Relationship between sexual abuse, gender, and sexually inappropriate behaviors in seriously mentally ill youths

The Prevalence of Adverse Childhood Experiences Among Children and Adolescents Who Display Harmful Sexual Behaviour: A Review of the Existing Research

There is no systematic review focusing on the prevalence of adverse childhood experiences (ACEs) among children and adolescents who display harmful sexual behaviour (HSB). This study addresses this gap to further our understanding of the aetiology of HSB among children and adolescents. The full text of 87 articles was retrieved and assessed for eligibility, following which 10 articles were deemed relevant for inclusion in the review. These 10 studies were then subjected to quality assessment, data extraction and synthesis. The present review included only studies that used data pertaining to both males and females, and some studies provided a comparison between males and females. There were higher rates of sexual victimisation among females who display HSB. Additionally, child sexual abuse perpetrated by female caregivers is likely to be higher than most of the existing body of research suggests. The findings of the present review corroborate many of the hypotheses discussed in the introduction, emphasising that children and adolescents who display HSB are more likely to have come from backgrounds of trauma, signaling the importance of multi-agency responses, early intervention and the importance of protective factors.

The Cycle of Abuse: When Victims Become Offenders

Various psychological theories exist in the literature to explain the behavior of men who commit child sex offences, including the belief that child sexual abuse (CSA) is a predisposing factor for the transition from victim to offender. These theories are, however, unable to explain the fact that while most victims of CSA are female, most perpetrators of CSA are male. The sex specificity of CSA in terms of victims and offenders suggests that the experience of CSA and its psychosocial effects may be different for boys, compared to girls. We hypothesize that CSA experiences may involve risk factors that affect the development of sexually abusive behavior for boys, rather than girls. Our aim was to determine whether the literature provides evidence of a cycle of abuse from victim to offender, and, if so, to document its characteristics. We undertook a comprehensive literature review of studies on both victims and offenders, including studies which revealed the following: age of onset of CSA, duration of abuse, gender of the abuser, the relationship between victim and abuser, grooming behaviors, the types and severity of abuse, and disclosure of abuse. While we found no evidence for the existence of a cycle of abuse for female CSA victims, we discovered evidence to support the existence of a cycle of abuse for male CSA victims who had experienced particular abuse characteristics. As an original contribution to the literature, we identified four factors that may be associated with a boy's transition from victim to offender as well as the methodological issues to be addressed in future research. Based on criminological theories, we argue that these four factors share a common theme, that is, that they represent experiences of power (for the abuser) and powerlessness (for the victim).

Physical and emotional abuse of primary school children by teachers

The existence of child abuse is unfortunately a reality of contemporary society. Although various organizations and researchers have been making progress in the struggle against abuse, it has not been decisively dealt with thus far. Most of the research on abuse has focused on the abuse of children in their family environment.

OBJECTIVE

The aim of the present study was the investigation of abuse in the school environment and the effects of the gender and school grade of pupils, as well as the gender of teachers on the various forms of abuse.

METHODS

The study utilized a questionnaire with a 5-point rating scale, with questions concerning physical abuse, emotional abuse and neglect, which was completed in class by a sample of schoolchildren. The sample consisted of 1,339 pupils in the 4th, 5th, and 6th grade of primary school in the Republic of Cyprus, who lived in both urban and rural areas. Two pilot studies were conducted initially to ensure the appropriateness of the questionnaire. Permission to conduct the study was gained by the headmasters of the schools, and authorization to participate in the study was granted by the students' parents.

RESULTS

More than half (52.9%) of the pupils reported neglect, almost a third (33.1%) reported emotional abuse, and almost one tenth (9.6%) reported physical abuse. The results of the statistical analysis revealed statistically significant differences between the 2 genders (p<.001), with boys being the most vulnerable group, with regards to all forms of abuse, but no significant differences between the 3 grades and the teachers' gender (p>.05). There were no significant differences between the 2 genders, the 3 grades and the teachers' gender with regards to the frequency of any form of abuse (p>.05).

CONCLUSIONS

The gender of the pupils seems to be related to abuse, since more boys than girls reported being victims of abuse, while abuse is not depended on the school grade, or the teacher's gender. The findings from this study may justify some concern on behalf of the Ministry of Education, but also from educators and parents in the Republic of Cyprus.

Effectiveness of medication combined with intensive behavioral intervention for reducing aggression in youth with autism spectrum disorder

BACKGROUND

The use of antipsychotic medications to treat aggression in youths with autism spectrum disorders (ASD) is based on open-label trials and efficacy studies. There are no studies examining the combined effectiveness of antipsychotic medications and intensive behavioral intervention (IBI) to treat aggression in ASD.

METHODS

Youths with ASD and aggressive behavior received IBI. Medication use remained stable during the study period and was coded into antipsychotic, mood-stabilizing, and nonstimulant attention-deficit/hyperactivity disorder (ADHD)/sleep medication classes. Analysis of covariance (ANCOVA) and survival analyses examined the effects of medication classes on the average number of aggressive behaviors and time to behavior plan success.

RESULTS

Thirty-two youths (mean age = 11.16, standard deviation [SD] = 3.31, range = 4-16 years, 75% male) with ASD received aggression reduction plans. Of these, 25 youths were taking at least one psychiatric medication (antipsychotic n = 18, mood stabilizing n = 10, and nonstimulant ADHD/sleep n = 12). Aggression dropped substantially following implementation of IBI (p < 0.001; d = 1.70). Antipsychotic medication use predicted significantly fewer sessions to achieve behavior plan success (chi(2)(1) = 5.67, p = 0.017; d = 0.93). No other medication classes influenced aggressive behavior (largest chi(2)(1) = 0.16, p = 0.694).

CONCLUSIONS

Behavioral treatment combined with antipsychotic medication was the most effective approach to reducing aggressive behaviors in youths with ASD. Mood-stabilizing and nonstimulant ADHD/sleep medications did not contribute to aggression reduction.

Predictors of problematic sexual behavior among children with complex maltreatment histories

Exploratory analyses of sexual behavior problems (SBP) were conducted within a larger epidemiological study of 347 preadolescent children in foster and kinship care. SBP was estimated from carergiver-reported scores on the Assessment Checklist for Children. The study simultaneously examined a large number of discrete and cumulative influences on the development of children at high risk for SBP. Most children with SBP had corresponding psychopathology, most notably conduct problems, inattention, and interpersonal behavior problems suggestive of attachment disturbances. Several correlates identified in previous studies were not associated with SBP. High concordance of SBP was found among 52 sibling dyads. Independent predictors of SBP were older age at entry into care, female gender, placement instability, and contact sexual abuse. The findings emphasize the significance of cumulative risk among children exposed to multiple adversities. The findings generated several hypothesized mechanisms involving attachment disturbances.

Identifying correlates of suicide attempts in suicidal ideators: a population-based study

BACKGROUND

Identification of factors that distinguish between ideators who act on their suicidal thoughts from those who do not is an important clinical and research objective.

METHOD

We examined correlates of suicide attempts in suicidal ideators, members of a French-Canadian, school-based cohort. Suicidal thoughts were evaluated in adolescence and early adulthood in the total sample of suicidal ideators, who were then stratified into subgroups consisting of persistent ideators, male ideators and female ideators.

RESULTS

In addition to persistent suicidal ideas [odds ratios (ORs) 2.1-2.8], Axis I psychopathology, female gender and childhood sexual abuse (CSA) were the most consistent correlates of suicide attempts. Externalizing disorders were significant contributors in persistent ideators [drug misuse: OR 2.8, 95% confidence interval (CI) 1.1-6.9] and in male ideators in particular (disruptive disorders: OR 5.9, 95% CI 2.2-16.0). In women, psychiatric co-morbidity also had a significant effect (OR 1.6, 95% CI 1.1-2.1). CSA was of relevance in both women (OR 1.2, 95% CI 1.1-1.4) and persistent ideators (OR 1.3, 95% CI 1.1-1.5). Personality traits showed gender-specific contribution with affective instability (OR 1.1, 95% CI 1.01-1.1) and anxiousness (OR 1.3, 95% CI 1.1-1.7) contributing in men and disruptive aggression (OR 1.1, 95% CI 1.03-1.3) in women.

CONCLUSIONS

Correlates of suicide attempts in suicidal ideators vary as a function of the persistence of suicidal ideas and gender. This heterogeneity across subgroups of suicidal ideators may be attributed, at least in part, to differences between the sexes, early environmental adversity, maladaptive personality, and psychiatric symptoms. Further exploration and continued prospective follow-up is necessary to examine these possibilities.

Psychosocial adjustment and psychopathology of men sexually abused during childhood

The purpose of this study was to evaluate psychosocial adjustment and psychopathology among men sexually abused during their childhood and arrive at a better understanding of the reasons for which, following such sexual experiences, some adult males manifest greater distress than others. In total, 64 participants were interviewed and completed eight questionnaires covering various aspects of childhood and adult life. Results suggest the existence of three types of sexual abuse scenarios. Participants in each of these three groups presented with an adult-specific adjustment. However, the methodology and multivariate analyses used in this study suggest that some of these problems were not only associated with the sexual contacts but also with other childhood experiences and with the participant's cognitive, affective, and psychological resources.

Adjunctive topiramate in hospitalized children and adolescents with bipolar disorders

OBJECTIVE

The aim of this study was to assess topiramate as adjunctive treatment in children and adolescents hospitalized with bipolar disorders.

METHODS

Medical records of all children and adolescents with a Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR) (APA, 2000) diagnosis of bipolar disorder, type I, hospitalized for an acute manic, mixed, or depressive episode, were reviewed. The primary outcome measure was the Clinical Global Impression-Severity (CGI-S) score.

RESULTS

Twenty-five (25) children and adolescents received topiramate, with a mean final dose of 126 mg/day (range, 25-350 mg). Overall CGI-S scores significantly improved from 5.3+/-1.0 to 3.5+/-0.7, and mania CGI-S scores decreased from 5.4+/-1.0 to 3.3+/-0.9. Sixteen (16) of 25 (64%) bipolar patients were classified as responders (defined by an endpoint overall CGI-I score of less than or equal to 2). No serious adverse events occurred during treatment. Of 25 patients evaluated, 1 (4%) experienced mild sedation while treated with topiramate.

CONCLUSIONS

Preliminary results of this retrospective chart review suggest that adjunctive topiramate may be associated with improvements in children and adolescents hospitalized for an acute manic, mixed, or depressive episode. Randomized and controlled trials with adjunctive topiramate in this population are needed to further explore this observation.

Prepubertal bipolar disorder: proper diagnosis should lead to better treatment response

Treatment research in prepubertal bipolar disorder remains in a rudimentary stage. Phenomenological evidence suggests it is a heterogeneous disorder with varying degrees of rapid cycling, aggression, and psychosis often accompanied by comorbid diagnoses of attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, and anxiety disorders including obsessive compulsive disorder. Longitudinal and family history studies suggest prepubertal bipolar disorder may be more treatment-resistant than later-onset bipolar disorder. Neurobiological studies to guide treatment, though promising, remain in their infancy. Clinical trials to date (mostly open studies) often have lumped together subjects with manic, hypomanic, and mixed presentations with different and/or undiagnosed comorbidities, making meaningful comparisons of treatment response difficult. Randomized, double-blind, placebo-controlled trials are needed to clarify best treatment options for bipolar subtypes with and without comorbid disorders. More homogeneous diagnostic groupings based on episode and duration criteria and a more patient-centered, symptom-based approach should be considered in treatment designs.

Trends in use of antidepressants, lithium, and anticonvulsants in Kaiser Permanente-insured youths, 1994-2003

In view of the current controversy regarding the use of antidepressants in children and adolescents, we examined trends from 1994 to 2003 in the use of antidepressants, lithium, and anticonvulsants by enrollees, aged 5-17 years, of Kaiser Permanente in Northern California. We found that the use of antidepressants more than doubled from 9.4 per 1000 enrollees to 21.3 per 1000. Most of this increase is associated with selective serotonin reuptake inhibitors (SSRIs), which increased from 4.6 to 14.5 per 1000. The use of tricyclic antidepressants (TCAs) decreased markedly, while the increase of other newer antidepressants rose from 1.3 to 6.5 per 1000. The use of anticonvulsants nearly doubled, from 3.5 to 6.9 per 1000, while lithium use was relatively stable at a rate of nearly 1 per 1000. Use of SSRIs, newer antidepressants, and anticonvulsants increased in boys as well as girls in each of three age groups: 5-9, 10-14, and 15-17 years. An increasing percentage of the antidepressant users had a diagnosis of depression, and an increasing percentage of anticonvulsant users had a diagnosis of bipolar disorder. Although the safety and efficacy of antidepressants in youths needs to be more firmly established, these findings may reflect progress in the diagnosis and treatment of mental illness.

Practice parameters in pediatric allergy

The primary role of practice parameter/guidelines and other boundaries developed for the field of medicine is to improve the quality of patient care. Practice parameters/guidelines are also important for education, interaction with managed care and third-party payers, establishing appropriate variables for outcome assessment, reducing inappropriate variation in clinical practice, and resolving medical-legal issues. National specialty organizations, the American Medical Association, and government agencies have been actively involved in developing and promoting practice parameters. These documents provide a framework within which pediatricians can provide the best quality of care for their patients.

Age and gender specific sexual behaviors in children

OBJECTIVE

The purpose of the present research was to explore the sexual behaviors of 2- to 7-year-old children through reports of day-care personnel. An overall aim of this exploratory study was to provide information about the frequencies of child sexual behaviors. Also, the aim was to explore any age and gender differences.

METHOD

A representative sample of 364 Finnish children not screened for developmental delay, sexual abuse history or psychiatric problems (181 girls and 183 boys) in 190 day-care centers were studied using the "Day-Care Sexuality Questionnaire" (DCSQ), with 244 sexual and other behavior items.

RESULTS

Age influenced more the extent of the 244 sexual behaviors of boys than of girls. In sexual behaviors increasing with age, girls showed behaviors with a more social character, whereas boys showed more explorative and information-seeking behaviors. Girls had a higher frequency of domestic and gender role exploring behaviors, whereas the boys tended to engage in explorative acting and information-seeking behaviors.

CONCLUSIONS

The results suggest that child sexual behavior reported by day-care personnel may provide useful information about the development of children's sexuality. Implications for sexual abuse investigations were discussed.

The diagnostic utility of sexual behavior problems in diagnosing sexual abuse in a forensic child abuse evaluation clinic

OBJECTIVE

This study examined the utility of sexual behavior problems as a diagnostic indicator of sexual abuse. The hypothesis was that sexual behavior problems are multiply determined and consequently are variably related to sexual abuse in a clinical sample.

METHOD

A sample of 247 children evaluated for sexual abuse at a multidisciplinary forensic child abuse evaluation clinic were included. Results from the Child Behavior Checklist (CBCL) and the Child Sexual Behavior Inventory (CSBI) were analyzed and compared to the results of a structured abuse assessment performed independent of these scores.

RESULTS

The forensic team assessment found evidence of sexual abuse in 25% of cases, and no evidence in 61%. Children in this sample exhibited an elevated level of both sexual and nonsexual behavior problems. However, considerable variability was noted in sexual behavior problem scores. Thus, in this study a high score or a low score had no relationship to the diagnosis of sexual abuse. Indeed, nonsexually abused children were just as likely to have high CSBI scores as sexually abused children.

CONCLUSIONS

This study found no significant relationship between a diagnosis of sexual abuse and the presence or absence of sexual behavior problems in a sample of children referred for sexual abuse evaluation. The finding suggests that community professionals should use caution in relying on sexual behavior problems as a diagnostic indicator of abuse.

Practice parameters for the assessment and treatment of children and adolescents who are sexually abusive of others. American Academy of Child and Adolescent Psychiatry Working Group on Quality Issues

The assessment and treatment of children and adolescents with sexually abusive behavior requires an understanding of normal sexual development. A multiplicity of biological and psychosocial factors determines the child's sexual development, gender role, sexual orientation, patterns of sexual arousal, sexual cognitions, sexual socialization, and the integration of sexual and aggressive patterns of behavior. The individual's sexuality evolves in concert and as a result of interaction with family, ethnic, social, and cultural influences. These parameters summarize what we know about the epidemiology and phenomenology of sexually abusive youths and provide guidelines for the assessment and the selection of treatment interventions for these youths. Essential considerations in the assessment and treatment of sexually abusive youths, as well as the different categories of sexually abusive youths which should be recognized and which influence treatment decisions, are presented. The spectrum of currently available psychosocial and biological treatments will be summarized.