عوامل مرتبط با مشکلات رفتار جنسی در کودکان مورد آزار جنسی

Objective: To identify variables associated with the presence of sexual behavior problems in young sexually abused children. Method: Data were gathered from the clinical records of 100 sexually abused boys and girls ages 3–7 years enrolled in two treatment programs. Information was coded systematically on approximately 350 areas related to the child and family’s history and functioning, the sexual abuse experience, and treatment outcome. The children were grouped and compared according to their presenting sexual behavior into three categories: (1) developmentally “expected”; (2) “sexualized/self-focused”; and (3) problematic “interpersonal” sexual behavior. Results: Bivariate and multivariate analyses highlighted five variables which were predictive of sexual behavior problems among sexually abused children. Sexual arousal of the child during his/her sexual abuse, the perpetrator’s use of sadism, and a history of physical and emotional abuse differentiated between those children with and without “interpersonal” sexual behavior problems. Who the child blamed for his/her sexual abuse further contributed to the distinction between children whose sexual behavior was exclusively “self-focused” (sexualized) versus “interpersonal.” Conclusions: The five major predictor variables, as well as other variables identified in this study, have potential utility in assessing child risk for negative outcomes and determining referral priorities for sexual abuse treatment. Given that sexual arousal and who the child blames for the abuse are prominent variables associated with sexual problems and self-blame, clinicians will need to ensure that sexually abused children and their caregivers are given specific opportunities to deal with these areas in the supportive context of treatment. Children with sexual behavior problems differ not only in the type and level of sexual behavior they exhibit but in most other areas as well, suggesting a need for differential assessment and individualized treatment approaches.

Problematic sexual behavior in young sexually abused children is well-documented in the clinical literature, though a precise estimate of its prevalence has not been established Cohen and Mannarino 1988, Deblinger et al 1989, Einbender and Friedrich 1989, Friedrich 1993, Friedrich et al 1992, Friedrich et al 1987, Friedrich et al 1988, Gale et al 1988, Kolko et al 1988, Mian et al 1996 and Wells et al 1995. Child and youth service workers in many fields express concern about children who exhibit sexual behavior problems, and professional demand for appropriate assessment protocols, policies, and intervention strategies is increasing. However, some argue that professional intervention in the lives of these children may be unwarranted or even harmful because of the risk of “pathologizing” what might simply be exploratory sexual behavior Kilpatrick 1987, Kilpatrick 1992, Levine 1996, July-August and Okami 1992. “Anti-interventionists” claim there is no convincing research evidence that child sexual behavior labelled as inappropriate by professionals is related to sex crimes in adulthood. They also argue that if left alone these children will likely outgrow their problematic sexual behaviors. Those who believe intervention is necessary claim that to do nothing may increase the likelihood these sexual behavior problems will persist and that some children may even go on to become sex offenders in adolescence or adulthood. Unfortunately, we do not know which children and adolescents who engage in problematic sexual behavior will develop ongoing patterns of sexual offending in adulthood (Vizard, Monck, & Misch, 1995). Also, there is little consensus regarding the role of previous victimization in the development of sex offending behavior. Few well-controlled studies have been conducted in these areas, though discussions concerning the intergenerational transmission of abuse abound in the literature Bagley 1992, Bagley 1994, Benoit and Kennedy 1992, Pierce and Pierce 1987 and Vizard et al 1995, July. There is a generally held belief that persons who have been abused are at greater risk to offend and that sex offenders are usually child sexual abuse survivors themselves. On-the-other-hand, research findings reveal that the majority of persons who have experienced child sexual abuse do not become adolescent or adult sex offenders (Becker 1988 and Murphy and Smith 1996, p. 181). A summary of this research Hanson 1990, Hanson and Slater 1988 and Murphy and Smith 1996 reveals that less than 30% of adult molesters report a history of child sexual abuse, with the percentage rising to approximately 50% (range 20%–70%) for adolescent male sex offenders Ryan 1996, Vizard et al 1995, July, Watkins and Bentovim 1992 and Worling 1995. However, among children who engage in problematic interpersonal sexual behaviors, preliminary findings from clinical treatment samples indicate that between 50%–100% are suspected to have been sexually abused with more girls than boys disclosing sexual victimization Burton et al 1997, Friedrich and Luecke 1988, Johnson 1988 and Johnson 1989. Although a multitude of theories exist which attempt to explain the etiology of sex offending behavior, most are based on retrospective accounts of adult offenders Abel et al 1985, Finkelhor 1984, Freeman-Longo 1983, Hall and Hirschman 1992, Howitt 1995, Marshall and Barbaree 1988 and National Task Force on Juvenile Sexual Offending 1993. Emerging from that research is evidence that a considerable proportion of sex offenders report molesting their first victim while still in adolescence Abel and Rouleau 1990, Groth et al 1982, Hindman 1988, Marshall et al 1991, Mathews 1987 and Mathews 1989. Historically, the sexually problematic behavior of juveniles has been minimized and treated as simple adolescent sexual “experimentation” Becker et al 1986 and Davis and Leitenberg 1987. In the past decade, however, the realization that adult sex offending may in fact begin in adolescence has sparked interest in the study of adolescent sex offenders and promoted the development of specialized treatment programs. Research on adolescent sex offending has begun to reveal similar patterns of early onset of sexual behavior problems seen in adult offender populations (Becker et al., 1986). The study of children’s sexual behavior problems is still in its infancy and to date much of the research has been based on small clinical samples. Part of the reason for the paucity of literature is the sheer difficulty of trying to conduct research in this area. Studies of vulnerable populations such as sexually abused children must meet rigorous ethical standards and protect their well-being. Discussions of controversial topics such as childhood sexuality with “at-risk” families are potentially stressful and can fuel negative parental reaction toward the child. Given that some of these children may be undisclosed victims of sexual abuse, caregivers would understandably be reluctant to expose themselves further by participating in research. Several definitional and conceptual issues also hamper research efforts. For example, there is no consensus regarding what constitutes “normal” sexual behavior over the developmental stages of childhood, although some researchers have begun to conduct systematic studies in this area Friedrich et al 1992, Friedrich et al 1991 and Johnson 1988. Also there is no evidence that the sexual behavior of children, which on the surface appears similar to adolescent and adult sexual behavior, is functionally the same behavior with the same meanings. These conceptual issues have hindered researchers in selecting and obtaining appropriate samples and in constructing basic definitions and operationally defining relevant variables. Nevertheless, in the past few years researchers have begun to make progress in this area (Burton et al 1997, Hall et al 1996 and Williams and New 1996, pp. 125–126). Insights into some of the characteristics of these children have been offered in several clinically-oriented texts Cunningham and MacFarlane 1991, Cunningham and MacFarlane 1996, Friedrich 1990, Gil and Johnson 1993 and MacFarlane and Cunningham 1991. Gender differences have also been explored in recent studies Cosentino et al 1995 and Ray and English 1995. Finkelhor and Browne (1985) include the concept of “traumatic sexualization” as one of the four traumagenic factors contributing to negative outcomes attributed to child sexual abuse. In comparison to other forms of child maltreatment, inappropriate sexual behavior is frequently presented as one of the most problematic, and treatment resistant sequelae of child sexual abuse Browne and Finkelhor 1986, Finkelhor and Berliner 1995, Friedrich et al 1988, Friedrich et al 1992, Gil 1993, Kelly 1995 and Livingston 1987. In the past 5 years systematic evaluation of the efficacy of various treatment approaches with children who exhibit interpersonal sexual behavior problems has been undertaken in the United States Gray and Pithers 1994 and Jean et al 1997, January and Canada (Wachtel, 1995). Because not all children who are sexually abused go on to develop serious sexual behavior problems, the major challenge regarding assessment is to determine which ones will and why. What is needed is a set of easily assessed, yet salient, variables which have the capacity to discriminate between those children who are more likely to develop sexual behavior problems from those who will not. While the literature has focused on children with interpersonal sexual behavior problems, the present exploratory study examined the association between a range of child sexual behaviors (including age-expected as well as problematic self-focused and interpersonal sexual behavior) and an array of child and family variables in young sexually abused boys and girls. (This study is part of a multi-phase research program [the DISC Research Project] consisting of three pilot studies exploring the development of sexual behavior problems in children and youth, funded by the Family Violence Prevention Division, Health Canada).