The stop and think group: Changing sexually aggressive behaviour in young children

Abstract

Until recently, relatively little attention has been paid to young children who are sexually aggressive to other children. In this paper, cognitive-behavioural group techniques which have been used in the treatment of aggressive, impulsive behaviour in young children were applied in a small group setting to the sexually aggressive behaviour of pre-pubescent boys. The boys initially learned a ‘Stop and Think” model for general interpersonal problem-solving, which was then used to work on their difficulties with verbal and physical sexual aggression. Observation of the children's behaviour, reports from carers, school staff and social workers indicated that the group programme increased the children's ability to inhibit impulsive, aggressive behaviour. In the nine months after the group finished there were no known incidents of sexual aggression. In the context of certain limitations discussed in the paper, this positive outcome suggests that these methods have potential for reducing the likelihood of sexually aggressive behaviour becoming habitual.     

Developing a therapeutic environment for boys in secure settings who have sexually offended

Abstract

The role of secure units in helping sexually abusive adolescent boys to change their behaviour and attitudes is examined. The problems presented by 23 adolescent sex offenders at Glenthorne Youth Treatment Centre were used to identify issues for management and treatment. These boys had committed a variety of non-sexual offences, and were responsible for 691 recorded crimes. Many had committed violent offences and had emotional, educational, relationship and substance-abuse problems. In contrast to the situation in community settings, the use of offence-focused groupwork and individual psychological therapy is limited in secure units. Many of these boys are not suited to this kind of work, or are not yet ready to benefit from it. Secure units also have difficulty resourcing these types of intervention. Nevertheless, the secure unit environment can be organised and structured to effect changes in behaviours and attitudes associated with sexual offending. Attention should be given to particular aspects of residential practice, including anti-discriminatory practice, organisational values, establishing behavioural boundaries, challenging unacceptable behaviour and language, reinforcing appropriate behaviour, encouraging interpersonal problem-solving, providing effective supervision based on an evaluation of risk, and education to raise victim awareness and respect for others. Liaison with community programmes for sexually abusive adolescents should be encouraged.     

Is sexually abusive behaviour in personality disordered inpatients analogous to sexual offences committed prior to hospitalization?

Abstract

Sexually abusive behaviour by personality disordered patients presents a serious threat to the integrity of staff–patient relationships and the safety of other residents. The occurrence of such behaviour is also problematic for the offending patient, as it may impact on perceived treatment needs and their access to the community. This paper reports on a study of sexually abusive behaviour in a high security psychiatric hospital. It also examines the relationship between these behaviours and patients’ history of sexual offending. The results showed a high frequency of low-severity sexually abusive behaviour and no significant associations between sexually abusive behaviour during hospitalization and sexual offence history. These findings imply that low-severity sexually abusive behaviour within secure settings may be determined, partly, by environmental conditions. This sexual abuse may also be functionally dissimilar to severe sexual abuse perpetrated in the community. The meaning and determinants of sexual abuse within secure settings must be scrutinized carefully and comprehensively before they are considered analogous to previous sexual offences.     

Staff members’ evaluation of inpatients’ motivation for aggression – the roles of staff restrictions and aggression severity

Improved understanding of inpatient aggression can come from systematic assessment of motivation for aggressive incidents. This study investigates staff members’ evaluation of motivation for aggressive incidents, and how such evaluations are influenced by staff restrictions and aggression severity. Staff reports of aggressive incidents in a secure psychiatric unit were collected in clinical practice over a ten-year period (2006–2015). Motivation for aggression was assessed with the Aggressive Incident Motivation Evaluation Scale, measuring irritable, instrumental, and defensive dimensions. Information about staff restrictions was collected with the Staff Observation Aggression Scale – Revised, and severity was rated with the Visual Analog Scale. Multilevel analyses of 2649 aggressive incidents, committed by 67 inpatients, revealed greater variation in aggression motivation across incidents than between individual patients. Staff restrictions preceding the aggressive incident and rating of severity were positively related to staffs’ evaluation of motivation for aggression, but their impacts differed across motivational dimensions. Staff reports of motivation provide important additional information beyond current standard report forms. Systematically evaluating motivation is essential to risk management, and may contribute to develop more fine-tuned interventions for preventing and managing aggression in inpatient settings.     

Behind closed doors: the effect of pretrial publicity on jury deliberations

Abstract

Effective treatment of aggressive behaviour and accurate release decision making are necessary components of adequate clinical practice in forensic psychiatric units. Unfortunately, methods to identify treatment targets and ameliorate aggressive behaviour have developed at a slower pace than risk assessment technologies. Recent progress on the identification of offence paralleling or functionally equivalent behaviour offers a framework for individually tailored treatment and idiographic release decision making, although empirical scrutiny of this approach is inadequate. This paper describes an examination of the relationship between aggressive behaviour prior to admission with aggression during inpatient psychiatric treatment, and reconviction for violent offending following discharge. Results showed a relationship between pre- and post-admission aggression but no relationship between aggression during inpatient psychiatric treatment with either pre-admission aggressive behaviour or violent recidivism. These findings indicate the importance of state psychological variables, specifically those states affected by symptoms of psychiatric illness, as well as environmental activators and inhibitors of violence that operate within the hospital. These require inclusion in an adequate functional analysis of aggressive behaviour for forensic psychiatric patients.     

An australian adolescent sex offender treatment program: Program and client description

Abstract

The following paper outlines the key components of the Adolescent Sex Offender Treatment Program (ASOTP), an Australian program that provides assessment and therapeutic services to children and adolescents with sexually abusive behaviours. The ASOTP is auspiced by the Children's Protection Society (CPS), Melbourne, Victoria, Australia. If is committed to an integrated program model, which focuses on the parallel process of work with child and adolescent victims and perpetrators of sexual abuse. Specific attention is paid to describing the main modules of the formal group therapy program, which most clients enter following risk assessment. Criteria for assessing positive outcomes are also outlined. The characteristics of children and young people who have attended the ASOTP are described, including prior history of victimisation and self-reported problem behaviours as assessed by the Achenbach Youth Self-Report Form. A summary of sexually abusive behaviour and victim characteristics is also provided. Findings are discussed in light of relevant practice and systems issues.     

Screening procedures in the United Kingdom for positions of trust with children

Abstract

Child services organisations need policies that minimise the risk of sexual abuse of the children in their care. In particular, managers (and the public) are justifiably concerned when abuse is perpetrated by individuals who should not have been working with children in the first place. Unfortunately, there has been relatively little work on determining unacceptable risk for sexually abusive behaviour in child service organisations. The purpose of this paper is to describe the contexts in which screening procedures are appropriate, review the academic literature on screening procedures and present the results of a pilot survey of current screening practices in the United Kingdom. We comment on the effectiveness of screening measures available for use by organisations and provide suggestions for improvement. Specifically, we recommend that screening procedures consider risk factors associated with the onset and persistence of child sexual abuse perpetration.     

The association between childhood sexual abuse and sexual coercion in men: a test of possible mediators

ABSTRACT

We examined the associations between childhood sexual abuse (CSA), childhood physical abuse (CPA), sexual domain variables, antisocial tendencies, and sexually coercive behaviour in a non-forensic sample of 173 heterosexual men. CSA was associated with paraphilic interests and experiences, a more extensive sexual life history, and early antisocial tendencies. CPA was associated with paraphilic interests and experiences, more self-reported delinquency, higher sensation seeking, and early antisocial tendencies. Sexual domain variables (e.g. number of sexual partners, sexual interest in sadomasochism) mediated the link between CSA and sexually coercive behaviour, but antisocial domain variables (e.g. delinquency, sensation seeking) did not. Of the two sexual domains examined, extensive sexual life history rather than paraphilias mediated the association between CSA and sexually coercive behaviour. These results suggest CSA and CPA are associated with both sexual and antisocial outcomes, and that, for some victims of CSA, having an extensive sexual life history may account for the association between CSA and sexually coercive behaviour later in life.     

The relationship between risk,deviance, treatment outcome and sexual reconviction in a sample of child sexual abusers completing residential treatment for their offending

Abstract

The study investigated the relationship between static and dynamic risk and reconviction in a sample of child sexual abusers who had completed a long-term residential treatment programme for their sexual behaviour problems. Results found that only High/Very High risk men as measured by a static risk assessment schedule (Risk Matrix 2000) were reconvicted for sexual offences (17% over a 2-year period, 42% over a 5-year period). Results also showed that it was generally men who were rated as a high level of dynamic risk that were reconvicted for a sexual offence (13% versus 5% over a 2-year period; 44% versus 10% over a 5-year period). The study also indicated the benefits of residential treatment for such High risk/High Deviance men in that no men who left the programme having responded to treatment had been reconvicted for sexual offences at either follow-up period.     

The use and acceptance of sexually aggressive tactics in college men

This study extended the findings of Cleveland, Koss, and Lyon's (1999) research on rape tactics to a sample of college men by examining the use and acceptance of sexually aggressive tactics. Participants included 297 male undergraduate students who filled out instruments assessing for a history of sexual aggression and other personality characteristics. In addition, a measure was created to assess acceptance of sexually aggressive tactics, the Sexual Strategies Questionnaire, and a principal components analysis indicated the presence of two components: overt and covert tactics. Although the overt and covert tactics are comparable to those found by Cleveland and colleagues, the former may provide a greater level of discrimination between general and tactical alcohol usage. Finally, a regression analysis demonstrated that a history of sexually aggressive behavior and increased hypergender ideology were found to predict acceptance of sexually aggressive tactics. Directions for future research are discussed.     

Understanding how sexual offenders compare across psychiatric and correctional settings: examination of Canadian mentally ill sexual offenders

Abstract

Much of what is known about sexual offenders is based on correctional samples and then applied across settings based on the assumption that this group is homogeneous. In this study, 149 files were compared, including 108 cases from the forensic mental health system (FMH) and 41 cases from the correctional system (COR). Although many similarities were observed between the FMH and COR groups, the results also revealed important differences. The FMH group was characterised by more frequent hospitalisations, higher rates of major mental illness and single status. The COR group was characterised by a history of physical and sexual abuse, family history of addictions, more intrusive sexual offences and higher rates of offending. These results highlight different profiles for sexual offenders in forensic mental health and correctional settings and challenge us to consider the implications for assessment, treatment and risk management of this unique group of sexual offenders.     

Perspectives of young adult males who displayed harmful sexual behaviour during adolescence on motive and treatment

ABSTRACT

Few studies have examined the subjective experiences of young people following interventions for sexually abusive behaviour. To learn more about how this population experienced these interventions and how these interventions, affect their adult life, 22 adult males (m?=?22 years) who were assessed as teenagers (m?=?15 years) for sexually abusing children or peers were interviewed, on average six years after the assessment of their offence. Three main themes were identified: something sexual happened (recalling memories of the sexual acts and motives of the behaviour), societal actions (interventions offered), and life has been affected (memories and feelings associated with the abuse still being present). Seven respondents (32%), who all had a cognitive disability, had sexually reoffended by follow-up. If the respondents received interventions that focused on their abusive behaviour, they were likely to find the interventions helpful. Interventions that did not address abusive behaviour, were perceived as less helpful for dealing with their behaviour, and the short- and long-term consequences associated with this behaviour. Respondents reported feelings of sadness and guilt associated with their sexually abusive behaviour and these feelings remained into adulthood. These findings suggest that interventions for this population need to address the individual needs of the adolescent as well as sexual behaviour problems. In addition, interventions should include opportunities for follow-up.     

Health and social care staff responses to working with people with a learning disability who display sexual offending type behaviours

Abstract

This study found that 59% of social care staff were currently supporting a client with a learning disability who had offended or displayed an offending type behaviour. The range of behaviours was similar to that displayed by clients in a secure health facility and included rape, sexual assault and exposure. Only 22.9% of social care staff had received training in this area, while none of the health staff had. Both groups expressed low levels of confidence in supporting this client group. The areas of difficulty were common to both groups and included personal attitudes and attitudes of others to the behaviour, and concerns over risk, responsibility and safety. In respect of attitudes, social care staff were found to be significantly more likely to hold negative attitudes towards the person's behaviour, while health staff were significantly more likely to feel negatively towards the person. Health staff were significantly more likely to identify training as a means of further support, while social care staff identified professional input. Both groups identified the need for theoretical training about working with this client group. Despite this no significant differences were found between those who had and had not received training and confidence, attitudes and the need for further support.     

Implications for the prevention of aggressive behavior within psychiatric hospitals drawn from interpersonal communication theory

Although interpersonal style is a defining feature of personality and personality disorder and is commonly identified as an important influence on aggressive behavior, treatment completion, and the development of an effective therapeutic alliance, it is rarely considered in practice guidelines for preventing, engaging, and managing patients at risk of aggression. In this article, the authors consider three potential applications of interpersonal theory to the care and management of patients at risk of aggression during hospitalization: (a) preventing aggression through theoretically grounded limit setting and de-escalation techniques, (b) developing and using interventions to alter problematic interpersonal styles, and (c) understanding therapeutic ruptures and difficulties establishing a therapeutic alliance. Interpersonal theory is proposed to offer a unifying framework that may assist development of intervention and management strategies that can help to reduce the occurrence of aggression in institutional settings.     

Comparing the developmental and behavioural characteristics of female and male juveniles who present with sexually abusive behaviour

Abstract

Relatively few studies have compared female and male juveniles who sexually abuse. These studies have reported that while female juveniles with sexually abusive behaviour are more likely to have experienced childhood sexual abuse, they display similar patterns of abusive behaviour. However, to date these findings have not been replicated in a UK sample. The current study compared 22 female and 254 male juveniles, referred to a UK specialist community forensic service, in relation to family environment, maltreatment experience, psychiatric diagnoses and perpetrated abusive behaviour. Consistent with previous studies perpetrated behaviour was similar across genders, but females were significantly more likely to have been sexually victimized as children, at a younger age and by a greater number of abusers. In addition, they were more likely to have been exposed to inadequate sexual boundaries at home. These findings suggest that females and males may follow different pathways to sexually abusive behaviour.     

Dynamic risk and violence in individuals with an intellectual disability: tool development and initial validation

Without a violence risk assessment designed for people with an intellectual disability (ID), assessors are reliant upon tools developed for mainstream offenders or develop their own tools. This study describes the early stages of development of the Current Risk of Violence (CuRV), an informant-reported measure of dynamic risk for aggression in adults with an ID. The pool of items was generated from a multitude of sources. Predictive accuracy for aggression was tested prospectively among 64 adults with an ID and history of aggression. The 34-item CuRV was found to be a brief, uncomplicated risk assessment. Initial findings revealed good predictive validity over a five-month period: area under the curve (AUC) range from .72, 95% CI [.59, .85] to .77, 95% CI [.66, .89]. These preliminary findings suggest that the CuRV may assist staff to perform assessments of risk in busy clinical settings. Future research effort is needed to fully explore the psychometric properties of the CuRV.     

Predicting multiple victim versus single victim sexual abuse: an examination of distal factors and proximal factors associated with the first abuse incident

Abstract

Official and confidential self-report data on 83 convicted adult male sexual abusers were analysed to examine whether sexual offending progression can be better predicted from distal antecedents, or from proximal antecedents and outcomes associated with the first sexual abuse incident. Fifty-six offenders who sexually abused more than one victim (multiple victim offenders; MVOs) were compared to 27 offenders who sexually abused a single victim only (single victim offenders; SVOs). MVOs were younger at the time of their first sexual abuse incident, and were more likely to first abuse male and non-familial children. With the exception of sexual attraction to male children, no differences were found between the two groups on distal antecedents. Proximal antecedents and outcomes associated with the first sexual abuse incident were significantly related to multiple victim offending. Logistic regression analysis identified the presence of sexual difficulties in the month prior to the first abuse incident, and sexual excitement immediately preceding the first incident, as significant unique predictors. Implications for risk assessment and risk management are discussed, and future research directions proposed.     

Characteristics of children with problem sexual behaviour and adolescent perpetrators of sexual abuse: a systematic review

ABSTRACT

People who commit sexual offences are a heterogeneous group, with research suggesting that children and young people commit a large proportion of all sex offences, especially those committed against other children. This systematic review provides a synthesis of literature concerning the characteristics of children and adolescents who exhibit harmful sexual behaviour. There is a particular focus in this review on studies that examine the characteristics of children and young people exhibiting these behaviours within institutional and organisational settings or which take a situational and/or developmental approach to understanding sexually abusive behaviour. Using a developmental and life-course criminology lens, this review explores implications from the literature for the prevention and response to child sexual abuse, with a particular focus on institutional contexts where the perpetrators are children and adolescents.