مشکلات رفتار جنسی در کودکان مورد آزار جنسی: گونه شناسی مقدماتی

Objective: The goal was to develop an empirically derived typology for sexually abused children exhibiting sexual behavior problems to assist practitioners in differential assessment, treatment, and case planning. Method: Data were systematically gathered from the clinical records of 100 sexually abused children, aged 3 years to 7 years, enrolled in two treatment programs. Twelve indexes were created corresponding to major areas of child and family history, functioning, and treatment response. After initial sorting into subgroups based on the presence or absence of interpersonal sexual behavior problems, further subdivision was based on hierarchical cluster analysis. Results: Five distinctive sexual behavior profiles emerged: (1) developmentally expected; and developmentally problematic (2) interpersonal, unplanned, (3) self-focused, (4) interpersonal, planned (noncoercive), and (5) interpersonal, planned (coercive). Elements of the child’s sexual abuse experience, opportunities to learn/practice problematic sexual behavior, and familial variables best differentiated between the types. Conclusions: The five types differed not only in child sexual behavior but in most areas of child and family functioning, including treatment outcome. The findings offer support for the development of an empirically-based typology for children with sexual behavior problems utilizing a range of variables which go beyond typical classification systems based on offender and victim characteristics.

Clinicians are recognizing that children with sexual behavior problems are not a homogeneous group, and that different treatment approaches may be required for various “types” of sexual behavior Araji 1997, Cantwell 1995, Johnson and Feldmeth 1993 and Pithers et al 1998b. Unfortunately, empirical research exploring the relationship between types of child sexual behavior problems and treatment outcomes is in its earliest stages. Of the five published typologies created specifically for the pre-adolescent child with sexual behavior problems Berliner et al 1986, Johnson 1993, Johnson and Feldmeth 1993, Pithers et al 1998b and Rasmussen et al 1991, only one has been developed empirically (Pithers et al., 1998b). A recent study conducted by Bonner, Walker, and Berliner (1999) also provides additional information about child and family characteristics associated with treatment outcome in children with sexual behavior problems. Berliner et al. (1986) advanced a typology to guide treatment consisting of three categories on a continuum from the least to most problematic developmentally unexpected sexual behaviors including: Sexually Inappropriate Behavior, Developmentally Precocious Behavior, and Coercive Sexual Behavior. The categorization system developed by Rasmussen et al. (1991) focuses primarily on the legal accountability of children, rather than treatment considerations. Two main categories were proposed: Sexually Reactive (for children less than 9 years old) and Pre-adolescent Offenders (aged 9–12 years). Each of these two main categories was further divided into three subcategories including: Victim Perpetrator, Delinquent Perpetrator, and Family Perpetrator. This system combines general characteristics of both victim and offender in defining its categories, as well as some aspects of the context and assumed motivation. Johnson and Feldmeth (1993) described a sexual behavior continuum which has elements of a taxonomic system. Four anchor points along their continuum correspond to the child’s level of sexual disturbance including Type I—Normative Sexual Exploration, Type II—Sexually Reactive, Type III—Extensive Mutual Sexual Behaviors, and Type IV—Children Who Molest. Each type is distinctive, varying in developmental appropriateness and pervasiveness of sexuality, primary affect associated with sexual behavior, resistance to limit-setting, level of coerciveness, and responsiveness to treatment. Most of these clinical typologies share a common notion, that is, that child sexual behavior exists on a continuum, and that aggression, coercion, and force represent the most pathological end of that spectrum. They also share many of the same difficulties. Some do not consist of mutually exclusive categories. Others rely on designations more relevant to the social service and criminal justice systems as opposed to the treatment sector. Most are based on offender and/or victim characteristics and exclude developmental (nonsexual) and familial characteristics which may be related to treatment outcome. Since none of these typologies for children or youth were created through full-scale empirical research, all have yet to be validated. As such, they may best be used as heuristics for research. An empirically derived typology for children aged 6- to 12-years-old with sexual behavior problems has been developed by Pithers et al. (1998b). It is based on a theory-driven selection of 14 demographic, psychometric, and “offense-related” variables entered into multivariate cluster analyses. Five types were identified: Sexually Aggressive, Nonsymptomatic, Highly Traumatized, Rule Breakers, and Abuse Reactive. Each of the types was examined in relationship to two treatment approaches—relapse prevention and expressive therapy. Their work moves typology development beyond categorization systems based solely on clinical comparisons and victim and offender characteristics. Despite these advancements, none of the typologies has considered developmental and caregiving environments. The current pilot study adopts an ecological perspective to examine an array of variables associated with child and family histories and functioning, maltreatment and other negative experiences, response of others/community to the abuse, as well as demographics. The children’s attachment and maltreatment histories are combined to incorporate developmental factors and capture the cumulative nature of these experiences. Clinical, theoretical, and multivariate approaches are utilized in developing the typology. Given the paucity of research in this area and the age of the children in this sample (3–7 years), an exploratory, as opposed to a theory-driven, approach to variable selection is chosen. Subgroups are based on statistically and clinically significant differences in key areas of child and family functioning, and the resulting types are examined in relationship to child sexual behavior and treatment outcome. Because sexually abused children are reported to exhibit more developmentally problematic sexual behavior than comparison groups Berliner 1991, Friedrich 1993, Friedrich 1995, Gale et al 1988 and Kendall-Tackett et al 1993 and are over-represented among children (12 years and under) with sexual behavior problems, this study was designed to create a typology specifically for this group.