Trauma and Adolescents Who Engage in Sexually Abusive Behavior: A Review of the Literature

ABSTRACT

While recent research has established the abuse and victimization histories of youth who engage in sexually abusive behavior, there is still debate regarding the significance of trauma and abuse as developmental antecedents to sexual offending in adolescence. Moreover, research has not conclusively identified the types, context, and timing of adverse experiences that act as catalysts for subsequent sexual perpetration. The present comprehensive literature review has one primary aim: Explore the adverse childhood experiences of youth who engage in sexually abusive behavior, considering whether trauma may be a consistent developmental antecedent to offending. Search method, inclusion criteria, and screening protocol are described, and the articles included in the review (N = 13) are qualitatively analyzed using thematic coding. Findings indicate that traumatic experiences and symptoms may be of developmental and etiological significance for subsequent sexually abusive behavior in adolescence. Implications for research, treatment, and policy are discussed, with the hope the findings will act as impetus to develop and deliver targeted treatment and prevention programs to sexually abusive youth who have histories of victimization.     

Collaborative Treatment for Sexual Behavior Problems in an Adolescent Residential Center

Abstract

Many residential treatment and sex offender programs for adolescents historically have used coercion-based interventions. Treatment programs employing coercive techniques often replicate the same destructive and intrusive behaviors they seek to eliminate. Tension between departments coupled with poor communication and discomfort around sexual behavior issues within the staff of residential treatment centers are more likely to inhibit the progress of the youths they serve.

Collaboration among residential, educational, and clinical components enables staff to work in a direct, genuine, and respectful fashion with students who have histories of sexually abusive behavior. It further assists in maintaining a safe and predictable environment for these students. Finally, it helps students eliminate destructive behaviors by directly and consistently addressing four key areas: sexually abusive behavior, antisocial attitudes, social/emotional functioning, and overall self-care. It is not the author's intention to hold Bennington School, Inc.up as a model residential treatment program or to criticize other residential facilities. Rather, it is hoped that what is working in Bennington may be helpful to others.

Many who have worked on the front lines of residential treatment with sexually abusive adolescents have received training in elements specific to sexually abusive behavior. The origins of treatment for youth who have sexually abused were noteworthy for their lack of offense-specific interventions (National Adolescent Perpetration Network, 1993). However, a wealth of literature soon emerged addressing the need for assessment and treatment techniques specific to this population (Perry & Orchard, 1992; Barbaree, Marshall & Hudson, 1993). Much of this literature made assumptions regarding high levels of chronicity (Perry & Orchard,1992) while other contributions stressed the role of denial and minimization (Barbaree & Cortoni, 1993). As a result, while many issue-specific forms of assessment and treatment were developed, they often did not take into account other developmental needs and issues in the lives of sexually abusive youths (Lane, 1997).

Concurrent with this emerging research was a substantial increase in the number of treatment programs for juvenile sex offenders (National Adolescent Perpetration Network, 1993). In this context, it is not surprising that many treatment programs relied heavily on treatment targeting denial, minimization, and perceived sexual deviance without taking into account other treatment needs of youths. Although a recent literature review of adolescent residential programs (Curwen, 2000) notes a trend away from shame-based approaches, there appears to be less clarity on specific criteria on which to base residential treatment of adolescents who have sexually abused (Curwen, 2000).

Finally, recent research shows that among adult populations, accepting responsibility for abusive behavior in treatment is more likely to result from a warm, genuine, and empathic treatment style (Marshall, Fernandez, & Anderson, 1999). Group therapy participation, similarly, results from encouragement, open questions, and nonconfrontational challenge. The emerging themes of recent trends and research should inspire those at the front lines of residential treatment to reconsider not just basic treatment approaches, but the most minute elements of their interactions with youths.     

Paradigm shift: implementing MEGA, a new tool proposed to define and assess sexually abusive dynamics in youth ages 19 and under

Previous definitions of sexually abusive behavior in children and adolescents were deficient in failing to (1) highlight salient neuropsychological elements and antisocial behaviors that may contribute to a youth's functioning; (2) discriminate among possible types of coercion (e.g., manipulation, threats, physical force, and use of weapons); and (3) include predatory elements of sexual abuse against strangers or casual acquaintances. This article discusses a new comprehensive assessment tool that assists in defining sexually abusive youth. This tool, the Multiplex Empirically Guided Inventory of Ecological Aggregates for Assessing Sexually Abusive Children and Adolescents (Ages 19 and under) (MEGA; Miccio-Fonseca, 2006b), encompasses neuropsychological elements, coercive aspects, and predatory elements as essential factors to consider in comprehensive assessments of sexually abusive youth.     

Child physical-sexual abuse: The role of sadism the role of sexuality

Abstract

Starting from several examples of clinical material, the author proposes an understanding of the mental functioning of a physically and/or sexually abusive parent. He bases his theoretical reflection on two analytical concepts: narcissism and perversion Relating the sadistic instinct to the former and the sexual instinct to the latter, he discerns two modes of functioning which have some points in common and some diverging points, but which show the dynamics involved in physical and sexual child abuse.

The relationship distinguished between the type of emotional relationship between the parents and the type of their emotional investment of their child allows us to understand how the complicity of the parents works against the child.

This approach to the functioning of the physically and/or sexually abusive parent implicitly gives an insight into the structuring of the personality of the child-victim, who in turn undergoes the risk of becoming a physically and/or sexually abusive parent with his own children.     

An examination of sexual risk behaviors in adolescent substance users

ABSTRACT. Objectives: This study examined the risk for engaging in high-risk sexual behavior associated with substance use in a sample of U.S. adolescents. Methods: The sample (N = 15,425) was obtained via the Youth Risk Behavior Surveillance System, a survey of public high school students. Results: Substance use was associated with sexual risk behaviors, with odds ratios being greatest for adolescents who used cigarettes and illicit substances, as well as those who engaged in injection drug use. Conclusions: Results highlight the need for prevention and intervention programs targeting sexual risk behaviors in substance-using adolescents as a means to decrease the spread of sexually transmitted infections.     

Assessing God Locus of Control as a Factor in College Students’ Alcohol Use and Sexual Behavior

Abstract. Objectives: This study explored God locus of control beliefs (ie, God's control over behavior) regarding their influence on alcohol use and sexual behavior as an alternative religiosity measure to religious behaviors, which does not capture perceived influence of religiosity. Additionally, demographic differences in religious beliefs were explored. Methods: College students aged 18–24 (N = 324) completed a survey between April 2012 and March 2013. Principal components and multivariate analyses were conducted. Results: Findings suggest that measures provide reliable, valid data from college students. God locus of control is linked to not consuming alcohol or engaging in sex. There were differences regarding relationship status and religious denomination. Conclusions: God locus of control beliefs are an appropriate construct for collecting data about college students’ religiosity. Furthermore, health educators at faith-based institutions could incorporate this construct into their programming, encouraging abstinence but also behaving responsibly for those who do drink and are sexually experienced.     

Perceptions of Abusive Parenting Behaviors: A Preliminary Exploration Into the Underrecognition of Mother–Daughter Sexual Abuse

ABSTRACT

The current study examined the influence of the sex of the parent and the sex of the child on perceptions of sexually abusive behaviors. Vignettes illustrating different forms of sexual abuse were rated by 124 participants, with the different parent–child pairs (mother–daughter, mother–son, father–daughter, father–son) substituted into the vignettes being the only difference between groups. Two-way between subjects ANOVAs revealed that sexually abusive behaviors by mothers were perceived as less damaging to child victims (F (1, 120 = 7.56, p < .01) than the same sexually abusive behaviors committed by fathers. In addition, sexually abusive behaviors by mothers toward daughters were perceived as the least abusive (F (1, 120 = 16.30, p < .001) and the least criminal (F (1, 120 = 4.44, p < .05) as compared to the other three groups. Results suggest that perceptions of sexual abuse may be influenced by perceptions of sex and gender.     

Emerging Strategies for Risk Assessment of Sexually Abusive Youth: Theory,Controversy, and Practice

SUMMARY

Clinicians and other professionals evaluating, managing, and treating sexually abusive youth are frequently called upon to offer judgments regarding risk for sexual reoffense. There are currently no empirically validated methods for accurately classifying risk among this population. Therefore, those faced with this task have an obligation to consider the research on the assessment of risk and recidivism. Five methods of risk assessment are reviewed, and four scales are discussed, with directions on how to obtain them. These include the Juvenile Sex Offender Assessment Protocol (JSOAP), the Protective Factors Scale (PFS), and Estimate of Risk of Adolescent Sex Offender Recidivism (ERASOR).     

THe Use of Hormone Therapy in the Male-to-Female Transgender Population: Issues for Consideration in Thailand

ABSTRACT

Objectives: Prejudice against transgender people is evident around the world with discrimination in many aspects of life, including access to health care. Even in Thailand, where male-to-female (MTF) transgender people are particularly visible and society is reputedly accepting, barriers to attaining appropriate health care still exist. The vast majority of MTF transgender people in Thailand are reported to be taking hormone therapy; however, most do not seek medical advice regarding these regimens, with the initiation and tailoring of medication often being guided by sympathetic peers instead. The objectives of this review are to consider hormone therapy in the context of the Thai population and provide recommendations regarding ways to improve practice and reduce health risks. Methods: The data analysis in this article represents a comprehensive literature review regarding hormone therapy for MTF transgender people including the guidelines for initiation, prescribing, and monitoring of hormone therapy, risks for serious adverse events and reported hormone use by the MTF transgender population in Thailand. Results: There is a notable lack of published research regarding hormone therapy in the transgender population. Guidelines, whilst relying considerably on expert opinion, do provide clear recommendations on the initiation, maintenance and monitoring of hormone therapy. Comparison of endocrine guidelines with reported practice in Thailand reveals significant opportunities for improvement in MTF transgender hormone therapy. Conclusions: The incautious use of hormone therapy may represent a considerable health risk behavior undoubtedly contributing to the morbidity and mortality in MTF transgender people. Although there is currently considerable focus on sexually transmitted infections in the MTF transgender population, a more comprehensive approach to health care is required, including education for transgender people and the health professionals who attend to them regarding appropriate hormone therapy.     

Associations between Croatian Adolescents’ Use of Sexually Explicit Material and Risky Sexual Behavior: A Latent Growth Curve Modeling Approach

Objectives: The aim of this biobehavioral longitudinal study was to assess the association between sexually explicit material (SEM) use and risky sexual behavior among Croatian adolescents (n?=?577). Methods: The data were collected over the period of 15?months. Conditional dual-domain latent growth modeling was used. Results: Male adolescents’ initial SEM use, but not subsequent growth, was related to changes in sexual risk taking over the observed period. Among female adolescents, SEM use and sexual risk taking were significantly related only at baseline. Conclusions: Our findings point to gender-specific association between adolescents’ SEM use and risky sexual behavior.     

A Physician's Experience: Taking Care of Ralph

Abstract

“Primary Prevention of Sexually Transmitted Diseases; A Primer for Clinicians,” KATHERINE M. STONE, et al. With the advent of sexually transmitted infections for which curative therapy is not available, primary prevention has assumed greater importance. The spectrum of sexually transmitted diseases (STDs) has broadened, and clinicians need to understand the mechanisms of their transmission and prevention. Modifying selection of sexual partners and avoiding certain sexual practices should theoretically reduce the risk of infection. Clinical and laboratory studies indicate that the use of condoms, diaphragms, and spermicides reduces the risk of acquiring certain infections. At present, hepatitis B is the only STD for which a safe, effective vaccine is available. Use of oral antibiotics cannot be recommended. Postcoital washing or urination have not been shown to have a protective effect against infection. Because of the potential benefits, persons at risk for STDs should be encouraged to modify their sexual behavior and use barrier methods and spermicides to protect themselves against sexually transmitted infections. (Journal of the American Medical Association 1986;255:1763–1766.)     

The Relationship Between Use of Sexually Explicit Media and Sexual Risk Behavior in Men Who Have Sex with Men: Exploring the Mediating Effects of Sexual Self-Esteem and Condom Use Self-Efficacy

ABSTRACT

Objectives: This study tests the following 3 hypotheses: (1) there is a direct association between consumption of sexually explicit media (SEM) depicting non-condom use and sexually transmitted infection (STI)-related sexual risk behavior among men who have sex with men (MSM); (2) the association between SEM consumption and STI-related sexual risk behavior is mediated by men's sexual self-esteem; and (3) the relationship between SEM consumption and sexual risk behavior is mediated by condom use self-efficacy. Methods: A cross-sectional, Internet-based survey on exposure to SEM and sexual behavior of 1,391 MSM in the United States was conducted in 2011. Results: The results confirmed Hypotheses 1 and 3, while Hypothesis 2 was rejected. Accordingly, a significant association between the use of SEM picturing condom use and STI-related sexual risk behavior among MSM was found. Likewise, we found that the association between the use of SEM and sexual risk behavior was mediated by condom use self-efficacy in an indirect path. However, SEM did not influence sexual risk behavior via sexual self-esteem. Conclusions: To promote STI prevention, the actors in SEM may be used as role models in managing condom use in sexual contexts.     

The Seven Challenges: An Effective Treatment for Adolescents with Co-Occurring Substance Abuse and Mental Health Problems

ABSTRACT

Recent developments in the provision of the substance abuse treatment for adolescents has included a focus on age appropriate treatment with consideration for adolescents' relatively low level of motivation for treatment and high incidence of co-occurring substance use and mental health problems. This study examines 3- and 6-month substance use and mental health outcomes for youth (n = 36) participating in The Seven Challenges Program. Results indicate significant reductions in both substance use and mental-health-related measures at 3 months with all measures except substance abuse frequency continuing to improve at the most distal 6-month assessment. The Seven Challenges treatment model is presented along with a discussion of the findings.     

A Novel,Self-guided,Home-Based Intervention to Improve Condom Use Among Young Men Who Have Sex With Men

Abstract

Objective: This pilot study tested the efficacy of a brief, novel, theory-driven, self-guided, home-based intervention designed to promote condom use among young men who have sex with men (YMSM). Participants: Thirty YMSM were recruited from a large public US midwestern university during spring of 2012. Methods: The intervention was tested using a repeated measures design with the primary follow-up assessment occurring 6 weeks after enrollment. Results: Forty-five percent of men reported a reduced frequency of unprotected insertive penile–anal intercourse in the past 30 days compared with baseline (p = .01). Consistency of condom use improved (p = .013), as did motivation to use condoms correctly, condom use self-efficacy, and condom attitudes. All participants indicated that they were glad they participated, would recommend the program, and that overall, they had liked the program. Conclusions: This pilot study supports an expanded trial of this intervention with MSM at high-risk of acquiring human immunodeficiency virus/sexually transmitted infections (HIV/STIs).     

Exploring the Overlap in Male Juvenile Sexual Offending and General Delinquency: Trauma,Alcohol Use,and Masculine Beliefs

Despite Burton and Meezan's (2004 Burton, D. L. and Meezan, W. 2004. Revisiting recent research on social learning theory as an etiological proposition for sexually abusive male adolescents. Journal of Evidence-Based Social Work, 1(1): 41–80. [Taylor & Francis Online] , [Google Scholar]) finding that sexually aggressive youth are three to four times more likely to recidivate nonsexually than sexually, there is little to no research to date that explores this overlap in criminality. With a sample of 290 male sexually violent adjudicated and incarcerated youth, this study was able to successfully predict those who are exclusively sexually violent from those who are both nonsexually and sexually violent with each of the following factors: childhood trauma, masculine beliefs, and alcohol use. While alcohol use accounted for the greatest variance between the groups, masculine beliefs offered the greatest basis for the discussion and future projects for the authors of the study. Treatment and research implications are offered.     

Correlates of African American female adolescent offenders 3, 4-Methylenedioxymethamphetamine (MDMA or “Ecstasy”) use and sexually transmitted infection morbidity

Abstract

The current study was designed to determine the extent to which self-reported ecstasy use in a population of juvenile adolescent detainees in a southern state is associated with high-risk health behaviors pertaining to sexually transmitted infection (STI) symptomology and past history of STI occurrence. Participants were 764 African American females extracted from an overall sample of 2,260 juvenile offenders housed at selected Youth Development Campuses in the state of Georgia. Significance tests were conducted using univariate logistic regressions to examine the independent associations of participant’s self-reported ecstasy use and dichotomized HIV risk behavior correlates and history of having a prior STI before the most recent incarceration Participants who reported ecstasy use prior to incarceration were 1.7 (OR = 1.68, 95% CI = 0.78–3.64) and 1.8 times (OR = 1.87, 95% CI = 1.24–2.81) more likely respectively to indicate having had genital warts or chlamydia, and were more than 1.5 times (OR = 2.21, 95% CI = 0.83–5.44) and two times more likely to report having had gonorrhea or herpes, accordingly. Prevention programs for adolescent offender populations should develop interventions that target adolescents’ substance use behavior as a function of STI risk taking as well as being culturally competent to deal specifically with these problem behaviors.     

Using the NIAAA brief alcohol screener in social work practice for selected prevention targeting youth

ABSTRACT

This article discusses the use of brief screeners in social work practice to identity adolescents in need of selected interventions for alcohol and other drug use problems. Brief screeners can increase access to alcohol or other drug intervention services and promote the diffusion of evidence-based interventions to underserved communities when integrated in Screening, Brief Intervention, and Referral to Treatment (SBIRT) initiatives. The two-item NIAAA Brief Alcohol Use Screener is discussed as a developmentally tailored assessment tool that can be integrated into SBIRT in social work practice to improve detection of early-stage alcohol problems among adolescents who lack routine access to preventative health care. The use of brief, empirically supported alcohol screeners in trainings for social work students and new professionals can enhance their preparation and competence to offer child and adolescent clients appropriate selected intervention options to reduce harms associated with underage alcohol use.     

Does Asking Adolescents About Pornography Make Them Use It? A Test of the Question–Behavior Effect

Longitudinal survey design is the preferred method for the robust assessment of outcomes associated with socially undesirable or potentially harmful sexual behaviors. However, repeated measurement may induce the question–behavior effect (QBE)—the phenomenon where asking about a behavior changes the probability of engaging in the behavior in the future. Using an online panel sample of Croatian adolescents (M_{age at baseline} = 15.8, SD = .50), the present study explored the QBE in the context of adolescent pornography use. To this end we compared the frequency of pornography use six months after the initial survey (T2) between adolescents who participated in both baseline (T1) and T2 survey assessments (n = 1,053; 41% of males) and those who began the study at T2 (n = 130; 42% of males). In line with the findings from a recent Dutch study, we found no evidence that surveying adolescent pornography consumption increased participants’ reports of subsequent use. Implications of the findings for studying pornography use in young people are discussed.