Sibling Abuse of Other Children

Full text

Sibling Abuse of Other Children
John Caffaro
Contents
Introduction . . . .................................................................................... 2
Historical Context . . . .......................................................................... 3
Identification and Assessment . . . ................................................................. 4
Sibling Physical Abuse . . . . . . . . . . . .. . .. .. . . . .. .. .. . .. .. . .. .. .. . . . .. . .. .. .. . .. .. .. . .. .. . . . .. .. . 4
Distinguishing Between Nonviolent Sibling Conflict and Physical Abuse . . . .............. 5
Identification of Sibling Sexual Abuse . . . . . .................................................. 5
Distinguishing Between Normative Sibling Sexual Contact and Abuse . . . . . . . . . . . . . . . . . . . . 5
Assessment of Sibling Abuse . . . . . . ........................................................... 6
Definitions . . . . . . . . . . . . . . . . . . . . . ................................................................... 7
Sibling Physical Abuse [SPA] . . . . ............................................................ 7
Sibling Sexual Abuse [SSA] . . . .. ............................................................ 7
Sibling Psychological Maltreatment [SPM] . . . ............................................... 8
Prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . .. .. .. .. . .. .. .. . . .. . .. .. .. .. . .. .. .. . . .. . .. .. . 8
Relationship to Other Forms of Family Violence . .. ............................................ 9
Fathers and Sibling Aggression . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Couples and Sibling Aggression . . . . . . . . . . ................................................... 9
Risk and Protective Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. .. .. . .. .. . . .. .. .. .. . .. .. .. .. . . .. . 10
Cultural, Ethnic, and Gender Considerations . . . . . . . . . . .......................................... 10
Gender Considerations . . . ..................................................................... 13
Research on Harmful Effects . . . .................................................................. 14
Sibling Physical Abuse . . . . . . . . . . . .. . .. .. . . . .. .. .. . .. .. . .. .. .. . . . .. . .. .. .. . .. .. .. . .. .. . . . .. .. . 14
Sibling Sexual Abuse . . . . . .................................................................... 14
Sibling Psychological Maltreatment . . . ....................................................... 15
Evidence-Based Treatment Strategies . . . ......................................................... 16
Case Illustration . . . . . . . . . . . . . . . . . . . . . . .. .. .. .. .. .. .. .. . . .. .. .. .. .. .. .. .. .. . . .. .. .. .. .. .. .. .. . . .. .. 17
J. Caffaro (*)
California School of Professional Psychology, Alliant International University, Los Angeles
CA, USA
e-mail: jcaffaro@alliant.edu;Jcaffaro@gmail.com
© The Author(s) 2020
R. Geffner et al. (eds.), Handbook of Interpersonal Violence Across the Lifespan,
https://doi.org/10.1007/978-3-319-62122-7_11-1
1

Current State of Research and Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 21
Policy and Prevention . . . . . . . . . . . . . . . .. .. . .. . .. .. . .. . .. . . . .. .. . .. . .. .. . .. . .. .. . .. . . . .. . .. .. . .. . .. . 21
Summary and Conclusion . . . ..................................................................... 23
Cross-References ... ................................... ........................................... 23
References ... ......................... ................................................... ......... 24
Abstract
Society’s awareness of sibling violence and sexual abuse, and its response, has
lagged behind other child abuse issues and concerns. In comparison with parent–
child abuse, sibling abuse is generally underreported by parents, teachers, mental
health professionals, and communities. Child welfare services and the legal
system are more reluctant to accept and respond to reports of sibling violence
and sexual abuse, and researchers agree that it has received less attention than
other forms of child maltreatment despite good evidence that suggests it is more
common and no less injurious than child abuse when a parent or other adult is the
perpetrator. This chapter describes the historical context of sibling violence and
sexual abuse, factors and methods essential in its identification and assessment,
definitions of sibling physical violence (SPV), sibling psychological maltreat-
ment (SPM), and sibling sexual abuse (SSA), its prevalence and relationship to
other forms of peer and family violence, as well as individual, family, and
ecological risk and protective factors. Cultural, ethnic, and gender considerations
are discussed as well as an overview of clinical research on sibling abuse and its
harmful effects. Evidence-based treatment strategies and clinical case material are
utilized to illustrate fundamentals of a therapeutic approach to child and family
intervention guided by trauma-informed principles. The current state of research
and practice, future directions, and recommendations for policy and prevention
are also summarized.
Keywords
Sibling abuse · Sibling sexual abuse · Sibling physical abuse · Sibling
aggression · Siblings
Introduction
Siblings are a central part of family life. Despite dramatic declines in family size in
the United States over the past century, almost 80% of children live in a home with at
least one sibling and share a family history. But what if that childhood history is
marked by abuse at the hands of a brother or sister? Is there any reason to think that
being abused by the person you live with –your brother –is less traumatizing than
being abused by your life partner? Sibling physical abuse may be at least as harmful
as other forms of familial abuse. van Berkel, Tucker, and Finkelhor (2018) summa-
rize the impacts found to be associated with sibling victimization, which include
2 J. Caffaro

lower self-esteem, depression, anxiety, self-harm, and delinquency. Likewise, sib-
ling sexual abuse has the potential for long-term and significant consequences for
physical health, mental health, and relationship difficulties, and may be as damaging
as sexual abuse by a parent.
This chapter’s focus is limited to the abuse of one sibling by another. Further, the
abuse is generally described from the victim’s point of view. Within these parame-
ters, a life span perspective is adopted that includes discussion of childhood sibling
issues. An inclusive approach is applied that focuses on sibling physical abuse,
psychological maltreatment, and sexual abuse.
Historical Context
Siblings have been trading blows since Biblical times. In Genesis, Joseph’s jealous
older brothers strip him of his coat of many colors and throw him into a pit in the
wilderness. It’s generally conceded that the narrative of Joseph and his brothers
reveals some essential emotional truths about sibling abuse: parents are usually
implicated and power differentials between children figure importantly in abusive
sibling contact. Since the seventeenth century, concentration on the child has been
for the most part viewed through the lens of an adult focus on children –within the
context of the adults on whom they depend rather than on child-on-child contact.
That partially explains why siblings have been largely missing from the family
violence and child maltreatment literature –they are not visible in society except
in the presence of adults. The rise in childhood violence and abuse can be seen as
partly due to the absence of an acknowledgment of violence perpetrated by a
biological sibling.
It’s a somewhat different story outside of the Western world; in the majority of
societies, siblings are principal caretakers and companions of younger children.
However, the strong influence of primarily Western-based sibling research results
in a largely ethnocentric view of sibling relationships. Before the mid-1980s, social
scientists published only a few substantive works concerning sibling relationships
(e.g., Bank and Kahn 1982). Since that time, numerous works have dealt with
various features of the sibling relationship, including siblings across the life span
(Cicirelli 1995), sibling abuse (Caffaro and Conn-Caffaro 1998), lesbian, gay,
bisexual and transgender siblings (Rothblum 2011), siblings of individuals with
disabilities (Rossiter and Sharpe 2001), and sibling bereavement (Fanos 1996).
Systematic studies of siblings began to appear in the literature approximately
30 years ago. Current understanding suggests that childhood sibling relationships
play a significant role in sociocognitive development (Kramer and Kowal 2005),
identity and attachment (White 2001), and emotional development (Tucker et al.
1999). Sibling relationships are also important in shaping an individual’s ability to
navigate other close personal relationships (Dunn 2005; Lockwood et al. 2001).
Systems theory applied to the study of sibling development is concerned especially
with the way change occurs both within and across elements of a family system.
Accordingly, this perspective emphasizes how the dynamics of one element of the
Sibling Abuse of Other Children 3

family system constrain or make possible changes in other elements. A prominent
sibling researcher (Dunn 2007) proposed that the skills learned with siblings may be
considerably more transferable to peer interactions than the skills learned in parent–
child exchanges. Understanding the process of sibling influence is important because
the sibling relationship may be a useful entry point for inducing positive change in a
child’s behavior and adjustment (e.g., Kramer 2004).
Furthermore, with drastic changes in the structure of the contemporary American
family –specifically the steady increase in both parents working outside the home –
siblings feel compelled to rely on one another far more than ever before. Today,
children are more likely to grow up with siblings than with fathers (Caspi 2011). And
unlike friendships, sibling relationships are automatic and exist from birth, or from
the moment when one’s sibling is born. But sibling abuse in childhood is also
somewhat invisible: frequently ignored by parents; rarely studied by researchers;
and considered by many, a normal part of growing up. While areas of familial
violence such as parent–child abuse, intimate partner violence, and elderly abuse
have gained much attention over the past several decades, relatively little consider-
ation has been focused on sibling abuse of other children. The lack of research is
surprising given that studies suggest sibling abuse is actually the most common form
of family violence (Morrill et al. 2018; Straus 2001).
Identification and Assessment
Sibling Physical Abuse
Sibling rivalry alone is not sufficient to explain the presence of sibling physical
abuse. The family is an interdependent unit and the actions of one family member
have an impact on all of the others. In troubled families, parents frequently scapegoat
one child, thus indirectly favoring another. Sibling physical abuse of a brother or
sister in these situations may reflect the child’s way of coping with power imbalances
brought on by parent–child coalitions. Key determinants include how often and how
long the behavior has been occurring, whether the behavior is appropriate to the
children’s ages, and whether one child is chronically harmed by another. Frequently,
what begins as benign competitiveness can escalate into something more when
parents fail to adequately supervise their children and teach them appropriate
means of resolving conflict. In one fairly common set of circumstances, parents
may leave an older sibling in charge of younger children. When a child misbehaves,
the older sibling may resort to extreme behavior to obtain the younger child’s
compliance.
4 J. Caffaro

Distinguishing Between Nonviolent Sibling Conflict
and Physical Abuse
Normal sibling rivalry is often characterized by interaction that leads to healthy
competition without anyone getting hurt. These sometimes-fierce-but-balanced com-
parisons regarding achievement, attractiveness, and social relations with peers may
actually strengthen the sibling relationship as well as teach children how to share,
compromise, and win without humiliation or lose without self-debasement. Violent
sibling conflict is a repeated pattern of physical or psychological aggression that
inflicts harm (Caffaro 2014). A family environment that supports power imbalances,
rigid gender roles, differential treatment of siblings, and lack of parental supervision
increases the risk of sibling physical abuse (Kiselica and Morrill-Richards 2007). An
escalating pattern of sibling aggression that results in the solidification of victim and
offender roles may result in dangerous abuse and must be stopped immediately.
Age differences appear to be more important between children reared with
siblings as caretakers, although this depends somewhat on the role and function
assumed by an older brother or sister. Overall, older siblings are a salient feature in
the lives of their younger brothers and sisters and younger siblings often passively
accept aggressive acts initiated by older siblings.
Identification of Sibling Sexual Abuse
The majority of sibling sexual abuse includes a misuse of power. In most cases, older
brothers sexually abuse younger sisters (Caffaro 2014; Carlson et al. 2006). A
thoughtful discussion of sibling sexual abuse must begin by delineating how to
distinguish between abuse and mutually consensual sexual exploration and curiosity.
Distinguishing Between Normative Sibling Sexual Contact
and Abuse
All children explore their own bodies to some extent and, at times, may engage in
visual or even manual exploration of a sibling’s body. One of the challenges in
collecting reliable data regarding the prevalence of sibling sexual abuse has been the
lack of universally acceptable criteria for distinguishing abusive sexual contact from
normal sexual exploratory behavior.
Sexual contact between siblings is generally considered to be abusive when there
are large age differences between the children (regardless of the form of sexual
activity) and/or when the activities go beyond normal exploration to include oral-
genital contact or intercourse. The closer in age the children are, the more likely the
sexual activity will be viewed as nonproblematic (Caffaro and Conn-Caffaro 2005).
Another way to distinguish “natural curiosity”from sibling sexual abuse appears to
be the presence of coercion. Sibling sexual abuse frequently includes force or
coercion by older or more powerful brothers or sisters. The average age of victims
Sibling Abuse of Other Children 5

at onset of the abuse is 9 years old (Laviola 1992). Offenders are generally older,
averaging about age fifteen. Physical size and strength, intelligence, developmental,
and gender differences can also create situations of power and dominance between
age-mate siblings. For example, a brother close in age to his sister may be able to
coerce her into sexual behavior, especially in a patriarchal family where males enjoy
greater power (Phillips-Green 2002). Parents often struggle with the issue of mutu-
ality; they may view sibling sexual abuse as normal childhood exploration rather
than as containing elements of coercion and force. This can lead to the under
identification of children in need of professional intervention. Additionally, sibling
sexual abuse is more likely to be concealed successfully. Unlike some cases of
parent–child sexual abuse, it does not require the nonparticipating parent’s collusion.
Sibling sexual abuse may also include behavior that may not appear forced but
nonetheless is based on coercion or manipulation. Both siblings may engage will-
ingly in the behavior as an attempt to cope with unmet needs for affection and
affiliation. The sexual contact, however, is usually not limited to developmentally
appropriate, transitory activity, that is, the result of normal curiosity.
Assessment of Sibling Abuse
A thorough evaluation of sibling abuse must assess how the victimized child
functioned before the abuse, the effects of the abuse itself, and what coping skills
and resources are available to support the child’s recovery and improve the func-
tioning and stability of the family. Developmental factors play an important role in
the clinical expression of symptoms. Given the diversity of causal and contributing
factors, family environments, and variations in the severity and intensity of sibling
abuse, assessments should be individualized and ecologically focused.
Out-of-home placements may be necessary when retaining the offending child in
the home can cause harm or significant distress to other members of the household,
when reasonable efforts to restrict problematic sexual behavior have not succeeded,
or when no reasonable efforts have been made to provide a healthy environment for
the children and sibling behavior problems persist (Chaffin et al. 2008). However, a
decision to remove a child should be the exception and not the norm and removal
should be short-term in most circumstances. Every effort must be made to conduct a
thorough family-based risk assessment that can help to determine an appropriate
treatment plan, whether to recommend removal of a child and, if removal is
indicated, how to proceed with reunification. Areas of individual and family strength
and risk must be identified. Information about interaction patterns and individual
personalities, as well as a developmental sibling history, is important in arriving at a
clear treatment plan. Several useful tools for assessing sibling abuse in families have
been developed, including the Sibling Abuse Interview (Caffaro 2014); Scale of
Negative Family Interactions (Simonelli et al. 2002); Conflict Tactics Scale (Straus
et al. 1998); and the Sexual Experiences Survey (Koss and Gidycz 1985).
6 J. Caffaro

Definitions
The lack of universally acceptable criteria for distinguishing normative sexual
contact from abuse, or age-appropriate sibling aggression from physical abuse, has
created significant problems for clinicians, researchers, and child and family protec-
tion agencies. In addition, states differ in their definitions of sibling abuse as a form
of child abuse, and, as a result, child protection caseworkers are frequently called
upon to apply their own definitions of specific behaviors that constitute sibling
abuse.
Sibling Physical Abuse [SPA]
Sibling physical abuse occurs when one member of a sibling dyad nonaccidentally
causes physical harm, injury, or death to a brother or sister. It consists of a range of
behaviors including pushing, hitting, kicking, beating, and using weapons to inflict
physical harm. Several other conditions are often present in families where SPA
occurs: problematic family interactions, adverse environmental influences, and
faulty behavior patterns among siblings that result in the solidification of victim/
offender roles.
Sibling Sexual Abuse [SSA]
Sibling sexual abuse consists of sexual acts initiated by one sibling toward another
without the other’s consent, by use of force or coercion, or where there is a power
differential between the siblings. It may involve children of similar or different ages;
aggression, coercion, or force; harm or potential for harm; occur frequently or
infrequently; and may include minor or advanced sexual behaviors. This includes
sexual behavior that the harmed child is not developmentally prepared for, is not
transitory, and does not reflect age-appropriate curiosity. It may or may not involve
physical touching, coercion, or force. Noncontact sibling sexual abuse may include
behavior that is intended to sexually stimulate the harmed sibling or the offender. It
can include unwanted sexual references in conversation, indecent exposure, forcing
a sibling to observe others’sexual behavior, taking pornographic pictures, or forcing
a sibling to view pornography. It also may include sibling sexual contact perceived
as nonabusive by both victim and offender, which nonetheless meets these criteria.
Professionals and the community are often confused as to when sexual explora-
tion between siblings becomes abusive. The possibility of normative sexual contact
between siblings contributes to a myth of mutuality regarding sibling sexual abuse.
Children, particularly younger children, may engage in inappropriate interactions
without understanding the hurtful effect on brothers or sisters. Therefore, it may be
helpful to talk about a child’s sexually “harmful”behavior rather than sexually
“abusive”behavior.
Sibling Abuse of Other Children 7

Sibling Psychological Maltreatment [SPM]
Sibling psychological maltreatment includes comments by one sibling toward
another aimed at ridiculing, insulting, threatening, terrorizing, bullying, and belit-
tling a child; rejecting, degrading, and exploiting a sibling; destroying a brother or
sister’s personal property; and behavior that includes neglect of a sibling as well as
exposing a sibling to violence by peers or other siblings (Caffaro 2014).
Sibling physical abuse is often accompanied by psychological maltreatment
(Caffaro and Conn-Caffaro 2005). Psychological maltreatment, one of the most
prevalent types of sibling abuse, can be difficult to detect and often persists under
the guise of “teasing.”Researchers regard such maltreatment as more prevalent and
potentially more destructive than other forms of abuse. The term emotional abuse is
often used interchangeably with psychological maltreatment and is probably an
inherent or core element of all forms of child abuse. Yet detection of sibling
psychological maltreatment is complicated by the fact that professionals and parents
have tended to accept emotionally abusive behavior as a normative aspect of sibling
interactions. Thus, many children harmed by sibling psychological maltreatment
may tend to overlook or deny this form of abuse.
Prevalence
Sibling abuse of other children is an extremely common form of family violence, yet
cases of sibling physical, psychological, or sexual abuse generally do not come to the
attention of authorities. Researchers agree that it has received far less attention than
other forms of interpersonal violence despite evidence that suggests it is no less
injurious than parent–child or spousal abuse. Finkelhor, Turner, Shattuck, and
Hamby (2015) report in an analysis of the National Survey of Children’s Exposure
to Violence conducted in the United States between 2013 and 2014 that 21.8% of the
sample had been physically assaulted by a sibling in the study year, compared to
15.2% who had experienced child maltreatment by a parent. Sibling sexual abuse is
estimated to be up to three times as common as child sexual abuse by a parent
(Stroebel et al. 2013).
Unfortunately, more widespread statistics based on reported cases of sibling
abuse do not exist because incidents of child-on-child violence (younger than
12 years old) are currently excluded from the National Crime Victimization Survey
(NCVS). An additional challenge is the lack of a formalized means to collect
accurate data on the incidence of sibling abuse. The National Data Archive on
Child Abuse and Neglect (NCANDS 2011) lists categories of victims by their
relationship to their perpetrator, such as parent, nonparent, foster parent, friend,
and legal guardian; however, no specific category exists for sibling offenders.
8 J. Caffaro

Relationship to Other Forms of Family Violence
Sibling abuse, left unchecked, can set the stage for violent interactions with peers,
and later with intimate partners and children. The evidence demonstrates the strong
effects of sibling violence on the likelihood of engaging in subsequent aggression. In
one study, Button and Gealt (2010) reported that instances of sibling psychological
aggression and physical violence significantly increase the chances of later aggres-
sion: participants in their study who had been verbally abused by a brother or sister
were 18.6% more likely to hit someone with the intent of causing physical pain.
Other findings suggest that the sibling relationship is a training ground for aggressive
behaviors, easily transferred to peers (Menesini et al. 2010) and, in the case of boys,
associated with a later tendency to be violent in intimate partner relationships
(Noland et al. 2004).
Fathers and Sibling Aggression
A father’s role may be particularly salient in forecasting the quality of the sibling
relationship. For example, father-to-child violence is a significant predictor of sibling
violence (Noland et al. 2004). Boys report higher levels of sibling violence and more
closely identify with, and imitate behaviors exhibited by, their male parent or
caregiver. Lower levels of paternal acceptance and involvement have pervasive
negative effects on children and are associated with higher levels of sibling conflict
(Brody et al. 1994). In addition, peripheral fathers are overrepresented in families
experiencing violent interactions between brothers.
Couples and Sibling Aggression
Researchers (Graham-Bermann et al. 1994) have studied the effects of conflict-laden
couples on the development of abusive sibling relationships. Although not every
study isolated the direction of effects (i.e., whether they flow from spousal process to
sibling behavior or vice versa), it seems reasonable to assume that a violent sibling
relationship can be a mirror for a high-conflict or abusive marriage. Children
exposed to parental violence learn to model assaultive behavior in both subtle and
overt ways. Margolin and Gordis (2000) suggest that children learn less about how to
act aggressively than about the “conditions under which aggression may be applied
in intimate relationships”(p. 31). Correspondent deviant beliefs or schemas associ-
ated with growing up in a family with interparental violence include accepting
violence as a way to resolve conflicts, rationalizing the use of violence under
stressful conditions, and devaluing females. Chronic conflict between parents or
caregivers regarding their children’s disputes may cause them to reject parental
authority and give siblings the message that they should take matters into their
own hands.
Sibling Abuse of Other Children 9

Risk and Protective Factors
Sibling abuse is determined by multiple individual and systemic risk and protective
factors. Among these, parental absence, poor parenting practices, and differential
treatment of siblings are thought to play a significant role in intensifying mutual
dependency, sexual curiosity, and hostility between brothers and sisters. Poorly
defined boundaries in the family can increase access to victimized siblings and
power imbalances may promote abusive sibling relationships. Individual risk factors
for sibling offenders may include thinking errors, which distort or minimize abusive
behavior; a history of victimization; empathy deficits; inadequate impulse control
and/or emotional immaturity; substance abuse; and a victim’s dependence on an
older, more powerful sibling. Some evidence suggests that children with special
needs are at increased risk of sibling physical or sexual victimization; more research
is needed in this understudied area of sibling abuse.
Siblings who encounter harsh or neglectful parenting may turn to each other for
compensatory warmth and support. They may target anger intended for parents at
their brothers or sisters. Researchers consistently report that increased access and
opportunity are important risk factors for the development of incestuous relation-
ships between siblings (Rayment-McHugh and Nisbet 2003). Parental lack of
supervision associated with neglect, in conjunction with other risk factors, may
leave one or more children vulnerable to sibling abuse. The quality of a family
support system and the child’s own coping strategies are among the best indicators
for successful recovery following sibling abuse. One of the most salient factors is the
caregivers’ability to provide emotional support (Cohen and Mannarino 2000;
Feiring et al. 1998; Tremblay et al. 1999). Therefore, caregivers’capacities must
be considered in reaching a comprehensive view of a child’s functioning because
higher levels of symptom development in maltreated children is associated with
parental or caregiver impairment such as depression, substance abuse, and person-
ality disorder (McFarlane 1988). These findings become particularly relevant for
sibling abuse victims in light of research (Walsh et al. 2012), which suggest that
parents are significantly more likely to report greater blame and doubt toward their
child when she or he was reportedly abused sexually by a child or adolescent rather
than by an adult (Tables 1and 2).
Cultural, Ethnic, and Gender Considerations
Four studies have directly explored race and ethnicity differences in rates of sibling
aggression and found that compared to African–American and Hispanic children,
White youth report greater frequency (Eriksen and Jensen 2008; Finkelhor et al.
2005; Krienert and Walsh 2011; Tucker et al. 2013). Each interaction between a child
and his or her sister or brother is influenced by the shared history of their relation-
ship. Their connection is also influenced by a wider context, namely the cultural
world outside the family. Every family relationship is set in a particular cultural
10 J. Caffaro

context, and different cultural expectations influence the developmental course of
relationships between siblings.
Cultural adaptation is a fluid process that takes into account what matters to
clients, based on cultural context as well as what matters in their local social context.
Although there are similarities in cultural values based on national origin, for
Table 1 Summary of family risk and protective factors
Risk factors
Parental unavailability and lack of adequate supervision of children in the home
Attachment difficulties in which parents may be physically available but emotionally absent
Ineffective parenting
Low levels of paternal acceptance and involvement linked to higher levels of sibling conflict
Parental favoritism and differential treatment of siblings
Sibling relationships characterized by power imbalances, role rigidity, and unclear boundaries
Consistent disregard for siblings’personal and psychological space, usually indicating more
serious problems
Families with distressed marriages and high levels of parent–child and spousal conflict
The relationship between family functioning and larger ecosystem factors, such as sexism in
society or pornography
Protective factors
Father’s level of positive involvement with sons closely associated with stability of siblings’
behavior problems
Quality of mother–child interaction mediating effects of overt marital conflict on older siblings’
tendency to behave aggressively toward younger siblings
Parental warmth and involved interactions; consistent, nonpunitive discipline management
Affectional ties with alternative caregivers including grandparents and older siblings
Presence and ability to make use of community support systems (i.e., neighbors, teachers,
friends)
Parents learning to create balance between over-involvement in siblings’affairs and a lack of
protective, competent parenting
Table 2 Individual risk factors
Sibling offenders
Offender’s thinking errors that distort or minimize abusive behavior
History of victimization by parent, older sibling, or persons outside the immediate family
Inadequate impulse control, empathic deficits, and emotional immaturity
Willingness to use coercion or force to control victim (sadistic, cruel behavior)
Drug or alcohol use
Dissociative reactions to trauma
Sibling victims
Large developmental, physical, or intellectual differences between siblings
Victim’s dependence on an older, more powerful sibling
Lack of other, supportive relationships
Prior history of victimization
Lack of sex education
Sibling Abuse of Other Children 11

example, these vary depending on economic, occupational, educational, religious, or
generational status. Treatment efforts with siblings are likely to suffer without
implementation strategies that account for cultural values and expectations, accept-
able coping practices within the particular culture, societal roles, assumptions, and
resources. This is a priority for clinical research which can help extend and integrate
cultural conceptualizations into empirically supported practices. Incidents of sibling
abuse of other children among nonwhite children and others outside the majority
culture are especially likely to go unreported. Social and economic barriers and
inequities have significant effects on the rates of interpersonal violence; yet those
barriers also cause fear of reporting and limit access to professional help. The
importance of addressing issues of race, class, and culture, not as “add-ons”external
to the “deeper”themes that concern clinicians but rather as intrinsic parts of the very
themes that come to define an individual’s social and psychological realms cannot be
overstated.
Clinicians working with sibling physical, emotional, and sexual abuse also must
attend to their own cultural contexts. The values that therapists bring to treating
families where sibling abuse has occurred may be incongruent with those of some of
the clients and families served. Awareness of one’s own worldview and specific
biases is particularly important during the assessment phase of working with victims
of sibling abuse trauma and their families, because behavior that the clinician views
as deviant or abnormal may in fact be culturally appropriate. For example, a White
clinician seeing a 9-year-old Latina child with caregiving responsibilities for several
of her younger siblings might be concerned about appropriate boundaries and
hierarchy in the family structure. Mexican families, however, typically include
more siblings than families from other ethnic groups (Colby and Ortman 2015);
those siblings value a hierarchical family structure that emphasizes the importance of
respect for elders, including older brothers and sisters. For an older sibling, devel-
opmentally appropriate caregiving responsibilities are a culturally consonant expec-
tation in such families.
Clinicians must also be attuned to the danger of retraumatizing children and
families by pathologizing them inappropriately. Consideration of within-group dif-
ferences (e.g., acculturation and racial identity status) is an important component of
the assessment process in that a person’s relationship to their culture directly affects
the way in which that person perceives problems and symptoms (Suzuki and Kugler
1995). Culturally diverse families and individuals in the United States vary greatly
with regard to acculturation level, depending on factors such as geographic location,
socioeconomic status, and overall exposure to the US mainstream culture. Accul-
turation level can vary significantly between generations and within a single family,
and intergenerational issues may need to be recognized and addressed sensitively by
the therapist (Gushue and Sciarra 1995).
Sibling ties are strong within many diverse cultures and offer continued support
throughout life. Cousins are often regarded as siblings: they may live together and
serve as primary playmates for one another. This sense of solidarity is often taught
beginning in childhood. In poor and working-class families, it is not unusual for
siblings and cousins to sleep together in one room or one bed, and for several
12 J. Caffaro

extended family members to share a living space. This relationship supports family
solidarity while maximizing resources (Bass et al. 2006).
The issue of sibling sexual abuse is also embedded in the larger cultural context
and is connected to the values, beliefs, and family dynamics unique to the cultural
group (Comas-Diaz 1994). Latino cultural norms derived from familismo are closely
connected to how the family and the larger cultural group respond to sexual abuse.
For example, the sexual abuse of males in Latino culture is regarded as taboo
because it threatens machismo. Therefore, when a Latino brother is sexually abused,
he may be even more reluctant than his Anglo counterpart to report the abuse: it not
only threatens the family’s stability but also creates additional shame because the
victim role is not acceptable for a male (Comas-Diaz 1994). Also, while race and
ethnicity do not appear to be risk factors for sibling sexual abuse, preliminary
research suggests that they may influence symptom expression. Two studies
(Mennen 1995; Shaw et al. 2001) report that Latina girls suffer worse emotional
and behavioral problems than African–American or White girls. African–American
children tend to have more caregiver responsibilities for their siblings than their
Caucasian counterparts. At equivalent levels of caregiving, however, Caucasian
siblings appear to feel the burden of care more strongly. Watson (1998), who
addressed the interaction of class, gender, and race dynamics in sibling relationships,
asserts that sibling relationships, regardless of race, prove to be as powerful as
parent–child relationships in regard to mental health, and to have strong implications
for both individual and family functioning.
Gender Considerations
The majority of boys sexually abused by siblings are victimized by older brothers.
Confusion about the abusive experience –that is, making sense of the mix of their
own positive and negative emotional and physical reactions –may be the most
traumatic element for male survivors. A positive physical response such as sexual
arousal may encourage a brother to feel complicit with the abuse and further cloud
issues of responsibility and masculinity.
Boys are less likely to report being a victim because of the embarrassment they
experience about seeking help and acknowledging that they have been abused
(Duncan 1999; Goodwin and Roscoe 1990). This has important implications regard-
ing outreach with sibling abuse victims because male victims tend to be overlooked.
Boys are also more likely to be perpetrators of sibling violence and this tendency
may be linked to societal messages boys receive about being tough. Clinicians must
be willing to explore attitudes about masculinity with families in treatment where a
male child has physically, emotionally, or sexually harmed a brother or sister.
Conversely, the lack of clinical attention directed toward girls who perpetrate
sibling violence may be linked to the societal gender stereotype that boys are
aggressive, and girls are not. Parents and professionals may have trouble accepting
and confronting sibling abuse in girls. Adults may deny that girls can be perpetrators
and dismiss aggressive acts as minor and not harmful because of the mistaken belief
Sibling Abuse of Other Children 13

that girls are not strong enough to do serious damage. Straus, Gelles, and Steinmetz
(1980) observed many years ago that more boys are severely violent toward their
siblings than girls (59% vs. 46%), but “differences are not as great as stereotypes
would suggest”(p. 90).
Research on Harmful Effects
Sibling Physical Abuse
Sibling conflict is not harmless; children experiencing high levels of sibling nega-
tivity are at much greater risk of behavioral problems (Bank et al. 2004). In this
regard, one of the most interesting findings in the literature (Jin Yu and Gamble
2008) is the significant direct pathway from the quality of sibling relationships to
parenting styles toward a particular child. Apparently, if children develop sibling
relationships marked by great antagonism and conflict, these relationships may exert
a negative influence on parents’attitudes towards their children or may disrupt
parent–child interactions in many situations. Additionally, parents whose children’s
sibling relationships are marked by frequent and intense negative interactions may
suffer shame, self-blame, or parenting stress, or experiences that can diminish their
self-efficacy as parents. Not all victims of sibling physical abuse develop psychiatric
problems requiring mental health treatment. Yet there is adequate evidence that
many children who are exposed to interpersonal traumatic stress may experience
changes in autonomic functioning (Perry 1994), in regulation of stress hormones
(DeBellis et al. 1994), and in neurophysiological functioning (Ornitz and Pynoos
1989). Self-regulation difficulties are some of the farthest-reaching effects of phys-
ical and psychological interpersonal trauma.
Sibling Sexual Abuse
Studies comparing victims of brother–sister and father–daughter sexual abuse (Cyr
et al. 2002; Rudd and Herzberger 1999) conclude that the harmful consequences of
sibling sexual abuse are of equal seriousness to those of father–daughter incest.
Similarly, Shaw et al. (2000), reporting on a culturally diverse sample, demonstrated
that children sexually victimized by other children manifested elevated levels of
emotional and behavioral problems and were not significantly different from those
who had been sexually abused by adults.
Parental support is central in promoting better outcomes for child victims of
sexual abuse (Elliott and Carnes 2001). It has consistently been associated with
children’s improved adjustment following disclosure (Cohen and Mannarino 2000;
Feiring et al. 1998; Lovett 1995; Tremblay et al. 1999). Parental support, however, is
a multidimensional construct that encompasses believing the child, providing emo-
tional support, and taking protective actions such as contacting professionals or
restricting contact between the suspected sibling offender and victimized child. The
14 J. Caffaro

circumstances of sibling sexual abuse may complicate parents’provision of support:
parental feelings can easily lead to divided loyalties when the offender and the victim
are siblings. Some research (Walsh et al. 2012) suggests that parents are significantly
more likely to report higher blame and doubt of their child when she or he reports
that they have been sexually abused by a child or adolescent rather than an adult. An
earlier study (Sawyer and Smith 2008), reported similar results: parents of minority
children showed significantly higher levels of blame and doubt about their child’s
sexual abuse when the alleged offender was a child or adolescent.
The victim’s age and gender, the age and gender of the offending sibling, the
nature of the relationship between victim and offender, and the number, frequency,
and duration of the abuse experiences all appear to influence outcomes. Age
differences must not overshadow other important concerns such as the offender’s
physical size and strength, intelligence, and developmental sophistication. Each of
these characteristics may create situations of power and dominance between siblings
of similar ages. Comparatively little research focuses specifically on sibling sexual
abuse, and society’s response remains tentative. The absence of a generational
boundary and difficulty in establishing the presence of coercion pose additional
challenges; it may not be easy to establish victim and offender roles.
Sibling Psychological Maltreatment
There is ample evidence that sibling psychological maltreatment has serious short-
and long-term effects. For example, research (Mackey et al. 2009) suggests that
younger siblings with aggressive older brothers or sisters are at greater risk for
developing conduct and academic problems and have fewer positive interactions
with peers. Parents tend to discount sibling psychological maltreatment because it
leaves no physical signs. It may be minimized with statements like, “all kids talk that
way to their brothers or sisters.”If a parent was raised in a family where sibling
psychological maltreatment occurred, he or she may not consider such sibling
interactions problematic. As a result, childhood exposure to sibling emotional
abuse may activate a powerful template for interpersonal violence in subsequent
relationships. Sibling psychological maltreatment is also associated with poor social
relationships, economic difficulties, and lower perceived quality of life in the middle
adult years. Studies have shown that children exposed to sibling psychological
maltreatment are at increased risk of revictimization and also of being subjected to
differing types of violence (Finkelhor et al. 2007). Finally, in line with hypotheses
derived from theories of the biological embedding of stress, research suggests that
bullying in childhood is associated with a blunted cortisol response and higher
serotonin transporter gene methylation levels (Ouellet-Morin et al. 2011). Effects
like this can presage poor outcomes across the life course.
It’s important to remember that there are no significant differences between the
negative effects of peer versus parental verbal and emotional abuse. Teicher et al.
(2010) found that exposure to peer verbal abuse was associated with increased drug
use and elevated psychiatric symptom ratings. Substantial exposure is also
Sibling Abuse of Other Children 15

associated with a greater than twofold increase in clinically significant ratings of
depression, a threefold to fourfold increase in anxiety and “limbic irritability,”and
tenfold increase in dissociation. Unfortunately, exposure to substantial levels of peer
verbal abuse is a relatively common occurrence; verbal aggression from siblings is a
potent childhood stressor.
Evidence-Based Treatment Strategies
Trauma-informed psychotherapy has answered several questions of general effec-
tiveness and now is focused on more prescriptive treatment that might favorably
respond to the challenge to find what treatment delivered by whom is most effective
with a specific problem under which set of circumstances. Psychotherapy with
children and families where sibling abuse occurs must be based on a trauma-
informed, relational, and strengths-based approach. Incorporating an attachment
perspective helps increase a child’sflexibility in interpersonal relationships beyond
seminal family-of-origin patterns. This is especially useful in cases of sibling abuse
because so much negative interaction and blaming typically takes place in such
families.
An integrative therapeutic approach also includes challenging a child’s abuse-
related cognitive appraisals about him or herself and the world. This point is
especially relevant in light of the frozen images often maintained by children
victimized by a sibling, which may serve as templates for other intimate relation-
ships. Cognitively oriented interventions can help the child abused by a sibling to
develop a more accurate self-image and a more realistic view of relationships with
others. Skills and behaviors needed for competent, effective day-to-day living are
frequently an important component of individual or family treatment. Finally,
effective treatment must also emphasize the importance of remediating affect regu-
lation and interpersonal skill deficits stemming from dysfunctional relationships in
the family of origin.
Yet the unique circumstances of sibling abuse treatment frequently require mod-
ification of traditional systemic approaches. In treating victims of sibling physical,
emotional, or sexual abuse, safety and accountability are front-and-center issues for
the clinician. It is very likely that certain kinds of therapies work for children from
some kinds of families but not others. For example, therapy with other family
members present is not always in the sibling abuse victim’s best interest. Sibling
offenders frequently require individual and group abuse-focused treatment before
they can benefit from family therapy. Alternatively, family-based therapy may be
one aspect of an integrative approach to treatment that includes individual, group,
and family intervention. Often therapy proceeds sequentially: family members are
included only after the offending sibling has made significant treatment gains.
Decisions about removal and placement are complex, especially in sibling abuse
cases, and newer guidelines recommend individualized case-by-case decision-
making rather than one-size-fits-all policies. In circumstances where a child has
sexually harmed a brother or sister in the same home and where appropriate
16 J. Caffaro

assessment has determined that out-of-home placement is not necessary, caregivers
must be willing and able to act so as to increase the protective capacity of the family
environment and provide safety for the child.
Favorable results have been reported with cognitively based intervention strate-
gies in a number of short-term interventions with sibling offenders younger than age
twelve (Chaffin et al. 2008). Researchers found, for example, that one brief treatment
for preteens reduced the risk of future sex offenses to levels comparable to those of
children who had no history of inappropriate sexual behavior (Carpentier et al.
2006). Sibling offenders in one study, however (Rayment-McHugh and Nisbet
2003), were assessed as having more risk factors, and therefore being at significantly
greater risk of recidivism than nonsibling offenders. Consequently, any treatment
program for sibling offenders must be undertaken cautiously with an eye toward
maintaining the safety of victims and others. Overall, research indicates that treat-
ment outcomes for youths who offend sexually are improved greatly if family is
involved in the treatment process (Burnham et al. 1999; Haskins 2003; Rich 2003;
Thomas and Viar 2005; Zankman and Bonomo 2004).
Case Illustration
Eight-year-old Rosa was the eldest of five siblings in a Mexican American family
who presented for treatment following the discovery of repeated sexual acts that she
engaged in with her 6-year-old brother, Pedro. The sexual behavior was ongoing for
approximately 1 year before her brother disclosed to her parents. Rosa reported that
the sexual behavior involved engaging in mutual and dual masturbation. She
reported touching her brother’s sexual parts and sometimes asking her brother to
touch her. No oral sex or intercourse was disclosed. Although no use of force was
indicated, Rosa did admit to bribing her brother in the months leading up to the
disclosure by agreeing to buy him candy and bubblegum to not talk about it. Rosa
did not endorse any history of traumatic events during a routine trauma screen, and
scores on the Trauma Symptom Checklist for Children (Briere 1996) were
unremarkable.
Questions remained, however, about the heightened sexualized climate in the
home. Frequency and intensity of the sexual interaction as well as the duration of the
activity were consistent with a sibling relational pattern in which children turn to
each other for unmet attachment needs ordinarily provided by caregivers. Literature
on children with sexual behavior problems indicates that disrupted attachment at an
early age is often correlated with sexual offending (Friedrich and Sim 2006; Rich
2006; Ryan 1999). In addition, the siblings had probably observed their parents
having sex on more than one occasion. They lived together in a three-room cottage,
where the living room also served as the parents’bedroom. Consequently, the sexual
behaviors displayed by the client with her brother, unclear boundaries at home, as
well as disrupted parent–child attachments became the focus of treatment.
Rosa’s parents were overwhelmed by their parenting and work responsibilities.
Her father worked long hours as a migrant farmer –he was intermittently absent for
Sibling Abuse of Other Children 17

weeks at a time. Rosa’s mother worked from home so that she could care for the five
children; a family pattern was solidly established whereby Rosa and Pedro sought
each other out for comfort and shielded their parents from many of their problems. In
time, the children also used the intense sibling contact to meet many of their needs
for closeness and physical contact. It was important to employ interventions consis-
tent with the cultural context of Rosa’s family. Her parents were raised in a small
rural town in Mexico. One of the key values that arose repeatedly in initial sessions
was the role of family. Familism has been described as a core system of values
centered on the family and is considered a commonality shared among a majority of
Latino cultures.
Rosa’s parents were proud of the self-sufficiency they had taught their two eldest
children. More than a year ago, they had placed them in the same bed so that when
one became afraid or needed something during the night, the other could offer
comfort and assistance. The clinician assured the parents that maintaining close
supervision of Rosa was essential for now and advised them not to allow Rosa to be
unsupervised with any children. Rosa’s parents nodded in agreement and stated their
wish to cooperate in whatever they could to help their children.
Early therapeutic conversations with the parents established a framework for
change by stating certain assumptions: the therapist emphasized how the children
were already trying to incorporate the parents’values, and thus how effective the
parents had been so far in helping to instill them. This was obvious because of Pedro
and Rosa’s efforts to be loyal and respect their parents’wishes –demonstrated partly,
by being self-sufficient. The therapist continued: “If we were to assign a numerical
value to hugs for younger children, we all would know and agree that a hug from a
parent is worth ten points, while a hug from a sibling is worth only one point.
Therefore, in an effort to meet their needs for parental attention and contact, Rosa
and Pedro were having lots more touching between them.”The therapist also
explained that their children probably felt a great deal of inner pain about their
infrequent contact with their parents, yet they continued to respect their parents’
wishes and remain self-sufficient. “We now know (the therapist continued), that the
children on their own can never fill the void of not having more parental love and
attention.”
Individual sessions with Rosa focused on developing therapeutic rapport by
allowing her to ask questions and engaged in play activities. The therapist made a
point to directly discuss the sexual behaviors during the play to gauge Rosa’s
comfort and openness in addressing this topic. Early sessions also focused on
teaching Rosa and her parents the areas of the body considered private as well as
rules for sexual behavior. Anatomical names for the sexual parts of the body were
reviewed using pictures showing male and female bodies. Simultaneously, as one
step toward addressing parent–child attachment-related concerns, efforts were made
to increase father’s involvement with Pedro. Father was labeled the family’s teacher
of how brothers are supposed to treat sisters. He was given brief assignments that
were initially discussed and practiced in the office. For example, he and Pedro were
to watch a television commercial or view a Web page and discuss any positive
messages they found about how boys treated girls. Father was also asked to review
18 J. Caffaro

various alternatives with his son, emphasizing appropriate and positive ways of
treating siblings. Special conversations exclusively between the father and Pedro
were also scheduled, with the understanding that this was to be done because Pedro
was the oldest boy.
Once their interaction became easier, another element was added. The therapist
asked Pedro and his father to review the advertisements from the perspective of a
brother or sister. Throughout the course of these assignments, Pedro’sfatherasked
some previously agreed-to questions that underscored differences in the ways brothers
and sisters relate, such as “Would a brother look like that at his sister? Would he touch
her in that way? Why or why not? When would a brother and sister hug? When would
they hold hands, or look at each other like that? What are the ways only adults look at,
and touch each other?”Father was coached not to include additional information about
sexual behavior, but only to clarify with Pedro the kinds of behaviors he had already
learned. At the same time, Rosa and her mother worked on a similar assignment
designed to teach and establish guidelines for physical contact between sisters and
brothers. Additional questions and exercises were included which emphasized the
delineation of boundaries, identification of feelings, encouraged empathy development,
and decreased reliance on dissociative absorption.
In Rosa’s individual sessions the clinician reviewed basic sexual safety rules:
(1) It is ok to touch your private parts when you are alone, (2) It is not ok to touch
other people’s private parts, (3) It is not ok for other people to touch your private
parts, and (4) It is not ok to show your private parts to other people. Each of the rules
was discussed in depth and examples of abiding by and breaking the rules were
provided. At the end of the session, the clinician presented Rosa with multiple
hypothetical situations and asked her to identify any sexual safety rules that might
have been broken. Sexual safety rules were also reviewed with Rosa’s parents.
Rosa’s responses during session were discussed and the importance of creating an
atmosphere where she could freely ask questions and not believe that punishment
will follow discussions of sexual topics was emphasized. The parents understood
and agreed. The clinician suggested that they make efforts to point out to Rosa in the
coming week any sexual safety rules that they notice her violating, especially
interpersonal boundary violations and to praise her compliance with the sexual
safety rules. The parents were also asked if they believed that any additional sexual
safety rules were needed in addition to those already specified; they did not.
Potential warning signs for sexual misbehavior were also reviewed with Rosa’s
parents, such as ongoing preoccupation with sexual topics. The parents had not seen
any of the warning signs discussed but did note that they had increased their
monitoring of their oldest child. In addition, various steps were taken to reduce
Rosa’s sexual behavior problems, including eliminating the amount of sexuality
displayed in the home and locking doors when parents were in bathrooms or
engaging in sexual activity. Rosa’s parents implemented many of these recommen-
dations and committed to improving in each of these areas. In addition, they noted
that they had begun correcting Rosa’s violations of interpersonal boundaries by
having her identify the sexual safety rule she was breaking at the time; they believed
correcting her behaviors by referencing the rules was helping.
Sibling Abuse of Other Children 19

Rosa was also taught self-control skills through a series of visualization and
behavior modification techniques. She particularly enjoyed a “spiral”visualization
and an imaginary exercise in creating a safe place (e.g., sitting in a tree on a sunny
day). After several in-session and homework practices, she moved on to playing a
game that eventually would help her develop problem-solving skills by relaxing and
not acting impulsively and processing her feelings before acting on them. Rosa was
taught that there are several steps to solving a problem: (1) stop and wait, (2) relax-
ation, (3) think of possible actions and evaluate each one, and (4) pick the action and
do it. The clinician discussed how this technique could be applied in the event that
Rosa considered breaking a sexual safety rule, or breaking other rules, including
times when she was feeling upset.
Throughout this process, Rosa was assigned to practice handling her distressing
feelings in this way at home or school. On several occasions she returned to therapy
with examples of new methods she had used to respond in a safe way to triggers in
her environment. These were added to the list of safe place activities at her disposal.
Subsequent meetings with Rosa’s parents focused on teaching effective child behav-
ior management skills. They were taught how to be concrete and specific with their
instructions and consistent in their approach to disciplining the children.
Parental sessions were also focused on applying the behavior management skills
specifically to Rosa’s sexual behavior problems. This specific focus was particularly
important given that St. Amand et al. (2008) has identified behavior management
skills as a technique strongly related to improving childhood sexual behavior
problems as well as to the treatment of other externalizing problems. Rosa’s parents
were encouraged to practice these techniques in various situations where Rosa had
previously engaged in the inappropriate sexual behavior with her brother (i.-
e., bedtime, when left unsupervised in the home, etc.). The importance of viewing
all of the techniques learned during treatment as an integrated set of skills that
complement and enhance the effectiveness of all of them was emphasized.
Rosa and Pedro were encouraged to devote more time to activities with peers.
This gradually increased their time spent apart and helped to develop their social
skills. Previously they had shared a bed; now, arrangements were made for them to
share beds with their same-sex younger siblings. Parental supervision practices were
adjusted to minimize their unsupervised time together and to monitor their interac-
tions with their younger siblings. Progress in the nurturing connections the parents
developed with Rosa and Pedro simultaneously influenced their interactions with
their younger children. The result was an increase in the amount of caring interaction
and in feedback exchange between children and parents. This increased the likeli-
hood that their parenting styles would be more responsive to future developmental
changes in the children. The context of Rosa’s sexual behavior problem, especially
the quality of overall parent–child relationships in the home was a key consideration
in this case. Parent–child relationships were substandard before Rosa’s sexual
behavior problems were known and it is possible that these poor relationships may
have in part contributed to the onset or persistence of the problematic sexual
behavior between the siblings.
20 J. Caffaro

Current State of Research and Practice
Randomized trials with preteen children having both sexual abuse-related PTSD and
sexual behavior problems (a common combination) have found that short-term
trauma-focused cognitive-behavioral therapy (TF-CBT) treatments that also teach
parents child behavior management skills are effective in reducing sexual behavior
problems (Cohen and Mannarino 1997; Stauffer and Deblinger 1996). Further, a
meta-analysis of treatment outcomes (St. Amand et al. 2008) for child sexual
behavior problems reported that the largest effect sizes for preteens are not found
among programs including adapted sex offender-specific elements, but among pro-
grams that teach parents general child management skills for enforcing behavior
rules (sexual and nonsexual) and that teach victimization prevention skills. Teaching
parents or caregivers structured behavior management skills is probably the single
best supported intervention element for child and adolescent behavior problems
(Brestan and Eyberg 1998; Kazdin and Weisz 1998; Reid et al. 2002), and while
many of these studies are not conducted exclusively with children who physically or
sexually harm a brother or sister, there is reason to think that similar positive results
would be obtained with parents and caregivers in cases of sibling abuse.
Changing a young child’s sexual or physical behavior problems for the long haul
may not always require in-depth treatment but treatment type does matter. Given that
good response is generally found using fairly time-limited treatments (especially
those that include evidence-based elements), there is little foundation to policies or
practices dictating long-term treatment or placing children into residential treatment
facilities on more than an occasional basis (Chaffin et al. 2006). Yet this is common
in many jurisdictions where children or teens with sexual behavior problems are
automatically earmarked for highly burdensome, restrictive, and lengthy treatments
often delivered in institutional or out-of-home settings. Of course, decisions about
removal and placement are complex, especially in sibling abuse cases, and newer
guidelines recommend individualized case-by-case decision-making rather than
one-size-fits-all policies.
Policy and Prevention
Clinical efforts to address sibling abuse must also influence society’s role in devel-
oping public policy designed to protect its most vulnerable citizens –children –from
current and future harm. At the practitioner level, there are too few comprehensive
measures focused on individual and family dynamics in cases where sibling abuse
has occurred. More must also be done to ensure the proper training of mental health
professionals treating cases of sibling abuse of other children. State-funded programs
and community-based clinics where many families are treated for trauma rarely
invest in developing data systems that permit them to monitor which programs are
working and which are not. State policymakers may be unaware of research evidence
on programs and policies that are not only effective in treating and preventing sibling
abuse but also cost-effective.
Sibling Abuse of Other Children 21

Child welfare services can vary considerably from state to state and even from
region to region in larger states. This situation may work to the detriment of sibling
abuse cases. In one study, Kominkiewicz (2004) found that child protection workers’
definitions vary widely in the identification of behaviors constituting sibling abuse.
If the case is not opened or is investigated but yields no finding of abuse, children can
be adversely affected because the abusive behavior may continue. This impairs our
national ability to collect accurate statistics on occurrence rates and to report trends
over time.
Schools and parents must take sibling abuse more seriously. Underreporting by
families is a significant concern and accurate detection is also a problem for
clinicians and researchers: the evidence suggests that sibling sexual and physical
abuse will not be disclosed unless explored specifically by professionals. Clearer
standards may need to be set for detecting such abuse and to design earlier inter-
vention strategies to prevent recurrences. Parents should be encouraged to establish
“no-hitting”policies among their children. Some have suggested that routine screen-
ing for childhood trauma should be available in schools.
It is now well understood that a propensity toward intimate partner violence and
parent–child abuse is “transmitted”from one generation to the next in vulnerable
families. Sibling abuse can be viewed in the same light. For example, intervention
with a young child with a sibling sexual behavior problem should be conceptualized
as primarily a public health, rather than primarily legal or moral concern. Adopting
the principle of reducing and preventing harm to all parties involved would allow
this kind of productive focus. Punishment of the child with a sexual behavior
problem may succeed in conveying the seriousness of the offense but it also
means that children are labeled as sex offenders at a time in their lives when they
are most vulnerable. Parents are forced to choose between family members; the
legally or morally based response punishes everyone involved, and families fre-
quently view it as an option that will actually make things worse. A policy approach
guided by the principle of harm reduction and reaches out into the community to
sectors and individuals makes more sense.
Professional intervention should involve more than the child who has harmed
their brother or sister. Parents and other family members should be engaged; study
after study (Burnham et al. 1999; Haskins 2003; Rich 2003; Thomas and Viar 2005;
Zankman and Bonomo 2004), demonstrates it is more than likely that the child who
harmed their sibling is only one manifestation of problems within the family. Young
girls rather than boys are overwhelmingly the victims of sibling sexual abuse.
Culture and society have an important etiological function; “the family is not the
only social institution which plays a role in causing and perpetuating the problem”
(Gilmartin 1994, p. 291). Many modern societies embrace patriarchy, a system in
which men hold institutional power and control, and in which women and children
are devalued. Efforts at social change, along with advances in treatment, must be
undertaken to address the cultural issues of male power and sexual privilege.
Community education about the risk factors for sibling abuse should be the first
step in any prevention program. Sibling violence affects a substantial proportion of
youths at all ages. It would be beneficial to incorporate prevention of sibling abuse of
22 J. Caffaro

other children into other initiatives for preventing family violence. When parents
understand how to promote positive parent–child relationships and sibling interac-
tions, the risk of abuse in the entire family tends to be reduced (Donnelly 1999;
Wilson 1987).
Routine assessment for interpersonal violence and safety should be part of every
health care visit. On a pragmatic level, physicians and other health care professionals
are mandated reporters when child abuse is disclosed, assessed, or suspected.
However, most sibling violence seems to be excluded from mandatory reporting
because of child welfare statutes that define child abuse as physical injury of a child
under age 18 “by a parent, household member, or person who has permanent or
temporary custody or responsibility for supervision of the child”(Sheridan 2004,
p. 385).
Finally, corporal punishment has been linked to a number of internalizing and
externalizing problem behaviors in children and adolescents (Aucoin et al. 2006;
Gershoff 2002; Grogan-Kaylor 2005; Turner and Finkelhor 1996). These findings
tend to support the increased questioning of corporal punishment, especially its
possible role in fostering an orientation to aggression, among a number of social
scientists and family experts. Sibling violence should be included along with these
emerging concerns as one of the potential consequences of corporal punishment.
Summary and Conclusion
Sibling abuse of other children is a form of family violence whose widespread
prevalence has been known for some time, but which has generated disappointingly
little specific scholarly and clinical attention. The lack of ongoing research limits our
understanding of sibling emotional, sexual, and physical abuse. In many ways,
trauma-informed psychotherapy has answered questions of general effectiveness.
A specialized focus on sibling abuse allows a trauma-informed clinical approach to
be tailored more closely to the unique needs of children and families where one
sibling has harmed another. In families where sibling abuse occurs, it is often parents
who, either physically or psychologically, abandon their children. Under these
conditions a child may depend on an older sibling even when that dependency is
fraught with pain, anxiety and further maltreatment; the long-term harmful effects on
children over the lifespan can be profound.
Cross-References
▶Adverse Childhood Experiences
▶Siblicide: The Psychology of Sibling Homicide
▶Sexual Abuse of Children
Sibling Abuse of Other Children 23

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