet article propose une description de la problématique des enfants présentant des comportements sexuels inappropriés. La première partie présente la sexualité des enfants sous l’angle des stades de développement sexuel et de critères cliniques et développementaux permettant de distinguer l’exploration sexuelle saine des comportements sexuels problématiques. La seconde partie est consacrée à l’examen de diverses classifications des comportements sexuels problématiques qui permettent de situer les comportements sexuels d’un enfant de part et d’autre d’un continuum allant de l’exploration sexuelle à l’agression. La troisième et dernière partie traite des facteurs de risque expliquant l’émergence des comportements sexuels problématiques chez les enfants. En conclusion, l’article identifie les limites des connaissances actuelles relativement à la compréhension des manifestations sexuelles chez les enfants et propose quelques pistes nouvelles de recherche.
Er seksuelle lege mellem børn eksperimenterende eller udnyttende? Giver det anledning til bekymring, når et barn udviser seksuel adfærd, eller er det helt »normalt«? Der er et grænseområde mellem børns almindelige indbyrdes seksuelle lege og seksuelle overgreb børn imellem. Referencerne i denne artiklen er internationale undersøgelser af henholdsvis børns almindelige seksualitet i førskolealderen og skolealderen og problematisk seksuel adfærd mellem børn i samme alder. Børns almindelige seksualitet kan indeholde masturbation, blottelse, undersøgelse af egne og andres (børns og forældres) genitalier med og uden manuel berøring. Det er også almindeligt, at børn tilsyneladende ikke udviser en seksuel aktivitet. Når der er seksuelle overgreb børn imellem, vil der ofte være en magtforskel mellem børnene. Der kan forekomme vold eller trusler, og den seksuelle aktivitet vil ofte ligge udenfor almindelige sexlege mellem børn. Oralt, analt og vaginalt samleje er meget ualmindeligt i førskole-alderen og heller ikke almindeligt i 6-12 års alderen.
Pediatric clinicians are key players in the sexual and reproductive health of children. Although clinicians often think about sexuality and sexual development during adolescence, it is essential that healthcare professionals address sexual development and gender identity in a culturally effective and developmentally appropriate manner with children and their caregivers. The American Academy of Pediatrics (AAP) has published guidelines for the promotion of healthy sexual development and sexuality spanning birth to adolescence. Clinicians have an opportunity to have open discussion with caregivers about healthy intimacy during infancy, sexual exploration during early childhood, and various elements of sexuality during middle childhood.
Sexual behavior problems (SBPs) and interpersonal SBPs (ISBPs) among sexually abused children often occur alongside a variety of other clinical difficulties, such as externalizing problems, attentional difficulties, social concerns, and posttraumatic stress symptoms (PTSS). Yet, as few studies have examined these links in a multivariate manner, it is unclear which symptoms are most strongly related to SBPs and ISBPs. Research regarding children’s reports of their difficulties and SBPs and ISBPs is also very limited. The current study investigated the relations between both caregiver- and child-reported trauma-related symptoms and SBPs and ISBPs among 248 treatment-seeking sexually abused children (ages 6–12; M = 8.06, SD = 2.52; 64.5% female; 55.6% white). Children’s caregiver-reported trauma-related sexual concerns and anger were associated with SBPs. For ISBPs, only caregiver-reported sexual concerns were related to ISBPs. Surprisingly, none of the child-reported symptoms were associated with either SBPs or ISBPs. Trauma-related sexual concerns and anger may be tied to SBPs, whereas other clinical difficulties may be less strongly implicated. Trauma-related sexual concerns may be most important in understanding interpersonally focused SBPs. Children’s self-reported difficulties may be unrelated to caregiver-reported SBPs, or these results may be a function of a low degree of caregiver and child symptom concordance.
Premature termination from child trauma-focused treatment is common; however, the role of children's level of symptoms as a risk factor for attrition remains uncertain. In particular, children's sexual behavior problems (SBPs) have received scant attention in the prior attrition literature, and no known studies to date have thoroughly examined SBPs in relation to premature treatment termination. The current study investigated whether higher levels of children's SBPs were associated with increased risk for attrition from trauma-focused treatment in a sample of 242 sexually abused children aged 2-12 years (M = 7.48 years, SD = 2.68; 64.5% female, 54.1% White). To assess the potential associations between SBPs and treatment dropout more thoroughly, two definitions of attrition were utilized: (a) clinician-rated dropout and (b) whether the child received an adequate dose of treatment (i.e., 12 or more sessions). Whereas only 34.3% of the children completed treatment per their clinician, 69.4% received an adequate dose of treatment. In contrast to the study hypotheses, neither development-related nor sexual abuse-specific SBPs were associated with either clinician-rated dropout or adequate dose status, ORs = 0.99-1.00. Sexual acting-out behaviors in sexually abused children may not correspond with attrition from trauma-focused treatment at multiple points of treatment. Given the heterogeneity of SBPs, further assessment of whether attrition patterns differ across subgroups of children who exhibit SBPs is needed.
Background:
Although prior research has indicated that sexual behavior problems (SBPs) are present among maltreated and non-maltreated children, risk factors for SBPs remain understudied. Further, few studies have examined multiple forms of trauma such as exposure to community violence and several likely important familial and environmental factors have yet to be investigated in the context of SBPs. The use of a more comprehensive ecological model of child, trauma-related, family, and environmental risk factors may help to further delineate the factors that contribute to the development of SBPs.
Objective:
The aim of the current study was to build upon previous research by utilizing an ecological model that includes child, trauma-related, caregiver and familial, and environmental factors as potential predictors of SBPs.
Participants and setting:
The present study was conducted with 1,112 8-year-old children (51.6% female; 48.9% Black) and their primary caregivers from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) study.
Results:
Several child, caregiver, and familial factors, as well as sexual and physical abuse demonstrated bivariate associations with SBPs. A number of these factors remained significant in a regression model, such as child's living arrangement, child's aggressive behaviors and posttraumatic stress symptoms (PTSS), sexual and physical abuse, caregiver's psychological difficulties, and children's perceptions of family health.
Conclusions:
The findings highlight the role of select child, trauma-related, caregiver and familial, and environmental factors in the context of SBPs and also demonstrate the need to examine multiple levels of children's environments when investigating SBPs.
The importance of the involvement of parents in treatment approaches for children and young people who have engaged in harmful sexual behaviour (HSB) has been consistently highlighted within the literature. Despite this, very little is known about their lived experiences of their relationship with their child following HSB and their representations of meaning remain largely unexplored. Semi-structured interviews with six parents were conducted to address this gap in the literature. Interviews were examined using Interpretative Phenomenological Analysis (IPA), resulting in five main themes; Feelings evoked: “it’s disturbing to be honest”; Searching for meaning: “where is this coming from?”; Child’s identity as fragmented: “you never knew what you got”; Wanting distance: “I just couldn’t bear to be around him”; and Moving forwards; “I gave him a cuddle”. Policy and clinical practice implications are discussed including the importance of systemic approaches to intervention.
Early childhood and primary educators’ and carers’ education and support in identifying and responding appropriately to children displaying problematic sexual behaviours has fallen behind the demands currently arising in care and education sites in Australia. This is a key finding of research examining professional educators’ and carers’ experiences of problematic sexual behaviours in their workplaces, their understanding of problematic sexual behaviours, and their source of training in this area. This paper reports on the professional development, workplace and community support for educators and affected children, which educators and carers wanted to have implemented to more adequately respond to their professional needs and the needs of affected children and their families. The research was conducted using an online survey in 2016 and involved 107 respondents from government, independent and Catholic primary schools, preschools and care organisations.
Background:
One of the determinants of successful service engagement to address problem sexual behaviours in children is the response when a parent/carer first discloses the behaviour, often to a trusted professional such as a teacher, allied health professional or the family general practitioner (GP).
Objective:
The objective of this article is to guide the response of medical professionals to parents/carers of children exhibiting problem sexual behaviours, to increase the likelihood of successful support service engagement.
Discussion:
Problem sexual behaviours in children can be a predictor of trauma or abuse, and their discovery can have a devastating impact on parents and families, sometimes leading to denial, blame, rejection and relationship breakdown. Understanding parental reactions, using correct terminology, and responding with sensitivity and understanding can increase the likelihood of successful service engagement and intervention.
Dans les milieux d’intervention, les enfants référés pour agression sexuelle (AS) et ceux référés pour comportements sexuels problématiques (CSP) sont généralement perçus comme deux populations cliniques distinctes. Bien que des services spécifiques soient dispensés à ces deux clientèles, il est possible d’observer de nombreux chevauchements entre ces deux clientèles dans la littérature scientifique. Or, ces nombreux chevauchements pourraient suggérer qu’une certaine proportion de ces enfants puisse présenter des caractéristiques et des besoins communs en matière d’intervention.
Cette thèse par articles a pour objectif d’approfondir notre compréhension du lien entre les problématiques de l’AS et celle des CSP, par la production de deux articles qui traitent de cette question sous deux angles différents, soit un premier article portant sur les facteurs associés au développement des CSP et un second article portant sur l’identification de profils psychosociaux chez les enfants référés pour AS ou pour des CSP.
Le premier article de la thèse recense de façon systématique les facteurs associés aux CSP, à partir de 18 études sélectionnées en fonction de critères préalablement définis. Une adaptation du modèle théorique proposé par Friedrich (2007) a été utilisée pour classer les facteurs recensés au sein de cinq domaines de risque liés au développement des CSP. Les résultats démontrent que la vaste majorité des études s’étant penchées sur le lien entre l’AS et les CSP concluent que les enfants manifestant des CSP sont davantage susceptibles d’avoir été victimes d’AS que les enfants ne manifestant pas de CSP. En outre, les résultats de la recension confirment la pertinence du modèle théorique proposé pour expliquer le développement des CSP.
Quant à lui, le second article vise à 1) identifier les différents profils psychosociaux d’enfants référés à des services en raison de leurs CSP ou suite à une AS subie, et 2) comparer la proportion d’enfants issus de ces deux clientèles dans chacun des profils identifiés. L’échantillon est constitué de 147 enfants québécois (62 % de garçons) âgés de 6 à 12 ans, dont 117 enfants qui sont en voie de recevoir un traitement destiné aux enfants qui présentent des CSP et 30 enfants pour qui une AS a été jugée fondée par les services de protection de l’enfance. Les indicateurs de quatre des cinq domaines de risque de l’adaptation du modèle théorique de Friedrich (2007) ont été utilisés dans la création des profils psychosociaux. À partir d’une analyse de classes latentes, trois profils psychosociaux d’enfants ont été identifiés : 1) les enfants résilients, 2) les enfants impliqués dans un cycle intergénérationnel de maltraitance, et 3) les enfants au fonctionnement grandement perturbé. Par ailleurs, les enfants référés pour des CSP et ceux référés suite à une AS se répartissent dans des proportions similaires dans chacun des profils. Les résultats soutiennent l’hypothèse selon laquelle les enfants issus des deux clientèles pourraient bénéficier d’interventions qui tiennent compte des spécificités des trois profils psychosociaux identifiés, plutôt qu’en privilégiant une intervention standard pour chacune des clientèles.
En somme, les résultats présentés dans cette thèse contribuent à démontrer un chevauchement important entre les deux clientèles à l'étude. De plus, les résultats exposent certaines caractéristiques communes chez une proportion importante d’enfants issus des deux clientèles, dont les symptômes liés au trauma, les problèmes de comportements extériorisés et la victimisation du parent dans l’enfance. Ainsi, il pourrait être judicieux d’explorer la possibilité d’offrir des interventions qui soient assorties aux particularités cliniques des enfants, plutôt qu’en fonction du motif de référence aux services d’intervention (AS ou CSP).
Over the past two decades, concern about adolescent sex offenders has grown at an astonishing pace, garnering heated coverage in the media and providing fodder for television shows like Law & Order. Americans' reaction to such stories has prompted the unquestioned application to adolescents of harsh legal and clinical intervention strategies designed for serious adult offenders, with little attention being paid to the psychological maturity of the offender. Many strategies being used today to deal with juvenile sex offenders-and even to define what criteria to use in defining "juvenile sex offender"-do not have empirical support and, Frank C. DiCataldo cautions, may be doing more harm to children and society than good. The Perversion of Youth critiques the current system and its methods for treating and categorizing juveniles, and calls for a major reevaluation of how these cases should be managed in the future. Through an analysis of the history of the problem and an empirical review of the literature, including specific cases and their outcomes, DiCataldo demonstrates that current practices are based more on our collective fears and moral passions than on any supportive science or sound policy.
This book describes an integrative, strengths-based approach to individual and family psychotherapy guided by the effects of abuse trauma on the development of sibling relationships. It fills a void in the training and education of family violence professionals and validates sibling experiences as an important part of human development. The second edition has been revised and updated to reflect more than 15 years of advances in the child maltreatment field. Current essential information on sibling development is provided to clarify the context in which sibling relationships unfold, and research on sibling relationships throughout the life course is incorporated into a clinical approach for treating victims and survivors. This second edition, much like the first, focuses primarily on assessment and treatment. Rather than choosing to concentrate solely on sibling sexual abuse or assault, the book applies a more inclusive, integrative approach to the study of sibling abuse trauma. The clinical material and experiences portrayed take a trauma-informed systemic orientation and represent children, families, and adults who may not have been described adequately elsewhere. Concrete illustrations and extended session transcripts demonstrate therapeutic principles in action. Whether you incorporate these findings into your clinical practice or become inspired to conduct your own research, Sibling Abuse Trauma will improve your understanding of how to treat and evaluate individuals and families with sibling abuse-related concerns.
To investigate which disruptive behaviors in preschool were normative and transient vs markers of conduct disorder, as well as which disruptive behaviors predicted the persistence of conduct disorder into school age.
Data from a longitudinal study of preschool children were used to investigate disruptive behaviors. Caregivers of preschoolers ages 3.0-5.11 years (n = 273) were interviewed using the Preschool Age Psychiatric Assessment to derive the following diagnostic groups: conduct disorder, externalizing disorder without conduct disorder, internalizing disorder without externalizing disorder, and healthy. At school age, participants were again assessed via an age-appropriate diagnostic interview. Logistic and linear regression with pairwise group comparisons was used to investigate clinical markers of preschool conduct disorder and predictors of school age conduct disorder.
Losing one's temper, low-intensity destruction of property, and low-intensity deceitfulness/stealing in the preschool period were found in both healthy and disordered groups. In contrast, high-intensity argument/defiant behavior, both low- and high-intensity aggression to people/animals, high-intensity destruction of property, high-intensity deceitfulness/stealing, and high-intensity peer problems were markers of preschool conduct disorder and predictors of school age conduct disorder. Inappropriate sexual behavior was not a marker for preschool conduct disorder but was a predictor of school age conduct disorder.
These findings provide a guide for primary care clinicians to help identify preschoolers with clinical conduct disorder and those who are at risk for persistent conduct disorder in childhood. Preschoolers displaying these symptoms should be targeted for mental health assessment.
Copyright © 2015 Elsevier Inc. All rights reserved.
Why do many people continue to believe that juvenile delinquents are getting younger and that they commit more serious crimes at earlier ages than the young offenders of 10 or 15 years ago? This study compared the characteristics of young offenders arrested in recent years with those arrested in 1980 and analyzed the juvenile court’s response to those offenders once they had been charged. Findings suggest that today’s serious and violent juvenile offenders are not significantly younger than those of 10 or 15 years ago. Yet many juvenile justice professionals, as well as the public, would assert the opposite. The study suggests several factors are at work: (1) Overall growth in the number of violent juvenile offenders has drawn increased attention to the problem of young offenders in general; (2) The nature of the delinquency cases involving juveniles age 12 or younger has changed; (3) Delinquency caseloads have doubled nationwide since 1970; (4) Justice professionals tend to accumulate memories of exceptional cases; and (5) The news media have increased their reporting of crime, especially violent crimes by the very young.
The sexually abused child has been described as more fearful, anxious, depressed, and guilty in comparison to normal children. However, these descriptions are largely derived from clinical impressions and little systematic exploration of the nature and extent of behavior problems among these children. The present study investigated the problem behaviors of a group of preschool and elementary-aged sexually abused children (N = 93) in comparison with a sample of nonabused children from a psychiatric outpatient clinic (N = 64) and a sample of nonabused children from a well child clinic (N = 78). Behavioral strengths and weaknesses in these children were examined by administering the Achenbach Child Behavior Checklist to their mothers. Sexually abused children displayed a significantly greater number of behavior problems than normals but were not as significantly disturbed as the psychiatric outpatients. The sexually abused children did display significantly more sexual problems than either comparison group. Caseworkersl therapists for the sexually abused child provided ratings of family conflict, cohesion, and support of the child. These were significantly related to the extent of behavior problems in the sexually abused children. This relationship equaled or exceeded the relationship of severity of sexual abuse to behavior problems.
Treatment of sexually abusive youth was initially informed by what had been learned in the treatment of adults who sexually offend. However, over time, important differences in understanding the developmental progression and in treatment approaches have evolved, some of which may now be used to inform the work with adults as well.
This paper presents initial validation data for a behavioral inventory of child conduct problems. The 36‐item Eyberg Child Behavior Inventory (ECBI) was completed by mothers of two‐ to seven‐year‐old children from several samples of problem and non‐problem behavior children. Results from this study indicated the usefulness of the ECBI in discriminating between problem and non‐problem children, for purposes of evaluation; provided data on the non‐problem child as a guideline in defining reasonable therapeutic goals; and demonstrated the ability of the ECBI to reflect the change following treatment intervention.
A sample of 31 boys sexually assaulted in the previous 18 months was compared on the Child Behavior Checklist with 33 boys who had a diagnosis of oppositional or conduct disorder. The boys ranged in age from 3 to 8 years old. The conduct-disordered boys were being seen in outpatient therapy with their parents. The two groups did differ significantly, with the sexually abused group being less externalizing and more sexualized than the conduct disorder group.
Effects of child sexual abuse are conceptualized as the result of conditioned anxiety and as socially learned responses to the victimization experience. This conceptualization is used to link existing psychological theory and research to therapeutic interventions. Strategies are proposed to alleviate anxiety, modify maladaptive beliefs and cognitions, restore or instate expectations of self-efficacy, and mitigate disturbed sexual attitudes or behaviors.
A normative sample of 880 children was contrasted with a sample of 276 sexually abused children on the Child Sexual Behavior Inventory (CSBI), a 35-item behavior checklist assessing sexual behavior in children 2–12 yrs old. The CSBI total score differed significantly between the 2 groups after controlling for age, sex, maternal education, and family income, with sexually abused children showing a greater frequency of sexual behaviors than did the normative sample. Test–retest reliability, interitem correlations, cross-validation, and correlations with abuse characteristics were also reported. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Describes a self-report measure of children's aggressiveness, assertiveness, and submissiveness, the Children's Action Tendency Scale. The development and validation of the measure followed the behavioral-analytic method described by M. Goldfried and T. J. D'Zurilla (1969). The measure's 3 subscales were shown to be highly correlated with peer and teacher reports of 6–12 yr old Ss' interpersonal behavior and to have moderate split-half and test–retest reliabilities. Scores on the Submissiveness subscale correlated positively with social desirability (Children's Social Desirability Questionnaire) scores and negatively with self-esteem (Self-Esteem Inventory) scores, and a negative correlation was found between Ss' aggressiveness scores and their social desirability scores. In addition, highly significant differences on the Aggressiveness and Assertiveness subscales were found between public school Ss and clinically aggressive children. Recommendations for the questionnaire's use and for further research are discussed. (23 ref)
The article describes a clinical sample of 87 boy victims of child sexual abuse and compares them to 226 girl victims. Boys were on average 6.3 years of age at onset of the sexual abuse; girls were 5.5 years. Boys were more likely to be victimized by someone outside the family than girls, but about two-thirds of the boys were abused by someone within the family. Male victims were more often abused by someone who sexually abused other children than were female victims. The majority of perpetrators were men; however girls were more likely than boys to be abused by men, and boys by both men and women. Only a small percentage of the offenders were women acting alone, but boys were more likely to be abused by women than girls. In addition, data on the role relationship between victim and offender and how these relationships differ for boy and girl victims are presented.
A sample of 85 children, ages 3 to 12, and sexually abused within the previous 24 months, were avaluated with the Child Behavior Checklist (CBCL). Data relating to the nature of the abuse were also collected. This sample was clearly more deviant behaviorally as measured by the CBCL. Internalizing behavior was related to the frequency of abuse, the sex of the child, the relationship of the perpetrator to the child, and the severity of abuse. Externalizing behavior was related to the duration, perpetrator's relationship, time elapsed, and sex of the child. Sexual behavior in this sample was related to frequency of abuse and number of perpetrators.
Children suffer more victimizations than do adults, including more conventional crimes, more family violence, and some forms virtually unique to children, such as family abduction. On the basis of national statistics, these victimizations can be grouped into three broad categories: the pandemic, such as sibling assault, affecting most children; the acute, such as physical abuse, affecting a fractional but significant percentage; and the extraordinary, such as homicide, affecting a very small group. They can also be differentiated by the degree to which they result from the unique dependency status of children. A field called the victimology of childhood should be defined that adopts a developmental approach to understanding children's vulnerability to different types of victimizations and their different effects.
The epidemiology of child abuse was investigated with data from the Second National Incidence and Prevalence Study of Child Abuse and Neglect. A statistical comparison of incidence rates suggested that age, family income, and ethnicity were risk factors for both sexual abuse and physical abuse, but county metrostatus was not. Gender was a risk factor for sexual abuse but not for physical abuse. A logistic regression analysis showed that ethnicity, county metrostatus, and a gender-by-income interaction distinguished sexual abuse from physical abuse.
A dual taxonomy is presented to reconcile 2 incongruous facts about antisocial behavior: (a) It shows impressive continuity over age, but (b) its prevalence changes dramatically over age, increasing almost 10-fold temporarily during adolescence. This article suggests that delinquency conceals 2 distinct categories of individuals, each with a unique natural history and etiology: A small group engages in antisocial behavior of 1 sort or another at every life stage, whereas a larger group is antisocial only during adolescence. According to the theory of life-course-persistent antisocial behavior, children's neuropsychological problems interact cumulatively with their criminogenic environments across development, culminating in a pathological personality. According to the theory of adolescence-limited antisocial behavior, a contemporary maturity gap encourages teens to mimic antisocial behavior in ways that are normative and adjustive.
A review of 45 studies clearly demonstrated that sexually abused children had more symptoms than nonabused children, with abuse accounting for 15-45% of the variance. Fears, posttraumatic stress disorder, behavior problems, sexualized behaviors, and poor self-esteem occurred most frequently among a long list of symptoms noted, but no one symptom characterized a majority of sexually abused children. Some symptoms were specific to certain ages, and approximately one third of victims had no symptoms. Penetration, the duration and frequency of the abuse, force, the relationship of the perpetrator to the child, and maternal support affected the degree of symptomatology. About two thirds of the victimized children showed recovery during the first 12-18 months. The findings suggest the absence of any specific syndrome in children who have been sexually abused and no single traumatizing process.
Attention-deficit hyperactivity disorder (ADHD) is a prevalent, persistent, and often perplexing behavioral disturbance of childhood. The typical clinical picture is that of a child with normal intelligence—most often a boy—who shows patterns of attentional deployment, impulse control, and behavioral regulation that (1) are severely deficient for his age or general developmental level, (2) have persisted since early childhood, (3) appear in multiple settings (e.g., school and home), and (4) are not explicable on the basis of other severe psychopathology (American Psychiatric Association, 1993). Thus, despite normal appearance and intellectual capacity, such a child has great difficulties negotiating the developmental tasks of childhood. Through overzealousness, disruptive tendencies, and lack of judgment, he exasperates parents and teachers alike. Furthermore, most peers actively reject him, largely because of an immature and aggressive behavioral style (see Erhardt, 1991; Pelham & Bender, 1982). In many cases, difficulties with schoolwork are salient, accumulating over time to precipitate academic failure (Hinshaw, 1992). Low self-esteem and frustration are common, as vicious cycles of negative interaction patterns ensue in home, school, and community settings.
In the past decade investigators have begun to emphasize the clinical, prognostic, and theoretical importance of hyperactive children’s social interactions (Barkley, 1982; Campbell & Paulauskas, 1979; Milich & Landau, 1982; Pelham & Bender, 1982; Whalen & Henker, 1985). Indeed, such social and interpersonal phenomena as disruptive interactions in classrooms, aggression against children and adults, noncompliance with parental directions, and disturbed peer relationships are currently considered to be as central to hyperactivity as are the “core” features of inattention, impulsivity, and motor overactivity (Barkley, 1985b; Hinshaw, 1987a; Pelham & Milich, 1984). Indeed, because of their tendencies to elicit undesirable reactions from others, hyperactive children have been characterized as “negative social catalysts” (see Whalen, Henker, Castro, & Granger, 1987a). Furthermore, the deficient social skills and disturbed interpersonal relationships of these children are likely to be implicated in their relatively poor prognoses with respect to adolescent and young adult functioning (Barkley, Fischer, Edelbrock, & Smallish, 1990; Gittelman, Mannuzza, Shenker, & Bonagura, 1985; Satterfield, Hoppe, & Schell, 1982; Weiss, Hechtman, Milroy, & Perlman, 1985). Clearly, no consideration of hyperactivity can ignore the social domain.1
Concern about the acceptability of various child-to-child sexual behaviors has heightened during the past few years. Some clinicians and researchers have put forward opinions regarding which sexual behaviors between children are acceptable and/or developmentally appropriate and which sexual behaviors are unacceptable and/or developmentally inappropriate. However, these opinions have little empirical support. This article describes a study of 335 professionals' opinions about the acceptability of various noncoercive sexual behaviors between children at ages 4, 8, and 12. It also describes a survey of 664 undergraduates' recollections of sexual experiences that they had with other children prior to the age of 13. The ways in which this research may inform beliefs about sexual encounters between children are discussed.
Reviews evidence regarding the efficacy of stimulant medications in treating aggression and antisocial behavior in externalizing youngsters, particularly those with attention-deficit hyperactivity disorder (ADHD). Despite claims that stimulant medication is not efficacious with respect to aggression, recent investigations with behavioral observation methodologies in large-group settings have revealed clinically significant reductions of aggressive behavior with stimulant treatment. Furthermore, among youngsters with attentional problems, both aggressive and nonaggressive subgroups show a positive response to such medication. Discussion focuses on the need for multimodality interventions with externalizing children.
Child victims of sexual abuse face secondary trauma in the crisis of discovery. Their attempts to reconcile their private experiences with the realities of the outer world are assaulted by the disbelief, blame and rejection they experience from adults. The normal coping behavior of the child contradicts the entrenched beliefs and expectations typically held by adults, stigmatizing the child with charges of lying, manipulating or imagining from parents, courts and clinicians. Such abandonment by the very adults most crucial to the child's protection and recovery drives the child deeper into self-blame, self-hate, alienation and revictimization. In contrast, the advocacy of an empathic clinician within a supportive treatment network can provide vital credibility and endorsement for the child.
[describes the implementation of relapse prevention (RP)] model in assessing and treating juvenile [sex] abusers / RP has served three distinct functions in sex offender treatment: (1) an Internal, Self-Management Dimension used to enhance the client's self-control; (2) an External, Supervisory Dimension used by a "prevention team" of professional and collateral contacts [including mental health personnel, probation officers and family members] who monitor the juvenile's behaviors and who model appropriate behaviors; and (3) a conceptual framework, which integrates highly specific therapeutic interventions within a unifying theory / each of these functions of RP is discussed (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Examined the relationship between poverty and violence toward children drawing on data collected in national family violence surveys (M. A. Straus et al, 1980; R. J. Gelles and Straus, 1988) held in 1976 (2,143 households) and 1985 (6,002 households). Data support the claim that violence and abuse occur in families across income categories. However, abusive violence was more likely to occur in poor homes. Social and demographic characteristics increased the likelihood that poverty will lead to abuse. Poor young parents who are raising young children have an elevated risk of using the most abusive forms of violence toward their children, as do poor single mothers. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article is the first report from a 5-year demonstration project examining the comparative efficacy of specialized and
traditional treatments with children who have exhibited sexual behavior problems. Baseline data concerning the demographics,
psychological adjustment, and victimization and perpetration histories of 72 6 to 12-year-old children who have engaged in
sexual misbehavior are reported in this article. Information regarding the caregivers and extended families of these children
is also presented. The data clearly demonstrate that families of children with sexual behavior problems are marked by an array
of characteristics indicative of parental and familial distress, including high rates of (1) violence between parents; (2)
sexual victimization and perpetration with the extended family; (3) physical abuse of the children who have exhibited sexual
behavior problems; (4) children who have witnessed violence between their parents; (5) parental arrest; (6) denial of responsibility
for perpetration of sexual abuse by members of the extended family; (7) poverty; (8) special educational services; (9) prior
therapy for children; and (10) clinical scores on behavioral rating instruments. In particular, several significant differences
emerged between younger children (6–9 years) and older children (10–12). Younger children had (1) been sexually and physically
abused at an earlier age; (2) been more likely to have witnessed physical violence between parents; (3) performed problematic
sexual behaviors at an earlier age; (4) a higher annual rate of problematic sexual behaviors; (5) had a higher percentage
of hands-on sexual behaviors; and (6) had higher scores on measures indicative of sexual behavior problems (e.g., Child Sexual
Behavior Inventory, Child Behavior Checklist—Sexual Problems Subscale). Based on these data, treatment recommendations are
made for families containing children with sexual behavior problems. Given the extensive data suggesting parental characteristics
that could serve as mediating variables in the sexual behavior problems of their children, effective intervention requires
the involvement of the children's caregivers. The comparative efficacy of specialized and traditional treatments for these
families will be reported in subsequent articles.
In this paper we examine the relationship between neighborhood poverty and three different types of child maltreatment; neglect, physical abuse, and sexual abuse. We explore both rates of reporting and rates of substantiated reports across low, moderate, and high poverty areas. We use 1990 Census data and Child Protective Services (CPS) data to study this relationship. We find that neighborhood poverty is positively associated with all three forms of child maltreatment, but to different degrees. Of the three types of child maltreatment, child neglect is most powerfully associated with neighborhood poverty status.RésuméCet article examine le lien entre la pauvreté du voisinage et 3 types de maltraitance: la négligence, les mauvais traitements physiques et l'abus sexuel. Nous explorons aussi bien les signalements que les signalements confirmés dans des quartiers pas trés pauvres, modérément pauvres et très pauvres. Nous utilisons le Recensement 1991 et les données des Services de Protection de l'Enfance pour étudier ce lien. Nous trouvons que la pauvreté du voisinage est associée positivement aux trois types de maltraitance, mais à des degrés divers. Des trois types de maltraitance, c'est la négligence qui est le plus associée à la pauvreté du voisinage.ResumenEn este artículo se estudia la relación entre la pobreza del vecindario y tres tipos diferentes de maltrato infantil: negligencia, maltrato fisico, y abuso sexual. Se exploran las tasas de notificaciones y de notificaciones confirmadas en areas de pobreza baja, moderada, y alta. Para estudiar esta relación se utilizan datos del censo de 1990 y datos de los Servicios de Protección Infantil. Se encuentra que la pobreza del vecindario está asociada positivamente con las tres formas de maltrato infantil, pero en grados diferentes. De los tres tipos de maltrato, la negligencia es la que está asociada de manera más intensa con la pobreza del vecindario.
This study reports gender and race differences found in seven types of characteristics for 15,758 households in Indiana that were investigated by Law Enforcement and/or Child Protection Services for child sexual abuse. Twelve hypotheses, generated from a literature review, were supported by the empirical testing of the data. Major conclusions include: (a) child sexual abuse is a complex, multi-faceted problem that involves dysfunctions at all ecological levels, (b) significant correlates accounting for between-race and between-gender differences in sexual abuse can be used for program planning, implementation, and evaluation, (c) future services require the development of community-wide cooperative programs; and (d) program implementation and evaluation require the integration of knowledge and skills of all professionals from different disciplines. More detailed descriptions of future programs and service needs are also discussed in reference to three (primary, secondary, and tertiary) types of prevention of child sexual victimization.
This research examined demographic and functional characteristics of parents of children with sexual behavior problems.
Families of 72 children with sexual behavior problems completed a structured interview and several psychometric devices at intake into a treatment outcome study.
As a group, caregivers manifested signs of a high level of life stress across a wide array of variables, including income, criminal arrest, family violence, sexual abuse, social support, modulation of emotion, and attachment to their child. Foster parents consistently reported significantly lower levels of stress than biological parents.
Parents and families of children with sexual behavior problems appear multiply entrapped. They are highly distressed and somewhat isolated. The data convincingly demonstrate that in order to maximize the efficacy of treatment for children with sexual behavior problems, parents must be centrally involved and receive services coordinated with those of their child. Group treatment may be advisable to foster formation of a network of peer support for caregivers of children with sexual behavior problems.
A widely variable overlap ranging from 10 to 92% has been reported in the literature between attention deficit disorder with hyperactivity (ADDH) and learning disability (LD), most likely a result of inconsistencies in the criteria used to define LD in different studies. The following study seeks to more accurately determine rates of LD in clinically referred children. Using a psychometrically reliable methodological approach, it was expected that the rate of LD in ADDH children would be far more modest than previously reported. Subjects were referred children with ADDH (N = 60), children with academic problems (N = 30), and normal controls (N = 36) of both sexes with available psychological and achievement testing. Using a liberal definition of LD, significant differences were found between the groups (ADDH = 38% versus academic problems = 43% versus normals = 8%; p = 0.002). In contrast, more modest rates were found using two more stringent methods of assessment (23 and 17%; 10 and 3%; 2 and 0%, respectively; p = 0.02). Arithmetic-based LD appears to be equally identified by both stringent methods, whereas the liberal definition overidentified children in all three groups. These findings show that a liberal definition of LD overidentifies LD not only in ADDH children but also in normal children.
The paper presents four alternative confirmatory factor models to represent the structure of measures of attention deficit and conduct disorder obtained from multiple sources. These models range in complexity from a simple one-factor model with no method effects to a two-factor model with method effects. These models were fitted to data gathered on maternal, teacher and self-report of attention deficit and conduct disorder for a sample of New Zealand children studied at ages 9 and 10 years. The analysis strongly suggests that the best representation of the data was a two-factor model in which there were distinct factors of attention deficit and conduct disorder with these factors being highly correlated (r = 0.87-0.88). It is suggested that the most suitable clinical nomenclature may be to describe conduct disorder and attention deficit generically as externalizing disorders, subscripting this classification with clauses which describe the relative contributions of conduct disorder and attention deficit. The implications of this finding for the measurement, classification and explanation of conduct disorder and attention deficit disorder are discussed.
This report assesses current knowledge about the ecological determinants of child maltreatment and presents data from an aggregate study of co-variation between seven community characteristics and maltreatment rates. A review of these findings revealed literature in the early stages of development. Nothing is known about the ecology of sexual abuse, and studies of physical abuse and neglect have done little more than demonstrate co-variation between reported incidence and neighborhood population and housing characteristics. Study findings reveal that (a) five of the seven community characteristics are significant and independent correlates of neglect, and four are correlates of abuse; (b) the strongest predictors of both types of maltreatment are percentage of families with income less than 200% of poverty and percent of vacant housing; and (c) the pattern of co-variation between the two economic stress indicators and three inadequate social support indicators are consistent with the ecological hypothesis. Discussion focuses on interpretation of findings and recommendations for future research.
Little is known about sexual perpetration by females or by young children. This paper describes the sexual perpetration behavior of 13 female child perpetrators between 4 and 13 years of age. These children were treated in a specially designed program for child perpetrators, the Support Program for Abuse-Reactive Kids (SPARK) at Children's Institute International of Los Angeles, California. All of these girls used force or coercion to gain the compliance of the other child or children. Of these child perpetrators, 100% had been previously sexually abused; 31% had been physically abused; 85% were molested by family members; 77% of the girls chose a victim in their family (the other 3 girls had no available family members). The mean age of their first known perpetration was 6 years, 9 months. The average age of their victims was 4 years, 4 months. The average number of victims of these girls was 3.5 with a range of 1 to 15. The girls victimized two times more boys than girls. There was a history of sexual, physical, and substance abuse in the families of these children. Hypotheses regarding the genesis of the sexually abusive behavior in these female child perpetrators are explored.
This study examines whether molestation is most likely to occur before or after the onset of puberty and also whether molestation is likely to be a one-time occurrence or last for a long time. The study analyzed intake interviews from 365 adults molested as children (AMACs). The AMACs were entering treatment at the Child Sexual Abuse Treatment Program, San Jose, CA. This paper presents data on the age of onset and end of the molestation and the duration of the molestation in years. For this sample, the average age of onset was 7.5; the average age at the end of the molestation was 13. The overwhelming majority of molestations lasted one year or more. We discuss results in the context of past studies and suggest areas for further research.
The replies to a survey of more than 1,000 undergraduates concerning childhood sexual encounters are reported. Linear structural equation modeling is employed to analyze which characteristics of the sexual encounters with other children were associated with more positive or negative responses by subjects. Approximately 42% of the subjects reported a childhood sexual encounter with another child. Most encounters involved sexual kissing or exposing of genitalia, and they generally occurred with a friend. High levels of coercion from the other child to gain the subject's cooperation, homosexual encounters, and encounters with those other than friends predicted a more negative response. The type of sexual activity was not associated with response. Subjects who experienced a high level of coercion from another child reacted to their sexual encounter similarly to other subjects who had a sexual encounter with an adult, while those who experienced low levels of coercion rated their encounter with a child more positively.
A retrospective record survey was performed using all child clients aged less than 7 years seen at a community mental health center during the period 1982-1984. The total number of 202 children fell into three groups: sexually abused (n = 37), physically abused (n = 35), and nonabused clinical children (n = 130). These groups were compared in order to learn more about sexual abuse in young children. Family background of both abused groups were similar to each other but differed from the nonabused group in having more factors related to family stress than the nonabused group. Clinical presentations of all the children overlapped a great deal symptomatically; however, the sexually abused children had a statistically significant higher frequency of inappropriate sexual behavior than the other two groups. Several characteristics of the abusive patterns suffered by the two abuse groups differed at or near statistical significance: sexually abused children were more often victimized in single acts by nonrelated child perpetrators than were physically abused children.
This study examined the incidence of childhood physical and sexual abuse in a sample of incarcerated rapists (N=97) and child molesters (N=54). The four major findings were: (a) the incidence of sexual assault in childhood among child molesters was higher than the incidence of such abuse reported in the literature; (b) the incidence of sexual assault in childhood among child molesters was more than twice as high as the incidence among rapists; (c) rapists were three times more likely to be victimized by a family member than were child molesters; and (d) when a sexual assault did occur, it was associated with many other indices of familial turmoil and instability.
The authors interviewed 34 young people who had been sexually abused as children 6 or 8 years after the abuse had occurred and compared them with 34 control subjects who had not been abused. They also compared subjects who had been abused for less than 1 year with those who had been abused for more than 1 year. The findings suggest a link between childhood sexual abuse and later drug abuse, juvenile delinquency, and criminal behavior. The authors explore the effects of pretrauma factors of previous childhood physical abuse and parental modeling of aggression and the postdisclosure factors of social and family blaming.
The DSM III category of Attention Deficit Disorder with Hyperactivity is considered within a framework of Rutter's (1977) outline of criteria for adequacy of psychiatry classification. Discussion of problems with the operationalization and definition of 'attention deficit' and the difficulty of using this rubric in distinguishing between ADDH and other related childhood disorders, along with the consequent failure to meet other important criteria, leads to the conclusion that the concept needs re-appraisal.
Sirmmary.-The clinical usefulness of a previously validated self-repon measure of children's assertiveness was examined for two white school-age samples (ns = 18 and 17; 6 to 14 yr. old) referred for training in group social skills. Subscale scores of a clinical sample supported the norms of the validation samples but the relationship of these scores to parental and self-report measures of self-esteem appeared equivocal. Use w~th a hyperkinetic sample showed the scale's sensitivity to treatment, but faking good during individual testing may be a problem with such children.
Based on multiple regression analysis to identify the socioeconomic, demographic, and attitudinal correlates of neighborhood differences in the rate of child abuse and neglect, a pair of neighborhoods matched for socioeconomic level was selected, one high risk, the other low risk. Interviews with expert informants ranging from elementary school principals to mailmen were used to develop neighborhood profiles. Samples of families were drawn from each neighborhood and interviews conducted to identify stresses and supports, with special emphasis on sources of help, social networks, evaluation of the neighborhood, and use of formal family support systems. The results lend support to the concept of neighborhood "risk." Families in the high-risk neighborhood, though socioeconomically similar to families in the low-risk neighborhood, report less positive evaluation of the neighborhood as a context for child and family development. Furthermore, they reveal a general pattern of "social impoverishment" in comparison with families in the low-risk neighborhood.
Recent genetic evidence suggests that the most important environmental influences on normal and pathologic development are those that are not shared by siblings in the same family. We sought to determine the relationship between differences in parenting styles and depressive symptoms and antisocial behavior in adolescence, and to compare the influence of these nonshared experiences with genetic influences.
We studied 708 families with at least two same-sexed adolescent siblings who were monozygotic twins (93 families), dizygotic twins (99 families), ordinary siblings (95 families), full siblings in step families (181 families), half siblings in step families (110 families), and genetically unrelated siblings in step families (130 families). Data on parenting style were collected by questionnaire and by video recording of interaction between parents and children.
Almost 60% of variance in adolescent antisocial behavior and 37% of variance in depressive symptoms could be accounted for by conflictual and negative parental behavior directed specifically at the adolescent. In contrast, when a parent directed harsh, aggressive, explosive, and inconsistent parenting toward the sibling, we found less psychopathologic outcome in the adolescent.
Parenting behavior directed specifically at each child in the family is a major correlate of symptoms in adolescents. Furthermore, harsh parental behavior directed at a sibling may have protective effects for adolescents, a phenomenon we call the "siblin barricade."
Using census and administrative agency data for 177 urban census tracts, variation in rates of officially reported child maltreatment is found to be related to structural determinants of community social organization: economic and family resources, residential instability, household and age structure, and geographic proximity of neighborhoods to concentrated poverty. Furthermore, child maltreatment rates are found to be intercorrelated with other indicators of the breakdown of community social control and organization. These other indicators are similarly affected by the structural dimensions of neighborhood context. Children who live in neighborhoods that are characterized by poverty, excessive numbers of children per adult resident, populations turnover, and the concentration of female-headed families are at highest risk of maltreatment. This analysis suggests that child maltreatment is but one manifestation of community social organization and that its occurrence is related to some of the same underlying macro-social conditions that foster other urban problems.
Using a prospective cohorts design, we assess the long-term criminal consequences of childhood sexual abuse through an examination of official criminal histories for a large sample of validated cases of childhood sexual abuse, compared to cases of physical abuse and neglect and a control group matched for age, race, sex, and approximate family socioeconomic status. Compared to other types of abuse and neglect, early childhood sexual abuse does not uniquely increase an individual's risk for later delinquent and adult criminal behavior. Childhood sexual abuse victims were at increased risk of arrest as a juvenile for being a runaway. As adults, child sexual abuse victims were at higher risk of arrest for sex crimes than controls, as were victims of physical abuse and neglect. Childhood sexual abuse victims were more likely to be arrested for prostitution as adults than other abuse and neglect victims and controls, regardless of gender. However, there was no support for a direct relationship among child sexual abuse, arrests for running away in adolescence, and adult arrests for prostitution. The findings also suggest an association for males between physical abuse and arrests for violent sex crimes (rape and/or sodomy). Caution is needed in interpreting these findings because of exclusive reliance on official record data and the possible impact of agency intervention.
Empirical research pertaining to sexual behavior in sexually abused children, including record reviews, parent ratings, psychological assessment, self-report, and behavioral observation is reviewed and discussed. Sexual behavior is reported significantly more often in sexually abused children than nonabused children. However, the consistency of this finding varies with the research method.
As part of a larger, prospective study, the authors examined concurrent and prospective relations among parenting and child antisocial behavior in inner-city boys at high risk for delinquent behavior.
One hundred twenty-six younger brothers (aged 6 to 10 years) of convicted delinquents in New York City and their parents were assessed; 15 months later 112 boys were reassessed. Demographics, parenting, and child diagnosis were examined as they relate to child externalizing behavior problems. Hierarchical multiple regression analyses predicted changes in Externalizing scores from year I parenting.
At years I and II, 22% and 27% of boys, respectively, scored above the clinical cutoff for Externalizing. Controlling for earlier Externalizing, each of three domains of parenting still made significant independent contributions to later Externalizing scores, explaining 17% of the variance. Altogether this model explained 51% of the variance in year II Externalizing scores.
Data support a cumulative risk model, whereby each of several adverse parenting factors further compounds the likelihood of child conduct problems.