11.15 Assessing Children who Sexually Abuse

11.15 Assessing Children who Sexually Abuse

Contents

1. Pre-Assessment Tasks
2. Interviews with the Parents
3. The Child’s Sexually Abusive Behaviours
4. Parental Attitudes towards the Abuser and the Victim
5. Interviews with the Child
6. Motivation to Change
7. Differentiating ‘Normal’ from ‘Abusive’ in Children
8. 21 Red Flags Regarding Children’s Sexual Behaviour
9. Risk Factors
10. A Prognosis Framework for Cases Involving Sexual Abuse within the Family
11. Analysis of Change Tables

Following referral, a Social Work Assessment of Needs and Strengths is needed to determine where the child lies on the continuum of sexualised behaviour, and whether a fuller assessment is needed. Where a more Social Work Assessment of Needs and Strengths is indicated, decisions need to be made to contain any perceived risks through decisions on placement and contact issues. It would be wrong for a full assessment to be undertaken in every case where a child is referred with sexualised behaviour problems. In many circumstances a Social Work Assessment of Needs and Strengths can identify whether the behaviour falls outside the normal range for their age and ability. This usually involves discussions with the parents, other professionals, and occasionally the child. A full assessment is indicated where the behaviours are extreme or where several problematic sexual behaviours are found. We know from work in the United States that this group is very small, although a full assessment of the child’s sexually abusive behaviour is necessary when we have to:

• Determine what factors play a part in the presenting behaviour.
• Identify whether there are thought feeling or behaviour problems for the child.
• Identify whether the behaviours are outside age-appropriate limits and part of an escalating pattern of behaviour, and
• Determine whether treatment is indicated, and what components it should contain, e.g. areas for re-education and re-learning, for the child and/or the family.

It is very important that we do not over-react to the presenting situation as this can have long term consequences for the child, e.g. becoming ashamed about their sexuality. The primary goal is for children to stop abusive behaviour because they have learned that the behaviour makes others feel bad, not because they will get into trouble if they do not.

The assessment work comprises two separate but inter-linking parts: work with the parents and work with the abusing child.

1. Pre-Assessment Tasks

• Workers need to collect all relevant background information (school, nursery, parents, carers, statements, etc.) Children are more likely to admit to their behaviour than adults, when faced with some evidence.
• Workers need to ensure that issues of placement, contact and strategies for the day-to-day management of the child have been addressed.
• Workers need to establish an agreed language and words with the child – on sexual acts, language, body parts etc. Workers need to frame the assessment with the child at a level they can understand and engage with.
• A written agreement needs to be constructed with the parents to address the work, and should include;
• A statement on why the assessment is needed
• A statement of intent, e.g. the goal is to avoid any repetition of problem behaviours, thoughts or feelings
• The areas that need to be covered in the work
• The number of sessions, the venue and times, and any practical arrangements such as transport
• The boundaries of the work need to be set with the parents and are non negotiable with the child and needs to include any agreed management strategies if the child acts out verbally of physically in the sessions.
• The role of the parents needs to be clarified, e.g. they are not to be part of the interview, but their presence in the building may assist the child.
• The allocation and completion of homework assignments and the role of the parents with these needs to be clear – they can be framed as ‘tests’ which have no ‘right’ or ‘wrong’ answers, but are simply to provide more information on the child.
• The limits of confidentiality need to be explicit. With this age group it is difficult to grant any confidentiality, as the parents have a right to know the general information given. The specifics can usually be spared, other than where new information needs to be formally passed on, and
• Agree the child can bring a valued toy or something of their own choice to the sessions to comfort them during times of stress and which can help them regain their confidence and reassurance in the absence of the parents.
• An education session should take place with the parents and the child as a preface to the work. Most parents are unaware of the dynamics of sexual abuse or about the developmental stages of their child. Education offers them a baseline from which to work. Many parents, given some insight, can offer a lot of support and encouragement to their child in the work that follows.
• The workers need to carefully plan any work with the child. Any programme of work needs to be constructed with a view to retaining the child’s interest. As such, the materials used are as important as the content, so that cards, quizzes, games, glove puppets, and questionnaires need to be used. Using the right media to engage the child can offer a vehicle for the expression of feeling and emotions in the development of understanding of what is a very complex area of work, e.g. developing stories can help them access otherwise confused feelings and information; kaleidoscopes can offer altered images, thus helping the child with the concept of change; and the use of a glove puppet can act as a vehicle for communication and can remove the focus from the child, thus reducing the intensity of any psychological pressure on them.

2. Interviews with the Parents

It is important to see the parents separately as well as together, as their responses may be influenced by their partner’s presence. It is also important to allow them an opportunity to raise issues on their own agenda, and to deal with any feelings of anger, denial and confusion. The areas needing to be covered with the parents include:

• A social history of the child.
• Family composition, history and functioning.
• The child’s sexually abusive behaviours.
• Parental attitude towards both the abuser and the victim.
• Management strategies with the child.

Each of these is now explored in more detail below.

Social history

This needs to explore several key areas:

• The child’s developmental history (sexual behaviours are only on part of their total being).
• The child’s developmental needs.
• The medical and psychological background of the child.
• School history – performance, behaviour, attendance, relationships, etc.
• Peer relationships.
• What are their social skills?
• Hobbies, likes, dislikes?
• The child’s strengths (what do they do well?) and weaknesses (what don’t they do well?).
• Any history of separations, and in what circumstances?

Family composition, history and functioning

Understanding the child’s broader family context is essential if we are to understand the origins of their behaviour. We need to help parents understand if any aspect of their family life of current family dynamics are contributing to the child’s sexually abusive behaviour, and we also need to consider whether the child’s behaviour is impacting on the family. The family dynamics can contribute to recidivist behaviours from the child, e.g. parental leniency with supervision or confused sexual messages/sexual climate in the home. Workers need to elicit what things can or cannot be changed, and why? We need to gather information around:

• A history of each family member.
• An overall family history – any problems, violence, sexual issues, parenting style and ability.
• Family composition, relationships, dynamics, rules, patterns, alliances, strengths and weaknesses.
• Any history of abuse in the family, and any links directly or indirectly with the presenting problem.
• Gender roles.
• Sleeping arrangements.
• Social supports and stresses.
• Any history of alcohol or substance abuse, psychiatric history, etc.
• Family approach to sex and sexuality, and
• Family secrets – here, families often have secrets that keep the unhealthy dynamics alive. There may be a silent or overt message to remain silent about relationships or about supervision issues such as sleeping arrangements, visitation, and recurrences of reactive behaviour. Parents may be silent about ongoing issues, but the children often are the family historians and will reveal the intimacies.

3. The Child’s Sexually Abusive Behaviours

This section needs to explore the history of the child’s sexually abusive behaviours (number, types, whether they acted alone or with others, and whether any force was used or threatened).

The following offers a broad checklist of the areas that need to be covered:

• When did this behaviour first come to light? Was it a complaint? From whom?
• Has the child been approached about their behaviour? By whom? When? With what outcome?
• If there was a victim, what is their gender, age, relationship, and ability level? Is there more than one victim?
• In what context did the behaviour occur, e.g. bathing, recreation, etc?
• Has the behaviour changed over time? In what way?
• Can they recollect any significant events or changes around the time of the abuse?
• Are they able to identify any antecedents to the behaviour?
• Was any force or threats used? Were they threatened themselves?
• What do they think is wrong with their son’s behaviours? What are the high-risk situations?
• Do they blame the victim for the problem? Themselves? The intervention?
• Has the child been abused themselves? By whom? And in what circumstances?
• Do they discuss sex and sexuality- At all? Openly? Can they discuss nudity, masturbation, etc.?
• Has the child ever had any ‘consensual’ sex to the parents’ knowledge? Give details.
• Are they aware of any concerns about the child’s behaviours in the past? If yes, what were they?
• Has the child ever expressed any interest in sexual matters? What have they asked?
• Do they show interest in sexual behaviours on TV, videos, magazines, etc? Do they have access to this material?
• Do they have any concerns about the child’s attitude to women, sex or children?
• Has there ever been any concern about the child’s sexual or physical behaviour towards others?

4. Parental Attitudes towards the Abuser and the Victim

Most parents are overly concerned with any sign of sexuality in their child. Questions that need to be asked include:

• Are they obsessed with the information about the abuse?
• What is their concern and understanding of the risks?
• What is their reaction to the abuse? Do they identify with their son as a victim only?
• Are they projecting blame elsewhere? Onto whom?
• Are they minimising the abuse, or denying any abuse took place?
• What feelings do they have towards the child who abused, the victim, the workers, etc?
• How will they respond to and manage any relapse by their child?
• What are their feelings towards the child?
• Do they feel contaminated?

We can remind the parents about the information on age-appropriate behaviours given in the education block, and we need to help them work through any of the negative feelings they have experienced, or else they become more entrenched in their denial, and this will be projected onto the child. What is clear is that the attitude of the parents is vital to a hopeful outcome.

Management strategies with the child

It is important that the parents are educated not to set their children up to continue their abusive behaviour. The aim of this block of work is for them to safeguard the home environment until the child had learned to develop internal controls. Such management strategies will be stressful to the parents. They need support themselves to prevent them from retreating further into isolation, depression, chemical dependency, etc, and ultimately framing themselves as the victim. We do need to acknowledge and work through any issues about their own abuse that may compromise their child’s supervision. We should never underestimate or minimise the importance of supervising the child, particularly around any identified high risk situations, e.g. toileting, bathing, sleeping arrangements, etc.

Questions to be asked include:

• How did they manage the child – before and after the abuse was uncovered?
• Have they taken any steps to prevent any repetition of the abusive behaviour?
• What do they consider the high-risk situations to be?
• How can they be managed or avoided? And
• Can they identify any signals, which may proceed the abuse?

Steps for managing the child in the home

Decrease the opportunity to abuse.

• Don’t leave your child alone with victim-age children.
• Don’t have your child and a known victim bathe, sleep, or change clothes together.
• If your child is playing with another child, stay in the room or check on them frequently.
• Discourage games your child may have used to get another child to go along with the sexual behaviour (playing doctor, house, Simon Says, hide-and-seek, etc.).

Teaching sexual safety and privacy rules

• Bathrooms are private; others don’t enter when someone is bathing or using the toilet.
• Doors are closed when someone is changing or using a bathroom.
• Bedrooms are private; other children enter only with an adult.
• Clothing is worn when one is in the presence of others.
• One should knock and wait for permission before opening a closed door.

Encouraging open communications

• Listen to your child when he/she shares feelings, problems or worries – compliment your child for sharing.
• Help your child figure out what to do about his/her worries. Avoid just saying ‘Don’t worry’ or ‘It’ll be okay’.
• Give your child permission to share both negative and positive feelings.

Limiting experiences that increase sexual thoughts

• Don’t expose your child to movies, soap operas, or music that show sexual or violent themes.
• Interrupt sexual jokes, stories, and language and describe how this can harm others.
• When adults engage in sexual behaviours, they should do so in private settings where they cannot be observed.
• Talk with your children about their sexual concerns and give clear, consistent messages about what is and is not okay.
• Give clear messages about when and where masturbation or touching one’s own private parts is okay and having healthy, non-abusive thoughts while doing this.
• Videos and magazines containing graphic violence or sex should not be stored or used by adults at home.

Interrupting and redirecting misuse of power

• Discourage your child’s bossiness or use of force to handle problems with another child. Help them problem-solve other ways to handle each situation.
• Encourage your child to feel good about his/her efforts. Discourage the belief that your child has to be best, the first, or have the most to be okay.
• Help your child say what he/she is feeling during acting out behaviour. Help your child think about other ways to handle those feelings.
• Set limits and give clear messages that it is not okay to hurt someone else.

Correcting distorted thinking

• When you hear your child say something that supports his/her sexual behaviour problem, help your child to replace it with a corrected thought (such as replacing ‘I can do what I want’ with ‘No, some things aren’t safe, I have to follow some rules’).
• Interrupt thoughts that allow your child to view him – or her-self as being ‘victimised’ by your discipline (such as, ‘you don’t love me because you said no’ with ‘I do love you; I don’t want you to do this because…’).
• Remind your child how others feel or are affected by his/her behaviours.
• Help your child say how he/she feels or is affected by problems that he/she experiences.

Stay calm

• Help your child feel he/she can tell you about what occurred. You can let your child know you don’t approve but want to help him/her not do it again.
• Let your child know that you want to hear when he/she is having sexual thoughts so you can help your child control the problem behaviours.
• If you observe your child starting to engage in a sexually abusive behaviour, calmly interrupt it, state why it is not okay, and help your child figure out how he/she can stop it or control it – stay with your child to provide control.
• If your child repeats a behaviour, let him/her know it is not okay but that you still want to work together to not let it happen again – know that your child may slip and it’s a hard behaviour to interrupt because it ‘feels good’ (reproduced by permission of Alison Gray).

5. Interviews with the Child

The assessment of the child has to address several key components:

• Social history
• Family history and functioning
• The nature of the child’s sexually abusive behaviours
• The child’s attitudes towards the sexually abusive behaviours
• The child’s motivation for their sexually abusive behaviours
• Fantasy
• Victim issues, and
• Their motivation to change.

Social History

You will already have gathered considerable information in this area following the interviews with the parents. The aim of discussing this area with the child themselves is twofold: to build up some kind of rapport on a non-threatening topic as well as establishing whether any fundamentally different information has been given by their parents. It will cover developmental information, school information, peer relationships, areas of social competence, behaviour problems, and issues around their own feelings. Despite differing views on many aspects of children who sexually abuse, there is consensus about the need to understand and then tackle the social aspects of the behaviour. Indeed, the younger the child, the more important this area of work becomes.

Family history and functioning

It is useful to crosscheck information given by the parents’, and the use of non-verbal exercises such as the ecomap and genogram can be useful engagement strategies.

Questions that need to be asked include:

• Any known history of abuse in the family.
• Family secrets/rules.
• How affection is shown and discipline administered.
• What solutions are applied to the presenting problems?
• Strengths and supports.
• Do they have secrets? That they are afraid of telling? Or threatened if they did? What would happen now if they were to tell?
• Has anyone touched them in a way they didn’t like? When? Who? Did they tell anyone? Did it recur?
• Who are they frightened of, and why?

Sexual History and Knowledge

It is important to follow a very simple format for collecting this kind of information, particularly as a history of abuse to them may be uncovered and relived by them. This is, however, a very essential block of the assessment work and the following template is a guide to the areas that require consideration:

Development

• What is your family’s attitude about sex? Was (or is) it discussed easily or with difficulty?
• How old were you when you started to think about sex? Who did you talk to about it most?
• Tell us about the way you learned about sex. Who gave you your sex education? DO you feel you know everything? What questions do you still have?
• What kinds of sex play did you get involved in? With boys, girls? How much of the time that you spent with friends was spent on sex play, sex talk?
• How do they fell about the prospect of puberty? And masturbation (‘playing with yourself’)
• Have you ever had sexual contact during ‘dating’?
• What was the most fun sexual experience you can recall?

About bad experiences

• Did someone else ever molest you sexually? How old were you when that happened? How often do you think back on that experience?
• Do you still feel angry about bad experiences? How so?
• Did you have other bad sexual experiences (other than being molested)? What did these experiences mean to you?

We need to uncover whether the communication about sex and sexuality in the family is healthy or not. We will have gathered useful information from the parents’ questionnaires on the child sexual abuse inventory and checklist. We then need to check out their level of knowledge and experiences about sex. Whilst we will have agreed names for body parts and language before the work begins, it is useful to take this a step further and assess their levels of understanding about them. This can be done by using body charts of males and females, or anatomically correct dolls, and get them to name all the body parts of each sex. We can then move on to consider which parts will be involved in sexual behaviours, and these may not correspond with what an adult or juvenile may identify. By asking them to explain why the parts are included on the list, we begin to understand how they view sex and sexuality. They can then be asked to describe the function of each of the sexual body parts they have identified, and this is helpful in assessing their level of understanding. We can use this session as an educational one by allowing them to ask questions of the workers. Any confusion can be clarified and we can reinforce any basic messages of privacy and their right to make all the decisions regarding their own private parts. It is interesting that children can find it more difficult to know when a female is being sexually inappropriate or abusive towards them than they do with a male.

The nature of the child’s sexually abusive behaviours

This work should be undertaken when all the available information has been collected and when some kind of relationship has been developed with the child. From the information collected, is the sexual behaviour outside the normal range for their age? We do need to remember that children are capable of denial in much the same way as older abusers, so we need to guard against confrontation or punitive reactions. It is often much better to move on to a new area and return to the issue or point at a later time.

The child’s attitude towards their sexually abusive behaviours

Questions that need to be asked include:

• Does the child accept any responsibility for their behaviour?
• Do they blame someone else for the problem? Who? For what?
• Do they accept and understand other people’s concern about their behaviour?
• Are they frightened they have done something wrong?
• Who else knows about the child’s behaviour? Does the child know this? How do others feel?
• What has the child said and done about their sexual behaviours?
• How do they feel about letting you help them?
• What areas do they want to change? Please list.
• What areas do they not want to change? Please list, and
• Will they let anyone help them in their effort to change? If so, who?

Motivation for their sexually abusive behaviours

Whilst it is important to try and isolate the individual motivators in each case, it may be more appropriate to consider some thoughts and emotions that accompany the behaviours:

• Some children feel more popular or grown-up when they engage in sexual behaviours.
• Some children believe they’ll feel less weak or helpless if they can persuade another child to be sexual with them.
• Some children feel less worried about their problems when they experience sex.
• Some children feel excited doing something they know adults won’t like, especially if they think they won’t get caught.
• Some children are curious about sexual behaviours they have heard about or seen.
• Some children have been abused and repeat behaviours that were sexually stimulating or they may be attempting to undo or understand the behaviour by repeating it.
• Some children like the way their body feels when their private parts are touched.
• Some children don’t know that it’s not okay to make another child do sexual behaviours.
• For some children, the behaviour has become a habit; they might feel unable to stop, and
• Some children think it is fun not recognising how their behaviour affects others.

The task for the workers is to differentiate whether the behaviour is the product of an overtly sexual, violent, emotionally barren family environment or wider influences beyond the control of the parents and others. It is easier to address issues within the family such as re-negotiating supervision, the physical and sexual rules and boundaries in the home, and the changes can be more speedily implemented and monitored.

Fantasy

Workers need to ask themselves what fantasies or daydreams may drive the child to act out sexually. It is often not the sexual sensation that drives them, although there may be evidence of some cognitive distortions in children:

• My body is dirty.
• I can’t feel anything, and
• I am a bad person.

Children who sexually abuse describe physiological arousal to a range of different emotions. Children who live in unstable and unpredictable environments frequently experience different states of physiological arousal. They seek to discharge such arousal quickly. The physiological arousal and feelings are paired with the environmental factors and the arousal is sometimes sexual or sometimes emotionally aggressive. Sexually preoccupied children often have highly developed fantasies than other children who molest, and are often reluctant to change their sexual behaviour.

Victim Issues

With children who sexually abuse there are different sets of victim considerations: to what extent does their own abuse contribute to their behaviour, how far are they able to empathise with the victim of their behaviour, and what part, if any, did the victim contribute to the incident?

Own abuse as a contributing factor

Children who have been both physically and sexually abused engage in a greater variety of sexual behaviours than do those who only experienced sexual abuse. The frequency, severity, the sex of the abuser and the child, are factors most associated with internalised behaviour, whilst the duration, the abuser, and the sex of the child determined any externalised behaviour such as anger. Workers therefore need to be cautious when they assess this, as there are no sexual behaviours that are exclusively engaged in by sexually abused children.

Empathy with the victim

We need to understand how they feel towards their victim, how they begin to understand the impact of their behaviour on others, and how they can make up for what they have done.

The role of the victim in the abuse

We need to assess the contribution (if any) the victim made to an instance of inappropriate sexual interaction. Some children who have been victims will try to re-enact their own abuse by getting another child to act the part of the abuser. One victim can involve others, who in turn involve others, and it can therefore be very difficult to identify the initial source of the behaviour. We also know that unchallenged, such behaviour is accepted as the norm by their peers. In the longer term, they need to develop empathy for their victims, recognise appropriate boundaries, and to master new skills in problem solving, anger management and social skills.

6. Motivation to Change

• Is there a need for continued work with the child? And his family?
• Have they tried to change in the past? What was the outcome?
• Are they willing and able to engage in further work? Are they able to generate any solutions to the identified problems?
• Are they able to effect any changes?
• Are they supported by their parents? Or constrained by them?
• Will a mandate be needed to ensure the continued co-operation of the child and/or the family? Can one be secured? How?
• What are the contra-indications for treatment?
• What is the treatment prognosis?
• What is the prognosis without any further work?

Feedback and report

The feedback needs to consider the concerns uncovered about the child, the families behaviour, any identified areas for future work, and whether a mandate or change of contact arrangements/placement are indicated. The headings in this section can be used as a framework for a report. The sessions with the child and the parents can be followed by an observational session of the family together to assess areas like interaction, communication, and behaviours. We can also discuss issues with siblings to try and uncover concealed information, or subsequently as part of a longer-term child protection plan.

Parallel assessment tasks

• Continued monitoring of the child (e.g. nursery/schools) – particularly in a similar situation to that in which the abuse occurred.

7. Differentiating ‘Normal’ from ‘Abusive’ in Children

Sexual Activity Compared to Developmental Level

Concerns exist where the sexual activity exceeds the developmental level of the child, e.g. oral sex is beyond the behaviours expected from children under-5 years, whilst anal and vaginal penetration in children aged 6-10 years suggests a sexual behaviour problem. Any child aged 10-12 years, who engages in sex play with much younger children, or who forces someone to engage in sex, has a sexual behaviour problem. Children tend to obtain sexual information progressively; firstly, interest in themselves, followed by an interest in experimentation with others. This may be accelerated by explicit sexual information from family or peers, pictures or videos, observation of sexual activity between parents or among siblings or others, and direct sexual experiences. We clearly need to look at the kind of presenting sexual behaviour alongside the age of the child, before considering the family context, how or where the behaviour has been learned, and possible access to sexually explicit material.

Inappropriate sexual behaviour may not always involve other children: persistent masturbation (particularly in public), excessive sexual interest in sexual matters, a sexualisation of non-sexual situations and a sexualised content in their play, art or conversation indicates the need for a fuller assessment. Where other children are involved, we also need to ask ourselves whether the behaviour of the other participants is commensurate with their developmental level.

Relative Power of Children

If one child participating in a sexual activity has more power than another, it is more likely that the sexual behaviour is a problem. This is sometimes referred to as social coercion and reflects the power imbalances. Power can be measured along several dimensions:

• age difference – where it is greater than two years the situation warrants further investigation. The younger the child the more questionable it is for them to give informed consent. We clearly need to differentiate consent from compliance to acquiescence.
• size difference – is crucial where two children of similar ages are engaged in sexual play, as issues of power, dominance or the misuse of authority need to be considered, and
• differences in status – needs to be considered, particularly where one child is acting as a baby-sitter or temporary caretaker, and has more authority which compromises the other child’s ability to make choices, even where no threat or force is used. Any child with higher status or authority can use the inequality to coerce co-operation in another child. Even where two children appear to be about the same size and age, they do not necessarily share equal power, as there may be an inequality in their developmental sophistication. The workers need to be clear about the relative power positions of the participants, e.g. it is an obvious or a less obvious power imbalance, or where one child was taken by surprise and thus placed at a disadvantage? Or where one is always ‘the leader’ and the other is always ‘the follower’? If one child has a severe learning disability and another has not, a clear difference in power exists.

Complaint Status

Where a complaint of sexual abuse has been made either by the victim or someone acting on their behalf, we can assume that someone has already objected to sexual behaviour initiated by a child and deemed it questionable, inappropriate, or abusive.

Behavioural Indicators of Sexual Abuse

The presence of any behavioural indicators in either of the child participants may be significant as it will help add weight to the diagnosis, although it clearly should never be considered in isolation.

Coercive Sexual Behaviours

This involves intimidation, force, trickery or bribes, and may involve the use of a weapon or threat of a weapon to obtain submission. We clearly need to establish whether the presenting behaviour involved any of these figures. If it did, there is a problem requiring further assessment. What did the victim believe would be the result of non-compliance with the sexual behaviour?

Compulsive/Obsessive Behaviours

Features of either compulsive (seeing as if the child cannot control it) or obsessive (something the child thinks about continually) behaviour are indicative of some kind of sexual behaviour problem, and a further assessment is indicated.

Ritualistic and Sadistic Behaviours

Any element of bondage, sacrifice, torture or other sadomasochistic elements within the sexual behaviour is an indicator that something is wrong.

Secrecy

The workers need to assess whether the sexual behaviour was initiated openly or furtively, with concerns about discovery or disregard for being detected, and whether the participants were bribed or threatened? There is a need to distinguish a child’s natural sense of privacy or embarrassment about sexual feelings from the secrecy that allows abusive sexuality to continue.

8. 21 Red Flags Regarding Children’s Sexual Behaviour

Cavanagh Johnson (1994) identified 21 red flags regarding children’s sexual behaviour:

1. The children engaged in the sexual behaviours do not have an ongoing mutual play relationship.
2. Sexual behaviours which are engaged in by children of different ages or developmental levels.
3. Sexual behaviours which are out of balance with other aspects of the child’s life and interests.
4. Children who seem to have too much knowledge about sexuality and behave in many ways more consistent with adult sexual expression.
5. Sexual behaviours which are significantly different than those of other same-age children.
6. Sexual behaviours which continue in spite of consistent and clear requests to stop.
7. Children who appear to be unable to stop themselves from engaging in sexual activities.
8. Sexual behaviours which occur in public or other places were the child has been told they are not acceptable.
9. Children’s sexual behaviours which are eliciting complaints from other children and/or adversely affecting other children.
10. Children’s sexual behaviours which are directed at adults who feel uncomfortable receiving them.
11. Children (four years and under) who do not understand their rights or the rights of others in relation to sexual contact.
12. Sexual behaviours which progress in frequency, intensity or intrusiveness over time.
13. When fear, anxiety, deep shame or intense guilt is associated with the sexual behaviour.
14. Children who engage in extensive, persistent, mutually agreed upon adult-type behaviours with other children.
15. Children who manually stimulate or have oral or genital contact with animals.
16. Child sexualises non-sexualised things, or interactions with others, or relationships.
17. Sexual behaviours which cause physical or emotional pain or discomfort to self or others.
18. Children who use sex to hurt others.
19. When verbal and/or physical expressions of anger precede, follow or accompany the sexual behaviour.
20. Children who use distorted logic to justify their sexual actions (she didn’t say “no”).
21. When coercion, force, bribery, manipulation or threats are associated with sexual behaviour.

She then went on to provide a risk index framework to help organise the information and concerns:

9. Risk Factors

Risk factors related to the child

• Displays oppositional behaviour.
• Has poor peer relations/coping skills/self-concept/academic record/few, if any, friends.
• Disregards rules and regulations at school, at home, in the community.
• Is aggressive at school, home, or neighbourhood towards adults and/or children.
• Destroys own property and/or the property of others.
• Threatens others with harm.
• Behaviour is beyond parental control.
• Has no (apparent) positive affective connections with adults or children.
• Extremes of affect, poor modulation of affective responses.
• Is cruel to animals/sets fires.
• Displays volatile temper, or rage reactions / manipulative behaviour.
• Has witnessed physical aggression directed at his or her primary caretaker.
• Is a victim of physical, sexual, or emotional abuse, abandonment or neglect, and
• Has low cognitive ability (in conjunction with aggressive physical and sexual behaviours).

Risk factors related to problematic sexual behaviours

• Denies the sexual behaviour, although there is good evidence that it occurred.
• Dislikes or has a highly ambivalent relationship to the other child.
• Has no relationship to the child with whom he or she engaged in the sexual behaviour.
• Planned the sexual behaviour without the knowledge or the other child.
• Doesn’t seem to care that the other child might be hurt physically or emotionally.
• Other child is highly vulnerable.
• Blames other people or circumstances, takes no responsibility for the sexual behaviour.
• Has a history of sexual behaviours apart from this incident.
• Caught multiple times for coercive sexual behaviours.
• Hurt the other child while engaging in the sexual behaviour.
• Has very intrusive sexual behaviour.
• Recruited other children to engage in the sexual behaviour with him or her.
• Doesn’t think it was serious to engage in coercive sexual behaviour.
• Used physical strength to gain compliance of other child.
• Bribed, teased, coerced, or threatened other child, and
• Used threats or other leverage to reinforce secrecy.

Risk factors related to the family

• Parents-caretakers with very confused sexual boundaries and confused notions about sexuality; poor physical and emotional boundaries in the family.
• Parent-caretaker uses child to meet his or her own dependency and sexual needs.
• Spousal battering.
• Mother with a personality disorder with dependent, narcissistic, and borderline characteristics, and depressive features.
• Psychiatric diagnoses in parents.
• History of prostitution; history of living in motels, the street, or cars.
• History of violence and impulsivity in the family to which the child has been privy.
• History of emotional, physical, or sexual abuse to parents themselves; history of emotional, physical or sexual abuse to other family members.
• History of child protective agencies or police involvement with the family.
• History of perpetration in the family.
• History of family disruptions including divorce, out-of-home placements.
• History of drug and/or alcohol abuse; history of inadequate parenting to the child (i.e. inconsistently meeting the child’s needs).
• Parents know little about the offence or deny the child committed the offence or do not see the offence as a real problem.
• Parents dislike the child or project negative attributes onto the child.
• Victim was a favourite child in the family.
• Father is incarcerated or otherwise involved with the law.
• Absent father who was authoritarian and distant from family members and emotionally/physically abusive to mother.
• Multigenerational sexually abusive family.
• Role reversals in which the child feels the intense need to care for the parent who cannot care for himself or herself without the child’s assistance, and
• Single parent with other children in the home.

Risk factors related to the environment

• Child who molests lives with the victims.
• Child who molests has access to vulnerable children.
• Economic stresses.
• Poor supervision.
• No sense or orderliness or predictability in the child’s life

The greater the number of factors present, the more serious the behaviour, and the higher the risk of further abuse. In young children, a number of factors may indicate a high risk for re-offending. These factors include the following:

• The use of force, threat or violence.
• A history of impulsive aggressive behaviour.
• A history of victimisation, which has remained untreated.
• Predatory, compulsive, and repetitive behaviour.
• An unresponsive family in denial.
• Selection of multiple victims
• Pervasive sexual behaviours across settings, and
• Lack of remorse and refusal to stop the behaviours

10. A Prognosis Framework for Cases Involving Sexual Abuse within the Family

Introduction

Intervention with families where a member of the family is believed to have offended sexually against a child whether within or outside of the family, requires a multi-faceted approach. All family members will have been manipulated, groomed and deceived by the perpetrator so that the abuse can be carried out. Thus, it is crucial that each family member is involved in the work so that a truly comprehensive assessment of the family can be made, the risks identified and future intervention planned.

This practice guidance provides a framework for determining prognosis when considering the viability for maintaining or reconstituting the family. Separate papers address more specialist areas such as contact in cases of child sexual abuse. The areas requiring assessment have been identified in table form alongside criteria of indicating hopeful, possible or poor prognosis for change.

11. Analysis of Change Tables

Click here to view the Analysis of Change Tables.

Rehabilitation

It is vitally important that rehabilitation work commences ONLY WHEN the protective parent has been able to assume a level of parental responsibility and authority that recognises the risks of living with a child sexual abuser, and is assessed as capable of protecting the child.

A rehabilitation programme that is led by the pace, progress or wishes of the offender is a recipe for failure. In such a situation, child protection workers are relying completely on the offender to prevent any future sexual abuse from occurring, this is not protecting the child.

Renewed or resumed contact should be gradual and phased. It should be structured and have a purpose, and only take place following the completion of a satisfactory risk assessment. Contact between the couple could be a first step. It should be structured and have a purpose, and only take place following the completion of a satisfactory risk assessment. Contact between the couple could be a first step. It should not include the children at this stage, nor should it involve them in any disruption to their lives and routine. Its purpose would be for the adults to set and agree roles and rules which work towards ensuring risk reduction.

Contact between the offender and children, including the child victim, should be supervised at first. This should involve a network of informed and protecting adults. Over time, the responsibility for the supervision of contact should be that of the protective parent, as this will be her overall responsibility should the family be reconstituted.

A positive indicator would be if the protective parent sought to “recruit” additional help from the extended family.

Workers need to assess the following and be satisfied that the protector has shown that she has achieved most of the following:

• Does she believe the abuse took place?
• With whom does she place the responsibility for the abuse?
• Is she confident in her ability to identify situations that are risky and to intervene in interactions that she deems inappropriate?
• Has she adequate knowledge regarding the risks both generally and is she familiar with the concept of “grooming” and specifically this particular offender’s methods?
• Has she been able to strengthen her parental role and authority? How?
• Are these respected by the children and the offender?
• Is her freedom of movement constrained or restricted? How and by whom?
• What is the nature of her access to outside sources of support?
• Can she bring any child protection issues to the attention of a protecting extra-familiar person or agency?
• Can she actually talk about the sexual abuse concerns or disclosure with her child and with her other children?
• Is the explanation she has given to her children and family members for her partner’s absence from home accurate and factual?
• With whom does she place the responsibility for the split-up of the family?
• How has any economic dependence been resolved?
• Is she able to accept the concept of on-going risk despite the minimisation and rationalisations from the offender that “it won’t happen again”?

The assessment should also make clear what progress the offender should have made prior to consideration have renewed contact or rehabilitation with children. This should include:

• acceptance of responsibility for the feelings, thoughts and actions which led to and sustained the abuse;
• understanding the harm caused by his offending behaviour and the completion of a satisfactory apology to his victim and his partner, where appropriate;
• some recognition of the need to change controlling and egocentric approaches to family relationships;
• improved ability to negotiate his emotional needs;
• control of any addictive/dependency behaviour;
• a willingness to abide by the rules set by the child protection workers, Probation and family members

In the situation where the offender is already in the family, workers are more constrained. He is probably already having a great deal of unsupervised contact with the child/ren. It is therefore especially important that the child protection plan is in place and firmly understood by all.

Family, friends and relatives can be a major help or a deterrent to a child in the prevention and detection of abuse. However, the “secret” of child sexual abuse still carries the mystical power to destroy the family as they have known it, and relatives and friends are generally fearful of the consequences of taking any action. If they fail to do so they remain part of the system that the abuser built around him.

Monitoring relapse post rehabilitation

Alert list Re: Child

• Sleep disturbance – nightmares, bedwetting, sleeping in clothing, sleeping elsewhere, constructing hiding places
• Depression
• Withdrawal
• Suicide plans/attempts
• Makes self ‘unattractive’, poor hygiene, self mutilation (including hair cutting)
• Appetite – weight change
• Avoidance of offender
• Concern regarding whereabouts of offender – wants to keep him in
• Avoidance of males
• Change in how victim refers to offender – eg. from father to first name basis
• Victim asks you about martial status-divorce
• Fears and anxieties (phobias)
• Clinging to you
• Bedroom door shut – lock on door
• Conservative/modest at home (covering up)
• Change in peer relationships: stops bringing friends home
• Protective of brothers and sisters
• Rebellious in the home
• Compulsive rituas i.e. overwashing, body/clothing
• Legal problems – theft, alcohol, drugs
• Victim becomes physically and /or verbally and/or sexually abusive of others
• Escapes: suicide attempts, alcohol and drug abuse, running away, out of marriage pregnancy, early marriage, sleeping elsewhere, home late
• Flight into adulthood (caricature): Seeks older acquaintances, sexual ‘acting out’, smoking, swearing, ‘adult’ interests
• Unexplained ‘presents’, money, sweets, etc.
• ‘Medical’ complaints with no apparent basis in fact
• Physical indicators: infection, rash, abrasions, frequent sore throats, blood on clothing, Sexually Transmitted Infections.
• School difficulty: discipline, truancy, homework, grades decline
• Abrupt change in new victim’s relationship with partner eg. mother of new victim stops talking with mother of primary victim

Finally:

• Take seriously everything that the child says regarding sexual deviance
• If there is the slightest doubt seek professional advice

Alert list Re: Offender/alleged offender

• Abuse of alcohol and other drugs
• Loss of control over other behaviours: eg. smoking, gambling, battering
• Sleep- last to bed, up at night, first to rise, restless
• Tucking victim into bed without being asked to do so
• Initiating/prolonging physical contact with target
• Possession/use of Pornography
• Sexual preoccupation
• Difficulty accounting for time – unstructured time
• Going out for drive in car with no destination -unexplained mileage
• Discipline – favouritism, harsh, erratic
• Challenging your authority over children
• Making excuses for child
• Stated over – confidence regarding impossibility of reoffence
• Not attending counselling or completing assigned tasks
• Attempts to discredit programme
• Attempts to discredit child
• Attempts to discredit you
• Attempts to intimidate child and/or you
• Attempts to get you to ‘side with him’ against the ‘authorities’
• Assuming the role of ‘sex educator’
• Inappropriate apparel – robe only, no underwear, patches, broken zipper
• Leaving bathroom/bedroom door open
• Invading childs privacy (ie. entering childs bedroom without being asked)
• Job stress- fired, laid off, change in job description, business problems
• Rapid religious conversion
• Secretly reading seilf help books
• Drawing your attention to news items about abuse to make the point that what he did was ‘not as bad as that’
• Self pity, blame shifting, i.e. ‘It was because of something’ someone
• else that he abused – he is really a victim
• Involvement in youth programme
• Involvement in child’s hygiene: bathe, massage, apparel, grooming
• Selecting children’s clothing: too small, adult, cosmetics
• Isolating the child
• Expressed(negative) interest in victim’s social/sexual behaviour
• Stated physical complaints in victim’s presence
• Reluctance to be with extended family
• Reluctance to be with others (adults) who have knowledge of the offence and warning signs
• Reluctance to discuss offence related matters
• Not able to account for money spent gifts, loans, purchase of drugs
• Anxiety, thin-skinned, uptight
• Difficultly getting things done
• Passive-aggressive (non-assertive) style
• Shift in parental responsibility: return to school/work triggers ‘abandonment’ and unsupervised time
• Return to offender following extended absence
• Offender retreats to childhood: clothing, language, cultivation of younger friends
• Unresolved marital conflicts – refusal to dismiss problems
• Change in sexual functioning: frequency, dysfunction, abuse, infidelity