David Skuse

Development of sexually abusive behaviour in sexually victimised males: a longitudinal study

BACKGROUND Sexual maltreatment is one of the most common forms of child abuse. To identify risk factors for sexually abusive behaviour by adults, we prospectively assessed childhood experiences and personal characteristics of male child victims who became abusers in later life. METHODS In a longitudinal study (7-19 years duration), we included 224 former male victims of sexual abuse. Risk factors contemporaneous with the abuse, and putative protective influences, were identified from social service and clinical records. Evidence of later criminal acts was obtained from a nationwide search of official records. FINDINGS Of the 224 former victims, 26 had subsequently committed sexual offences (victim-abusers), in almost all cases with children, mainly outside their families. Risk factors during childhood for later offending included material neglect (odds ratio 3.4, 95% CI 1.2-9.7), lack of supervision (3.0, 1.1-8.3), and sexual abuse by a female person (3.0, 1.1-8.7). Victim-abusers had more frequently witnessed serious intrafamilial violence (3.1, 1.0-10.0). Six (29%) of 21 victim-abusers on whom we had relevant data had been cruel to animals (7.9, 2.0-31.4). No single putative protective factor, nor a composite protective index, significantly reduced the risk of paedophilic behaviour. INTERPRETATION Most male victims of child sexual abuse do not become paedophiles, but particular experiences and patterns of childhood behaviour are associated with an increased risk of victims becoming abusers in later life. Our findings have implications for the design of selective interventions with a vulnerable subgroup of male victims, aimed at reducing the risk of paedophilic behaviour in later life.

Schedule for Oral-Motor Assessment (SOMA): Methods of validation

The Schedule for Oral Motor Assessment (SOMA) was developed for the purpose of objectively rating the oral-motor skills of preverbal children, with a view to identifying areas of deficient abilities that could have clinical significance. The instrument can be administered without special equipment, by a trained observer. Oral-motor function is assessed across a range of food textures and fluids. Ratings of oral-motor skills are largely made post hoc by analysis of a videorecording of the test administration. The test-retest and interrater reliability of the instrument have been shown to be excellent. Criterion validity was investigated by means of a novel ‘seeded cluster analysis’ procedure in which 127 young children were assessed, most of whom were between 8 and 24 months of age. Ten percent of the sample had known abnormal oral-motor function in association with cerebral palsy (ages between 12 and 42 months). Not only was criterion validity satisfactorily established by the analysis but an abbreviated version of the SOMA—suitable for screening purposes—was developed. This has been shown to have a positive predictive validity greater than 90% and sensitivity greater than 85% for the detection of infants with clinically significant oral-motor dysfunction.

ORAL-MOTOR DYSFUNCTION IN CHILDREN WHO FAIL TO THRIVE : ORGANIC OR NON-ORGANIC ?

Forty‐seven children with non‐organic failure to thrive (NOFT) were identified from a whole‐population survey of childrens growth and development. A significant proportion (N=17) of these 47 children were found to have oral‐motor dysfunction (OMD) identified using a previously validated assessment tool. NOFT children with OMD and those with normal oral‐motor function (N=30) were compared in order to ascertain whether there were any neurodevelopmental differences which might explain this finding. We hypothesized that children with OMD might have a subtle neurodevelopmental disorder. Few psychosocial variables discriminated the two groups. However, cognitive stimulation within the home and cognitive‐growth fostering during mealtimes was much poorer for children with OMD. Some evidence has suggested that NOFT children with OMD may be‘biologically’more vulnerable from birth. We suggest that the continued use of the term‘non‐organic’to describe failure to thrive in such children is questionable and requires redefining.

Risk factors for development of sexually abusive behaviour in sexually victimised adolescent boys: cross sectional study

Abstract Objective: To identify factors that may increase the risk of a sexually victimised adolescent boy developing sexually abusive behaviour. Design: Sexually victimised boys who had sexually abused other children were compared with sexually victimised boys who had not done so. Setting: Social services departments in south east England were invited to refer sexually abused and sexually abusing boys to a London postgraduate teaching hospital. Subjects: 25 adolescent boys aged between 11 years and 15 years and 11 months. Main outcome measures: Adjusted odds ratios estimated from unconditional logistic regression. Results: Unadjusted odds rations for witnessing (8.1) as well as experiencing (18.0) intrafamilial violence and discontinuity of care (7.2) discriminated boys who had sexually abused from others who were solely victims of sexual abuse. Only the adjusted odds ratios for witnessing intrafamilial violence (39.7)discriminated the two groups. Conclusions: The risk of adolescent boys who have been victims of sexual abuse engaging in sexually abusive behaviour towards other children is increased by life circumstances which may be unrelated directly to the original abusive experience, in particular exposure to a climate of intrafamilial violence. Our findings have implications for the management of boys found to have been sexually abused and raise important questions about the possibility of secondary prevention of subsequent abusive behaviour in those at greatest risk.

The Developmental Sequelae of Nonorganic Failure to Thrive

The developmental sequelae of infant failure to thrive (FTT) were examined in an unreferred group of 6-year-olds with a history of severe nonorganic growth retardation, sampled from a 1-year birth cohort in an inner-city area of South London. Children who failed to thrive in infancy (weight below the third centile for at least 3 months) and their pairwise matched comparisons were originally studied at 15 months, and 42 cases and 42 controls (89.5% of the sample) were followed up. At 6 years, previously growth-retarded children were considerably smaller than matched comparisons, in terms of body mass index (BMI), and height and weight for age Z scores. History of FTT explained substantial variance in weight and BMI at 6 years, with maternal height also contributing to variation in height for age. Child cognitive functioning at 6 years was examined using the McCarthy Scales: cases had more limited quantitative and memory skills than comparisons, but there was no intergroup variation in general cognitive performance. In contrast to analyses of physical development, failure to thrive did not account for cognitive functioning; maternal IQ was the sole significant predictor of performance on all indices of child cognitive abilities. At 15 months, earlier growth faltering was linked to limitations in mental development, but these findings were not confirmed by the follow-up data: the timing of FTT was not related to cognitive abilities at 6 years. Results correspond to past research indicating that nonorganic failure to thrive is associated with persistent limitations in physical stature. There was little evidence of cognitive disadvantage for case group children at school age, suggesting that the adverse effects of early malnutrition on cognitive functioning appear to diminish over time.

Characteristics of mothers of boys who sexually abuse

Depression, child abuse histories, and current attributions were investigated for 80 mothers of boys in three abuse referral groups (victimized perpetrators, nonvictimized perpetrators, and victim only) in comparison with a group of boys showing externalizing behaviors. During semistructured interviews with mothers, child abuse histories were elicited and the Beck Depression Inventory (BDI) was administered. The Leeds Attributional Coding System (LACS) was used to code spoken attributions from verbatim interview transcripts. Sexual victimization in their own childhood was reported by 55% of mothers of perpetrators and 30% of mothers of victims; high rates of domestic violence were reported by both mothers of perpetrators (72%) and mothers of victims (50%). There were no significant group differences on BDI scores. Mothers of the externalizing comparison group showed “low perceived control” in their attributions for negative events and blamed their sons for negative events significantly more than those of the three case groups (p < .05). The findings are discussed in terms of their implications for clinical interventions and research.

Failure to thrive: Current perspectives

The term ‘failure to thrive’ should refer, purely and simply, to the problem of failure to grow in accordance with expectations. It is a symptom, and a presenting problem, and may have a myriad of causes. For the sake of clarity, and to minimise confusion with other related disorders such as psychosocial dwarfism, the expression should be reserved for the description of infant growth (i.e. under 2 years of age). Usually the growth retardation is defined in terms of lack of appropriate weight gain. However the parameters of poor growth are defined, it is unlikely that any clearcut aetiology, in terms of physical (or organic) disease or disorder, will be discovered in most cases. For many years a distinction was made between ‘organic’ and ‘non-organic’ failure to thrive. This dichotomy is unwarranted and unwise. Paediatricians now realise that in all cases of nonorganic failure to thrive (NOFT) and in most cases of organic failure to thrive (FTT), the primary biologic insult is undernutrition. For many children with serious medical illnesses such as congenital heart disease, cerebral palsy, and gastrointestinal disorders a major cause of the associated growth failure is a nutritional intake that is insufficient to maintain a normal rate of weight gain. In cases of failure to thrive that are associated with inadequate parenting, including neglect and abuse, the cause of the associated growth impairment is not emotional but caloric deprivation.’ Having emphasised that growth failure is the essential symptom, the question arises what degree of growth retardation should arouse clinical concern? This is a contentious issue but some guidelines may

Oral‐motor dysfunction in children who are failing to thrive

A whole population prospective survey of inner-city infants (N=2510), aged from birth to 15 months, found the prevalence of failure to thrive (FTT), unassociated with any medical aetiology, to be 3.3%. A speech therapist, blind to case status, used the Schedule for Oral Motor Assessment (SOMA) to rate abilities across a range of food textures and fluids. One in four FTT cases, but only 11% of comparisons, obtained dysfunction scores outside the normal range. Most difficulty was observed with purees, least with liquids. Oral-motor dysfunction did not simply reflect developmental delay. SOMA scores did not correlate with either the mental or psychomotor index of the Bayley Scales of Infant Development (BSID), but did correlate negatively with birth weight (r=−0.3, p<0.01); weight at 3 months (r=−0.28, p<0.003); 6 months (r=−0.3, p<0.01); and 9 months (r=−0.28, p<0.02), but not with weight at follow up. Children with the highest dysfunction scores weighed least at all ages and had smaller head circumferences. High oral-motor dysfunction scores were not linked to overt feeding difficulties, by maternal report. It was hypothesised that the disorder reflects the influence of early post-natal growth failure (presumably due to undernutrition) upon developing brain structures, rather than a congenital abnormality.

De karakteristieke voedingsproblemen bij jonge kinderen met een cerebrale parese

Bij twaalf kinderen met een cerebrale parese werd de aard en ernst nagegaan van de voedingsproblemen, zoals die bij deze aandoening vaak voorkomen. De kinderen hadden allemaal een matige tot ernstige motorische dysfunctie van de mond. De kinderen met een cerebrale parese werden vergeleken met een controlegroep. De gegevens werden verzameld bij de kinderen thuis, via een interview en door directe observatie bij de maaltijden.