The Handbook of Clinical Intervention with Young People who Sexually Abuse

Gary O'Reilly, William L. Marshall, Alan Carr, Richard C. Beckett

• Publisher: Psychology Press
• Year: 2004
• ISBN:
  9781135454036
• Edition: 1
• Topic: Psicología
• Subtopic: Psicoterapia

The Handbook of Clinical Interventions with Young People who Sexually Abuse provides authoritative, critical and up-to-date reviews of the growing body of empirical and theoretical knowledge in this field and clearly demonstrates how this knowledge can be used to guide and develop evidence-based practice for assessment and treatment. Key features include: * essentials of effective treatment programmes
* relapse prevention
* adolescents with intellectual disabilities and female offenders
* work with families of young people who sexually abuse. Practical guidelines from acknowledged international experts with extensive experience of research and clinical practice will beinvaluable to all those working with young people who engage in sexually abusive behaviour.

Part 1

---

Foundations for practice

---

Chapter 1

---

Preadolescents and adolescents

Evaluating normative and non-normative sexual behaviours and development

Sharon K. Araji

---

Introduction

In discussing sexual development in both children and adolescents, Bukowski et al. (1993, p. 87) ask, “What is healthy sexual development?” In response, they argue that descriptions of the goals of sexual development are unclear and have relied heavily on abstractions. As such, they say that little guidance has been provided with respect to identifying what constitutes healthy or unhealthy sexual development. They continue by saying that specifying the goals of healthy sexual development is a very difficult task because the development consists of factors that are subjective, interpersonal and socially embedded and vary as a function of age, sex and culture. Distinguishing between normative and non-normative sexual behaviours and development among preadolescents and adolescents is like drawing lines in the sand. Definitions shift across individuals, professionals, groups, organizations, communities, social institutions, societies and situations. While there are some cases that most would agree involve crossing the line between normative, non-normative and even criminal sexual behaviours, others are less clear. This is apparent from reflecting on the two cases below, both of which were reported in the media.

Case One: In Alaska three boys aged eleven, twelve and thirteen were apprehended by police and charged with first degree sexual assault for the forcible raping of a five-year-old girl. Police indicated that the boys used objects, although the specifics were not disclosed. The three boys chased the young girl, caught her, held her on the ground, took off her pants, and took turns raping her. This “gang rape” took place in a wooded area near the victim’s home and came to light in a therapy session. All three boys had a record with social services or the law before this incident.

Case Two: A six-year-old, first grader in Lexington, North Carolina, was barred from his class for one day because he kissed a classmate on the cheek. He said he did it because “he liked her and she asked him to”. A teacher saw the incident differently and reported that the girl had complained. As a result, school officials said the boy had broken school rules against sexual harassment. They later lowered the charge to a violation of a general school rule that prohibited “unwarranted and unwelcome touching of one student by another” (Zoglin, 1996).

In comparing these two cases, most would agree that Case One involves nonnormative, abusive and even criminal sexual behaviours. In Case Two, fewer would agree that the boy engaged in a sexually deviant or a non-normative act for a six-year-old. His parents certainly did not and neither did many of the townspeople.

The obvious question for professionals who come into contact with cases such as these is, “What are the factors that can be used to determine when the sexual behaviours of children cross the line from normative to non-normative or criminal behaviours?” From a sociological perspective, there are several reasons why professionals need to develop guidelines to distinguish between the sexual behaviours exhibited by preadolescents and adolescents. First, guidelines are of particular interest as societies develop and become increasingly multicultural. Second, they are also necessary so that youth are not labelled as deviants if their behaviours are normative, but only when their behaviours can be clearly defined as non-normative, abusive or criminal.

Aims of this chapter

The purpose of this chapter is to review relevant information that helps identify sexual behaviours considered normal, normative, non-normative, deviant or criminal for preadolescents and adolescents. This will be accomplished by reviewing the literature on the sexual behaviour and development of preadolescents and adolescents who experience sexual behaviour problems. Following this review, the commonalties and differences between the descriptions for these two age groups will be examined. A synthesis and analysis will then be offered and implications for clinical practice and social policies will be outlined. Finally, guidelines will be provided that can help assess problematic sexual behaviours.

Defining concepts

Preadolescence and adolescence

There is a tendency to attach chronological ages to differentiate preadolescents from adolescents. Biologically, the event that is used to separate these two phases in the lifecycle is puberty; the time in life marked by the onset of physical changes that make reproduction possible (e.g. menstruation and ejaculatory responses) (Martinson, 1991). However, over the years, trying to match ages with puberty has become problematic. Since the 1840s the secular trend in the characteristics of the population of young people reaching puberty (Bullough, 1981) decreased from about seventeen years of age to about twelve-and-a-half or thirteen-and-a-half years in the 1980s (Eveleth and Tanner, 1990). This downward trend appears to be continuing into the twenty-first century.

The earlier onset of puberty increases the difficulties of differentiating behaviours considered normal and normative from those considered abnormal or non-normative. Recognizing the issues associated with defining the concepts of “preadolescence” and “adolescence” for purposes of this chapter we still need to come up with some definitions. As much of the literature reviewed uses the age of twelve to separate these two groups, this will be used as a guide. As a heuristic tool, preadolescents will be defined as children twelve years of age and under and adolescents as youth who are teenagers.

Normal and normative sexual behaviours and development

It is helpful to discuss concepts that are sometimes used interchangeably when describing sexual behaviours and development among preadolescents and adolescents. The concepts of “normative” or “appropriate” tend to be used when sexual behaviours are defined in a socio-cultural way, that is to indicate what is considered the norm in a given society, culture or group. Those who use the term normative are likely to be sociologists, professionals in the area of social work, administrators, and those associated with the justice system. These researchers or practitioners are likely to use “deviant” or “criminal” to describe preadolescents’ and adolescents’ sexual behaviours that lie outside the realm of social norms or laws.

In contrast to the concepts of normative or appropriate, the term ‘normal’ frequently describes sexual behaviours that occur as a result of the natural human biological and physiological development process. Those who use the term normal tend to work in areas related to medicine, psychology, sex education or child development. This group of professionals uses terms such as pathological or abnormal sexual behaviours to indicate that something has happened to disturb or alter sexual behaviours that would be expected as a part of the normal sexual development process. To compare these two perspectives, a child psychologist may consider exploratory sexual behaviours in young children as normal because it has been observed across societies and history as part of the natural developmental process. Those following a cultural or sociological perspective, however, may define certain exploratory behaviours as deviant or inappropriate if they go against group, religious or social norms.

Sexual behaviour and development

Normative preadolescent sexual behaviour and development

While sociologists have been late to enter discussions about the sexual development of youth, the sociological perspective is necessary even in a clinical setting because sexual behaviours are embedded in the broader context of interpersonal, social and cultural factors. It is only within this context that sexual behaviours and development come to be defined as normal, normative, deviant or criminal. As we will see, sexual behaviours and sexual development cannot be understood apart from physiological, cognitive, emotional, interpersonal, environmental and cultural factors that facilitate or hinder the developmental process.

Comprehensive reviews of research on preadolescents’ normal, normative, non-normative and abusive sexual behaviours are fairly recent. Araji (1997) completed an extensive review of the many attempts to differentiate for preadolescents, normal, normative and appropriate sexual development from abnormal, non-normative and deviant/criminal development. Selected examples from this review are presented in Table 1.1. As can be seen, some practitioners and researchers are more comprehensive in their descriptions of normal or appropriate sexual behaviours as well as in differentiating by age groups within the preadolescent category, (e.g. Cunningham and MacFarlane, 1991; Gil, 1993).

An overview of the information in Table 1.1 provides some clues as to what various experts in the area of childhood and preadolescent sexual development view as normal or normative. As can be seen, very early sexual behaviours include only random and exploratory behaviours primarily involving the self. The behaviours tend to be touching self and others, genital play, masturbation, poking, watching, and showing interest in bathroom functions. Children may insert fingers or objects into body openings but stop when it hurts. The primary motivations appear to be exploration and curiosity.

As children grow older, they begin to imitate what they observe in their environment. This may involve playing doctor, house or mimicking sexual activities (see Gil, 1993; Cunningham and MacFarlane, 1991, in Table 1.1). At these early ages interpersonal imitative actions include kissing, holding hands, and exploratory sexual behaviours with others such as “I’ll show you mine, if you show me yours.” Males may compare penis size. As children move into the end of preadolescence, some practitioners (such as Cunningham and MacFarlane, 1991; Gil, 1993) view as normal or normative more advanced sexual activities such as fondling others’ genitals, dry humping, and even various types of sexual intercourse and oral sex. Most practitioners and researchers argue, however, that intercourse and oral sex are uncommon in preadolescents and in the young adolescent population, as well. Preadolescents’ sexual experiences may be either homosexual or heterosexual and include a wide variety of participants such as siblings and friends. As children move closer to late preadolescence and into adolescence, normative interactions become increasingly heterosexual in response to societal norms.

Table 1.1 Normal, normative and appropriate sexual behaviours and development in preadolescents

Regardless of the types of sexual interactions, researchers generally agree that for behaviour to be considered normal or normative, children should be of similar ages and participation should be mutual. While sexual activities may be spontaneous or planned, they should be balanced with respect to other activities such as sports, school activities and scouting, among others. Sexual arousal may or may not be present, and it is not considered to be the primary motive for engaging in sexual behaviours. The affect associated with sexual activities in the early stages of preadolescence are characterized as light-hearted and are associated with silliness and giggly behaviours. As children age during the preadolescent stage they may express shyness or embarrassment if they are discovered. This is a reaction to the societal norms learnt from interactions in their environment.

The families, subcultures and cultures in which children live will influence the extent to which these behaviours and social interactions are considered normative or non-normative. For example, if children grow up in sexually repressive homes where sex is seen as “dirty”, any sexual behaviours presented in Table 1.1 may be viewed as non-normative. On the other hand, if children grow up in families where there are no sexual boundaries within or outside the family or in homes that are sexually charged, it may be normative for them to participate in the full range of behaviours shown in Table 1.1 regardless of age. Similarly, the restrictiveness or permissiveness of cultures will influence the degree to which behaviours described in Table 1.1 are viewed as normal, normative or non-normative (see Arnett, 2001).

Non-normative preadolescent sexual behaviour and development

Table 1.2 describes behaviours, emotions, motives and interactions that would no longer be considered normal or normative for preadolescent children. Using Cunningham and MacFarlane’s (1991) typology as an example, it is obvious that some practitioners view behaviours such sexual penetration, and genital kissing, as normal in late preadolescence but not when it is being performed by children in early or mid-preadolescence. Rather than using age as a criterion for deciding what is normal or normative sexual behaviours for preadolescence, Ryan et al. (1993) use the concepts of “Yellow Flag”, “Red Flag” and “No Questions” to indicate a progression of non-normative to abusive sexual behaviours.

Table 1.2 Non-normative and abusive sexual behaviours in preadolescents

The information in Table 1.2 indicates that sexual behaviours cross the line from normal or normative when they are no longer in balance with other activities in preadolescents’ lives. The sexual activities become patterned rather than isolated events and children become preoccupied or obsessed with sexual activities. As children begin to engage in sexual behaviours they know are inappropriate, they become secretive. If caught by parents, caretakers or others their typical response is to deny it if they can; if not, to blame others. In sum, as children begin to engage in sexual behaviours they know are wrong, they begin to develop defensive strategies to protect themselves.

As evidenced in Table 1.2, sexually abusive or aggressive behaviours represent the extreme end of the sexual behaviour and development continuum. These sexual behaviours are far too advanced for children twelve years of age and younger. The behaviours have an aggressive quality, involving use of force, coercion (social or physical), and secrecy. As previously noted, the sexual acts represent patterned rather than isolated events (see Ryan et al., 1993; Johnson and Feldmeth, 1993). The sexual behaviours may be opportunistic, but many are planned, calculated and predatory. Sexually deviant behaviours exist in combination with other antisocial behaviours such as those associated with conduct and oppositional disorders. Furthermore, sexually abusive behaviours continue even when intervention occurs. Children who exhibit these extreme behaviours are very resistant to treatment.

Repeated or chronic behaviours such as peeping, exposing or pornographic interests are also viewed as non-normative and not part of the normal sexual development of preadolescent children. Further, any behaviours that inflict harm on the self or others, are viewed as not only non-normative, but also abusive. The normal or normative motives for engaging in sexual behaviours are no longer confined to curiosity and exploration. Johnson and Feldmeth (1993) provide a detailed description of deviations from normal motivations, suggesting that engaging in sexual behaviours is no longer exploratory in nature, but serves as a coping mechanism for satisfying unmet needs that are manifest in feelings of loneliness, isolation, anxiety, fear, and other affective states.

The information provided in Table 1.2 suggests the sexual behaviours increasingly involve children or others who are viewed as vulnerable. This may be relative to size, age, cognitive or physical abilities, or social status. Language becomes sexually explicit with children who are of significantly younger ages. The beginnings of sexual harassment may be seen in the form of sexual teasing or embarrassment of others (see Ryan et al., 1993). Threatening language, both verbal and non-verbal, may also be used. The affect associated with sexual behaviours is no longer light-hearted, but rather it takes on negative qualities such as anxiety, guilt, fear, confusion, anger and rage (see Johnson and Feldmeth, 1993).

Several programmes, most notably Hindman’s (1994) “It’s About Childhood”, add a dimension not included in the programmes discussed in Table 1.2. In this programme, if a youth (under age 18) engages in sexual behaviours that have non-normative characteristics, and the child knows the behaviour is inappropriate and associated with punishment (i.e. the child is viewed as culpable), the behaviour is viewed as a criminal act. This view gives new meaning to sexually abusive and aggressive behaviours by children. That is, if the sexual behaviour is defined as criminal, it would be processed through the criminal justice system and the child would be labelled criminal. This view is very controversial among those who work with preadolescents and even adolescents.

Classification comparisons

Table 1.3 provides a summary of preadolescent sexual behaviours that are considered not only deviant but abusive. It also provides associated risk factors. As can be seen, the sexual behaviours and development are far advanced from what is considered normal. These behaviours involve the use o...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Figures
• Tables
• Contributors
• Preface
• Acknowledgements
• Editors’ note
• Part 1
• Part II
• Part III
• Part IV
• Part V