Children with Sexual Behavior Problems

Judges are encountering more cases (both dependent and delinquent) involving juveniles under the age of 12 who have acted out sexually. The youth's own trauma history and protection issues often complicate the cases. This article reviews the research about treatment for children with sexual behavior problems (SBP) and discusses guidelines for making placement decisions in order to assist judges to determine an appropriate level of response in cases of children with SBP. To this end, information about typical sexual development with strategies for determining whether a sexual behavior is problematic or developmentally appropriate is provided. Children with SBP are contrasted with adolescent and adult sexual offenders. Assessment and treatment guidelines based on the current state of clinical research are provided, noting that a number of treatments have demonstrated efficacy with SBP in children. Information to facilitate decision making regarding residential placement, school participation, and family reunification is provided. Public policy should be based on scientific results and reflect the very low risk posed by children with SBP when making decisions about application of the Adam Walsh Act and national lifetime registries in general.     

Adolescents with Psychopathic Characteristics in a Substance Abusing Cohort: Treatment Process and Outcomes

Psychopathy is a condition with important consequences both for individuals who experience it and for the communities in which they live. Although the assessment of psychopathy among adolescents remains controversial, some evidence suggests that the affective and behavioral traits of adult psychopathy begin to emerge in childhood (B. B. Lahey & A. Kazdin, 1990) and continue across the lifespan (A. E. Forth, S. D. Hart, & R. D. Hare, 1990). The present study used the Psychopathy Checklist: Youth Version (PCL:YV; A. E. Forth, S. D. Kosson, & R. D. Hare, in press) to retrospectively assess psychopathic characteristics, treatment process, and outcomes of 64 individuals referred for treatment to a substance abuse program for adjudicated adolescents. This study focused on the relationship between psychopathic characteristics and treatment process and outcome variables, including attrition rates, quality of participation, substance use throughout treatment, clinical improvement, and 12-month recidivism rates. Psychopathic characteristics were negatively related to treatment process and outcome variables, including attrition, participation, substance use, and clinical improvement. Psychopathic characteristics were positively related to the number of arrests in the 12 months following treatment completion. Implications for treatment and future research with adolescents displaying psychopathic characteristics are discussed.     

Overlooking Feigning Behavior May Result in Potential Harmful Treatment Interventions: Two Case Reports of Undetected Malingering

Clinicians tend to overestimate their ability to recognize feigning behavior in psychiatric patients, especially if it concerns patients who have been admitted for observation. Feigning can be either externally motivated (e.g., for financial compensation, known as malingering) or internally motivated (e.g., to assume the “sick role,” known as factitious disorder). Persistent presentation of severe symptoms is usually associated with the factitious disorder. We present two patients with strong external incentives who consistently and convincingly feigned severe psychiatric symptoms during a protracted period of inpatient observation in a specialized center; both were engaged in a procedure for medical asylum. The first case presented with the clinical picture of a psychotic depression with severe motor symptoms, and the second case showed symptoms of a chronic post-traumatic stress disorder with secondary psychotic symptoms. Both cases were thoroughly investigated but feigning was overlooked, and unnecessary and harmful treatment interventions were given. To prevent iatrogenic damage, we recommend a critical attitude that takes malingering as an option into account in settings where patients are often involved in high stake legal procedures. A clinical sign that might indicate feigning is therapy-resistant symptoms. To rule out feigning a comprehensive, multimethod approach is required, but an active stance toward collateral information is essential. Specialized psychological tests may be useful for preliminary screening, but for their use in culturally diverse populations as in refugee mental health more research is needed.     

Female Domestic Violence Toward Male Partners: Exploring Conflict Responses and Outcomes

The general purpose of this study was to investigate domestic violence within a conflict framework. Specifically, the association between conflict-based, communication response and outcome behaviors and the frequency and severity of female domestic violence towards male partners was examined. Participants were 153 female volunteers who reported on a range of communication responses and outcomes for both self and partner. The contribution of relationship distress was controlled for and also examined as a moderator. Relationship distress was not found to be a significant moderator. Results showed that seven communication response variables and four outcome variables were significantly associated with the frequency and/or severity of female domestic violence. Relative to nonviolent relationships, relationships with female violence had more male and female unilateral verbal aggression, more mutual verbal aggression, more male verbal aggression/female calms things down, more male demand/partner withdraw, more mutual avoidance, and less constructive relative to destructive communication. Relationships with female violence also had poorer resolution of problems and more emotional distance after problem arguments and discussions than their nonviolent counterparts.     

Treatment Profiles of Troubled Female Adolescents: Implications for Judicial Disposition

Increasing numbers of girls are entering the juvenile justice system. This growing number of females creates a dilemma for judges concerned with appropriate disposition to treatment and diversion: since current intervention methodologies were developed primarily for males, how effective are they for females? The current paper describes a research process that addressed this issue. A sample of troubled adolescents was selected from a residential treatment facility. Data were collected from 137 youth between the ages of 12 and 17 (65 female [47%] and 72 male [52%]) regarding variables related to twenty-three behavioral and psychosocial problems. These data were then subjected to a cluster analysis. Two distinct treatment profiles were formed, each differing in composition by gender. Based on the results of the cluster analysis, the researchers conducted a literature review to determine the implications of those profiles for successful disposition and treatment.     

Physical Aggression and Sexual Behavior Among Siblings: A Retrospective Study

Retrospective recall of physical aggression and sexual behavior among siblings was investigated. Participants described behaviors between themselves and siblings in the family, their estimation of the appropriateness of the behavior, and their current relationship with their siblings. Additionally, participants completed measures of family structure and stress. Results indicated that rates of physical aggression among siblings was high, with varying severity. Rates of sexual behavior were lower. For both physical and sexual behaviors, participants were more likely to believe that the behaviors were abusive in retrospect than when they actually occurred. No differences were found in family structure among abusive and nonabusive siblings, but siblings who reported physical or sexual behaviors also reported higher levels of intrafamilial stress. Certain types of stressors may predict particular sibling relationships.     

Matricide and Two Sexual Femicides by a Male Strangler with a Transgender Sadomasochistic Identity

Abstract: While violence against sexual minorities is a well‐known phenomenon, sexual homicides committed by men with cross‐dressing or transsexual identity are not, because they are relatively few. We report a 23‐year follow‐up of the case of a transvestite, possibly transsexual, man who killed his mother by strangulation at the age of 20, and later in two separate cases strangled a female victim towards whom he felt sexual desire. He reported being sexually aroused by being strangled himself. The case raises questions concerning legislation which does not allow life‐long control of criminals.     

Sexual Assault Case Outcomes: Disentangling the Overlapping Decisions of Police and Prosecutors

The rape reform movement of the 1970s and 1980s was designed to improve the likelihood of prosecution and conviction in sexual assault cases. However, there is evidence that the attrition rate for sexual assaults reported to the police remains high, and that the locus of case attrition is arresting and charging decisions. In this paper, we analyze police and prosecutorial decision-making in sexual assault cases using quantitative data on sexual assaults reported to the Los Angeles Police Department and the Los Angeles County Sheriff’s Department in 2008. We argue that decisions made by police and prosecutors should not be examined in isolation from one another and that researchers who analyze arrest decisions by examining only cases that are formally cleared by arrest or who focus only on charging decisions that follow the arrest of a suspect may be ignoring important aspects of police and prosecutorial decision-making. This is confirmed by the results of our study, which reveal that a significant proportion of cases in which the police appear to have probable cause to make an arrest do not result in the arrest of the suspect and that a substantial number of cases are rejected for prosecution by the district attorney before an arrest is made. Moreover, the factors that predict arrest and charging vary depending upon the way in which the outcome is operationally defined. These results have a number of important policy implications for police and prosecutors handling sexual assault cases.     

Real Life Heroes in Residential Treatment: Implementation of an Integrated Model of Trauma and Resiliency-Focused Treatment for Children and Adolescents with Complex PTSD

Real Life Heroes (RLH) engages children and caregivers to rebuild (or build) emotionally supportive relationships, develop self-regulation and co-regulation skills, reduce traumatic stress reactions, and integrate a positive self-image through conjoint life story work. RLH includes psychoeducation, a life story workbook, multi-modal creative arts, and a toolkit to help practitioners implement National Child Traumatic Stress Network recommended components of treatment for Complex PTSD as a child and family transition from residential treatment to home and community-based programs. A case study and results from pilot studies highlight utility of the model for residential treatment and how RLH can help residential treatment programs implement evidence-supported trauma and resiliency-focused treatment including incorporation of NCTSN curricula to provide an integrated framework for practitioners, residential counselors, county case managers, educators, resource parents, home-based counselors, mentors, and other caring adults.     

The Darkest Figure of Crime: Perceptions of Reasons for Male Inmates to Not Report Sexual Assault

Although sexual assault behind bars is recognized as problematic, very few of the sexual assaults that occur behind bars are officially reported. Many researchers have examined the individual and institutional variables which can help predict an inmate’s probability of being victimized by his fellow inmates. With a sample obtained from a sample of eight Texas prisons, the current survey will disentangle the individual, institutional, and individual–institutional level variables which contribute to the rationales behind inmates choosing to report or not report sexually assaultive behavior. The findings somewhat mirror the findings of sexual assaults in the free community, with inmates indicating that the primary reasons to not report include embarrassment, fear of harassment, and retaliation from the perpetrator.     

Complex Histories and Complex Presentations: Implementation of a Manually-Guided Group Treatment for Traumatized Adolescents

It is consistently recognized that children and adolescents who have repeatedly experienced or witnessed violence are at significant risk for a multitude of lasting difficulties across many domains of functioning. Adolescents in residential settings often have extensive trauma histories and experience profound behavioral, emotional, and interpersonal difficulties. Unfortunately, there are few structured trauma-informed treatments that have been implemented in residential settings, and even fewer that have been evaluated. This article describes the core components of Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS), a manually-guided trauma-informed group treatment, and provides clinical examples within residential facilities for adolescents with emotional and behavioral difficulties and extensive victimization histories. Preliminary data on self-reported emotional, behavioral, and posttraumatic stress symptoms are presented.     

Multivariate Comparison of Male and Female Adolescent Substance Abusers with Accompanying Legal Problems

Purpose

The factors that distinguish adolescent male and female substance abusers with and without legal problems were investigated.

Method

Youths (N = 4,071) admitted for substance abuse treatment were administered the revised Drug Use Screening Inventory (DUSI-R) to measure severity of health, behavior, and social adjustment problems.

Results

Legal problems were more frequent among boys; however, severity of disturbance was greater in girls on 9 of 10 scales. Substance abusing girls and boys with legal problems reported more severe behavior, substance abuse, family adjustment, and peer relationship problems than substance abusing peers without legal problems. Quality of peer relationship mediated the association of family dysfunction, substance abuse and behavior problems with legal problems in boys only.

Conclusions

Gender and legal status both need to be taken into account to potentiate treatment prognosis of substance abusing youths.     

Treatment issues and Cognitive Behavior techniques with battered women

Described in this paper is the use off Cognitive Behavior techniques with battered women. Through reeducation, women are taught to identify, analyze, and change distorted beliefs that impact upon the way they feel and respond to abuse. Through this process, battered women are empowered to respond to life situations in a more self-enhancing manner.     

Relationship Abuse and Victims’ Posttraumatic Stress Disorder Symptoms: Associations with Child Behavior Problems

This study examined associations among male-to-female physical and psychological relationship aggression, female partners’ PTSD symptoms, and behavior problems among the children (n = 62) of men enrolled in a treatment program for relationship abuse perpetration. Psychological aggression was a stronger predictor of child behavior problems than physical assault. Restrictive engulfment and hostile withdrawal behaviors evidenced the strongest bivariate associations with child behavior problems, and were the strongest predictors of this outcome when considering four distinct forms of psychological aggression together. Victim PTSD symptoms largely mediated the effects of psychological aggression on child behavior. Findings suggest that male-to-female psychological aggression and victim PTSD symptoms play an important role in understanding behavior problems among children living with male relationship abuse perpetrators. Portions of this work were presented at the annual convention of the Association for the Advancement of Behavior Therapy, New Orleans, Louisiana, November, 2004.     

Adoptions Gone Awry: Enhancing Adoption Outcomes Through Postadoption Services and Federal and State Laws Imposing Criminal Sanctions for Private Internet Rehoming

The federal government should invest in adopted children who make up the future of the country and are in dire need of rehabilitation and therapy because of their past circumstances. If the government steps in to rescue vulnerable children from inadequate or abusive birth parents by removal, it should also intervene when adopted families are faced with behavioral problems of adopted children that the adopted parents cannot address on their own. Postadoption services need to be accessible and effective to ensure the success of adopted families. Assisting families in crisis postadoption will lower the instances of dissolution and rehoming and keep adoptive families intact. In cases in which postadoption services fail, uniform federal legislation is necessary to make it a federal crime to advertise children for adoption on the Internet without proper certification and state legislation is required to make it a crime to pass on adopted children to strangers without judicial consent, to dissuade Internet rehoming. Internet rehoming of adopted children should be a serious crime as it is tantamount to child trafficking.© 2014 Association of Family and Conciliation Courts

Key Points for the Family Court Community:
• Postadoption services need to be more accessible and more narrowly tailored to the needs of adoptive families to ensure the success of adoptions.
• Better postadoption services create better adoptive families and adoptive parents will not reach the point of dissolution or private Internet rehoming.
• Adoptive parents should be provided with information regarding all available postadoption resources after adoption is finalized and a government Web site should be created that lists all available resources.
• The federal government needs to provide funding to states that specifically target postadoption services.
• A uniform federal statute is required to punish parties who use Internet forums to avoid government oversight and privately rehome their adopted children.
• States should enact laws that criminalize the unauthorized interstate placements of children.

     

Treatment of Child Sexual Abuse: Programs,progress, and prospects

Recent years have witnessed the development and implementation of clinical services designed to remediate the many deleterious effects of child sexual abuse. However, little information has been disseminated and reviewed in the professional literature to facilitate clinical application and empirical investigation of specific procedures with child victims and their families. This paper provides an overview and critique of treatment programs and modalities, highlighting their achievements and limitations. The methods, characteristics, and empirical outcomes of specific programs are discussed along with future directions and recommendations.     

TREAD: A Promising Change-Target for Partner Abuse Prevention with Adolescents

There is consensus in the partner abuse prevention education literature that a skills-focus is needed. However, appropriate instruments for evaluating the effectiveness of skills-focused programs do not exist. Against this background, and based on the dyadic slippery slope model of partner abuse, the Tendency to Resist or End Abusive Dynamics (TREAD) scale was developed. TREAD is defined as one’s tendency to respond assertively or protectively in situations involving warning-sign (potentially hurtful or controlling) behaviors by a partner. The scale’s development drew on the input of three Australian samples: mixed-gender adolescent focus groups, 426 young female respondents to an online survey, and 152 adolescent girls participating in a school-based program trial. When tested with the 152 adolescent girls, the TREAD scale had acceptable internal consistency and high inter-rater reliability. Principal components analysis identified three interrelated TREAD subscales (i.e., Conflict-Retaliation TREAD, Denigration TREAD, and Dominance-Possessiveness TREAD) all of which were negatively associated with frequency of exposure to warning-sign behaviors. This paper charts the preliminary development of the TREAD scale, presenting evidence supporting its validity as a change-target for partner abuse prevention education with adolescent girls and, potentially, boys.