Treating Children with Sexually Abusive Behavior Problems

Guidelines for Child and Parent Intervention

Barbara J Christopherson, Jan Ellen Burton, Lucinda A Rasmussen, Steven C Huke, Julie Bradshaw

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9780789004727
• eBook ISBN: 9781317790334
• Topic: Social Sciences
• Subtopic: Developmental Psychology
• Index: Social Sciences

Treating Children with Sexually Abusive Behavior Problems: Guidelines for Child and Parent Intervention is a unique, pioneering venture in the area of sexual abuse. Unlike most books on sexual abuse, which focus on children as victims, this integrated treatment approach suggests ways to develop parallel treatment strategies for both parents and children who display harmful sexual behavior.In many ways a first in its field, Treating Children with Sexually Abusvie Behavior Problems gives you the tools to orchestrate your own treatment and intervention techniques, specifically for those children under age 12 who display sexually harmful or unlawful behavior. You'll find in this useful volume a one-of-a-kind approach to linking together individual, group, and family treatment into one integrated, comprehensive program that treats both perpetrator and victim in tandem. Effective applied techniques are presented to teach:

• accountability of the offending party
• concern for others/empathy
• social competence
• the establishment of appropriate boundaries
• healthy sexuality
• coping with prior trauma
• safety and supervisionTreating Children with Sexually Abusive Behavior Problems is intended for professionals in child sexual abuse; graduate and undergraduate students in psychology, social work, marriage and family therapy, and psychiatry; juvenile court workers; child welfare case workers; teachers; attorneys; and judges. It will also serve to better inform the victim, family, and general public. If you're concerned about the spread of sexually abusive behavior in children, you'll want to become informed and armed with the practical and useful guidelines found in this innovative approach to a prevalent social problem.

PART I:

GUIDELINES FOR PRACTICE

Chapter 1

Sexually Abusive Behavior Problems: Definitions and Current Knowledge

ALL I REALLY NEED TO KNOW about how to Uve and what to do and how to be I learned in kindergarten.… These are the things I learned:

• Share everything.

• Play fair.

• Don’t hit people.

• Put things back where you found them.

• Clean up your own mess.

• Don’t take things that aren’t yours.

• Say you’re sorry when you hurt somebody.

• Wash your hands before you eat.

• Flush.

• Warm cookies and cold milk are good for you.

• Live a balanced life—learn some and think some and draw and paint and sing and dance and play and work every day some.

• Take a nap every afternoon.

• When you go out into the world, watch out for traffic, hold hands, and stick together.

• Be aware of wonder….

—Robert Fulghum*

Childhood: A picture emerges of a group of children in a kindergarten class behaving as Robert Fulghum describes. However, children often stand apart in classrooms, confused or rebelling against these simple kindergarten rules. Some children do not know how to “share everything” or “play fair.” They have not known fairness. Many of these children have been victims of traumatic events, abused by those closest to them, unable to express their anger and pain. Without an acceptable way to express how they feel, they may hurt themselves or strike out and treat others abusively, as their abusers treated them. If they display harmful, sexually inappropriate behavior, they have “sexually abusive behavior problems.”

It has taken a long time for society to admit these children exist. The societal myth that only “strangers” commit sexual abuse persists. In reality, the ever-increasing number of child sexual abuse referrals documents that most sexually abused children are victimized by someone they know—a parent, relative, friend, baby-sitter, or another child. The myth that children do not commit sex offenses is no longer tenable. When children experience sexual abuse, observe others’ sexual activities, or discover explicit sexual material, they become more aware of their own sexual feelings. Unless abused and sexualized children can express their feelings, they remain vulnerable to developing maladaptive behavior patterns, including sexually abusive behaviors.

Research on adult sex offenders has indicated that approximately 50 percent began offending as juveniles (Abel, Mittelman, and Becker, 1985; Groth, Longo, and McFadin, 1982). Adolescent sex offenders in treatment programs have reported beginning offending patterns as early as age five (Stickrod and Ryan, 1987). Children who exhibit sexually abusive behavior problems are at risk to continue offending as adolescents or adults. Early assessment and treatment are therefore essential; it is important to intervene when these children’s inappropriate sexual behaviors are first identified. Cunningham and MacFarlane (1996) stated:

All sex offenders come from somewhere … if we ignore them in their youth, they will likely revisit us in their adulthood when they will be harder to reach and when the results of their behavior will have left its painful mark on other young lives, (p. 262)

There is a growing body of literature that focuses specifically on children with sexually abusive behavior problems, including research on the characteristics of these children (Berliner et al., 1996; Cantwell, 1988; Friedrich and Luecke, 1988; Gil and Johnson, 1993; Glasgow et al., 1994; Gray et al., 1993; Gray et al., 1994; Gray and Friedrich, 1996; Johnson, 1988, 1989) as well as discussion of family dynamics, etiology, and treatment approaches (Araji, 1997, Cunningham and MacFarlane, 1991, 1996; Gil and Johnson, 1993; Gray and Pithers, 1993; Johnson, 1995a; Johnson and Berry, 1989; Lane 1991a, 1997a; MacFarlane and Cunningham, 1988; Ryan, 1991a, 1997a). In addition, a few resources have been developed to help parents (Gil, 1987; Johnson, 1995b; Pithers et al., 1993; Ryan and Blum, 1994). A recent survey conducted by the Safer Society Foundation identified 390 treatment programs that work with children with sexually abusive behavior problems (Knopp and Freeman-Longo, 1997). Unfortunately, the field of treatment for sexually abusive children is young, and research on individual characteristics, family dynamics, etiology, and treatment outcomes is still limited. Clinicians who treat these children must often rely on their own clinical experiences or make developmental adjustments to treatment approaches used with adult and adolescent sex offenders.

The purpose of this book is to help clinicians recognize and interrupt sexually abusive behavior in children. Clinicians need to simultaneously address children’s sexually abusive behaviors as well as prior experiences that may have contributed to that behavior. It is important that interventions focus on the entire family system. Parent involvement is critical when teaching children to make responsible choices regarding their sexual thoughts and feelings. Many of these children can learn to express their feelings appropriately.

This book presents a multidimensional treatment program for children who have sexually abusive behavior problems. Although the primary practice model is cognitive-behavioral, there is a strong family systems component. Psychodynamic and play therapy approaches are also incorporated in the therapy process. Treatment strategies are derived from the authors’ clinical observations and experience. This treatment program attempts to teach sexually abusive children healthy ways to manage their feelings and confront incorrect thinking. A parallel group treatment model is presented, as children and parents attend therapy groups at the same scheduled times.

DEFINING SEXUALLY ABUSIVE BEHAVIOR PROBLEMS

The literature lacks congruence regarding what to call sexualized behavior in children. Cunningham and MacFarlane (1991; 1996) have referred to children who act out sexually as abuse-reactive. Others have called them sexually aggressive or reactive (Friedrich and Luecke, 1988; Gray and Pithers, 1993), children with sexual behavior disturbances (or problems), (Berliner et al., 1996; Berliner and Rawlings, 1991; Gray et al., 1993; Gray and Friedrich, 1996; Lane 1997a), child perpetrators (Johnson, 1988; Lane 1991a), sexualized children (Gil and Johnson, 1993), and children who molest (Cunningham and MacFarlane, 1991; Johnson, 1995a). Friedrich (1995) has clearly objected to labeling children as sexual perpetrators. The National Task Force on Juvenile Sexual Offending (1993) has opposed describing sexually abusive behavior manifested by young children as reactive or acting out, as such terms deny or rationalize the abusive nature of the behavior. The National Task Force advocates, “when the behavior of children is potentially abusive, it is referred to as sexually abusive behavior” (p. 64).

We have chosen to use the terms children with sexually abusive behavior problems or sexually abusive children to refer to children who act out sexually toward others. These terms indicate the problematic nature of the sexual behavior without implying causation. Similarly, Araji (1997) advocates for the term “sexually aggressive.” However, some young children appear less aggressive than sexualized, and it is our opinion that the word “abusive” connotes the effect of their behavior on their victims.

Age-Appropriate Sex Play

Not all forms of sexual behavior in children are problematic. For example, masturbation is common among infants, toddlers, and preschoolers (Martinson, 1991, 1997). Once they discover their genitals, toddlers may attempt to see or touch the genitals of others. It is not unusual for young children to take their clothes off, look at one another’s bodies, and sometimes touch one another. This can be normative sexual behavior (Friedrich, 1990), age-appropriate sex play (Gil, 1993a), or expectable sexual development (Gil and Johnson, 1993) for children who do not have a history of sexual trauma or exposure to explicit sexual material. Curiosity may motivate this typically naive experimentation.

Activities such as “playing house” or “playing doctor” are common games among young children. However, the sexual content of their play is likely based on what they have observed or experienced (Gil, 1993a). Unless the children involved have been previously exposed to sexuality (through abuse, observation, or pornography), play activities are generally limited to undressing, looking, and touching. These activities are typically between same-age peers, without coercion, and the affect of the children involved is often spontaneous, playful, or embarrassed (Gil, 1993a; Johnson, 1988; Ryan, 1997a). When adults discover children engaged in age-appropriate sex play, they may “educate, redirect, or limit behavior, but the behavior itself is not deviant” (Ryan, 1997a, p. 439).

Some children engage in sexual behavior that is problematic for themselves but not necessarily abusive to others. Excessive masturbation and explicit sexual talk are examples of such behavior. These behaviors may interfere with a child’s normal developmental progression, provoke rejection from others, increase risk for victimization, and/or cause distress for the child (National Task Force on Juvenile Sexual Offending, 1993). Individual therapy and psychoeducation can be sufficient interventions for these children. If placed in group therapy, it is usually best not to include them with others who act out more severely. The treatment program discussed in this book focuses specifically on children who act out sexually against others.

Sexually Abusive Behavior

It is important to differentiate developmentally appropriate sexual behaviors from behaviors that are sexually abusive. Research on sexual development in children (Gil, 1993a; Johnson, 1993a, 1993b; Martinson, 1991, 1997; Ryan, 1991a, 1997a; Sgroi, Bunk, and Wabrek, 1988) has provided guidelines for distinguishing age-appropriate from abusive behaviors. The type of sexual behavior exhibited helps discriminate abusive sexual interactions from age-appropriate sex play. Friedrich and colleagues (1991) studied normal sexual behavior in children. Of their sample of 880 children ages two to twelve, 45.8 percent were reported to have touched their own sexual parts, and 6.0 percent were reported to have touched others’ sexual parts. Only .1 percent of this normative sample were reported to have put their mouth on another’s sexual parts. Other sexual behaviors rarely noticed by the caretakers of these children (e.g., asks others to engage in sexual acts, inserts objects in vagina/anus, imitates intercourse) tended to be behaviors that were “more aggressive or more imitative of adult sexual behavior” (p. 462).

A sexually abusive child is one who initiates sexual behavior in a manipulative or coercive manner. The actual behaviors may encompass anything from fondling to sexual intercourse and include object insertion, oral-genital contact, frottage, and bestiality. Other less intrusive sexual behaviors can be abusive if they are repetitive and invasive. Examples of such behaviors include: exposing genitals, window peeping, grabbing others’ breasts or buttocks, looking up skirts, etc. Ryan and colleagues (1988) described a “range of sexual behaviors in children.” They defined the following behaviors as “no questions” as to their abusive nature: “oral, vaginal, or anal penetration of dolls, children, or animals; forced touching of genitals; simulating intercourse with peers with clothing off; and any genital injury or bleeding not explained by accidental cause” (cited in Ryan, 1997a, p. 440). Similarly, Johnson (1993b) described a “continuum of sexual behaviors.” Typical behaviors of “children who molest” included “oral copulation, vaginal intercourse, anal intercourse, and/or forcibly penetrating the vagina or anus of another child with fingers, sticks, and/or other objects” (p. 48).

Abusive sexual behaviors are coercive and nonconsensual and exploit equality in relationships (National Task Force on Juvenile Sexual Offending, 1993). Ryan (1997a) stated, “It is the relationship and interaction that define sexual abuse rather than an isolated behavior that occurs out of context” (p. 439). Power differential, intimidation, manipulation, and coercion are abusive dynamics that help define sexually abusive interactions between children. The first abusive dynamic, power differential, refers to differences in age, size, intelligence, and physical ability. An offending child may be older, larger, more intelligent, or abuse a child who has a disability. Second, an abusive child may use status or authority to intimidate other children. Examples could include baby-sitting, being a class officer, being popular, etc. The third dynamic, manipulation, refers to deliberate actions used by sexually abusive children to secure their victims’ cooperation and participation in sexual activity. Hamilton, Decker, and Rumbart (1986) define manipulation as “deliberately influencing or controlling the behavior of others to one’s own advantage by using charm, persuasion, seduction, deceit, guilt induction, or coercion” (p. 191). Sexually abusive children manipulate their victims with verbal persuasion, games, tricks, and bribes or coerce other children into sexual activities by use of threats or force. The abusive dynamic of coercion is also apparent when children try to hide or cover up their sexually inappropriate behavior: they may carefully choose a hidden location for sexual contact, and they may either suggest or demand their victims keep silent, occasionally enforcing their silence with threats of bodily harm.

CURRENT KNOWLEDGE

A number of different theories have been proposed as explanations for the development of sexually offending behavior (Ryan, 1991b, 1997b). Araji (1997) and Gil (1993b) have reviewed various theories and practice models as they apply to the etiology of sexually abusive behavior problems in children. The following etiological theories and models are included in one or both of these reviews: psychodynamic trauma models (e.g., post-traumatic stress disorder model—Cunningham and MacFarlane, 1991, 1996); social learning trauma models (e.g., traumagenic dynamics model—Finkelhor and Browne, 1985, 1988); adaptation perspective and coping theory (Friedrich, 1990); four preconditions of abuse model (Araji and Finkelhor, 1986; Cunningham and MacFarlane, 1991, 1996; Rasmussen, Burton, and Christopherson, 1992); addiction model (Breer, 1987; Carnes, 1983; Cunningham and MacFarlane, 1991, 1996); and the Trauma Outcome Process (Brown and Rasmussen, 1994; Rasmussen, Burton, and Christopherson, 1992).

Our own perspective for the etiology of sexually abusive behavior problems in children is based on four major theoretical perspectives: psychodynamic, social learning, humanistic, and family system). We take a psychodynamic view in our belief that unresolved feelings related to prior trauma may be reenacted in abusive behavior. We also emphasize the role of developmental factors in modulating children’s resilience to the effects of trauma and in shaping their social competence and capacity for empathy. We follow social learning theory when we acknowledge the importance of modeling and stress confrontation of maladaptive thinking processes. We highlight the importance of awareness (a humanistic concept) and believe that sexual awareness is an essential motivator of sexually abusive behavior problems in children. Our work is systemic because we believe that children develop sexually offending behavior as a result of the interaction of their individual characteristics and family dynamics.

Over time we have identified salient treatment factors common to children with sexually abusive behavior problems. These factors include: (1) effects of prior traumatization, (2) accountability, (3) social competence, (4) empathy, (5) establishment of boundaries, and (6) the sexual abuse cycle. These individual characteristics interact with other family dynamics and contribute to the development of sexually abusive behavior. Research pertaining to these factors is reviewed in the following material.

Prior Traumatization

Over the past ten years, much research has linked the experience of prior sexual abuse with increased sexualized behavior (Browne and Finkelhor, 1986; Cosenti...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• About the Authors
• Preface
• Acknowledgments
• PART I: GUIDELINES FOR PRACTICE
• PART II: TREATMENT EXERCISES
• References
• Index