Eileen Vizard

Children and adolescents who present with sexually abusive behaviour: A UK descriptive study

Abstract Background: This study describes the largest UK sample of young people presenting with sexually abusive behaviour to a fourth-tier NHS specialist service. Aims: To describe the psychosocial and behavioural characteristics of these children. Method: The case files of 280 referrals to a national assessment and treatment service for young people displaying sexually harmful behaviour were reviewed using a specially designed research protocol. Results: The sample had experienced extremely emotionally deprived and abusive upbringings, with family instability and dysfunction. Early onset of sexual and aggressive behaviour, neuropsychological deficits, and mental health problems were noted. Conclusions: A matrix of developmental risk factors underlies the onset of sexually abusive behaviour in this sample. The need for a developmental model of sexually abusive behaviour in children is stressed.

Zoophilia in young sexual abusers

Zoophilia or bestiality is a rare paraphilia which has received little attention in recent psychiatric literature. We describe a cohort of seven patients who were referred to a tertiary child and adolescent psychiatry service specializing in the assessment and treatment of young abusers. On the basis of the available material, we highlight the importance of enquiring into this type of behaviour and consider its implications for the risk assessment and treatment of young sex abusers.

Comparing the developmental and behavioural characteristics of female and male juveniles who present with sexually abusive behaviour

Abstract Relatively few studies have compared female and male juveniles who sexually abuse. These studies have reported that while female juveniles with sexually abusive behaviour are more likely to have experienced childhood sexual abuse, they display similar patterns of abusive behaviour. However, to date these findings have not been replicated in a UK sample. The current study compared 22 female and 254 male juveniles, referred to a UK specialist community forensic service, in relation to family environment, maltreatment experience, psychiatric diagnoses and perpetrated abusive behaviour. Consistent with previous studies perpetrated behaviour was similar across genders, but females were significantly more likely to have been sexually victimized as children, at a younger age and by a greater number of abusers. In addition, they were more likely to have been exposed to inadequate sexual boundaries at home. These findings suggest that females and males may follow different pathways to sexually abusive behaviour.

A community treatment programme for convicted child sex offenders: A preliminary report

This article reports on the group treatment of 9 convicted child sex abusers in the community. Out of 69 men referred for treatment between August 1987 and October 1988,25 men were assessed using a multidisciplinary approach. A probation order with a condition of treatment was imposed in 9 cases, as an alternative to custody. Treatment was provided in the form of weekly group meetings by a psychiatrist and a probation officer. We describe the characteristics of the men referred, the dynamics and themes arising in treatment and preliminary outcome data.

Early-onset sexually harmful behaviour in childhood: a marker for life-course persistent antisocial behaviour?

While traditionally adolescent sexually harmful behaviour (SHB) has been considered beyond the domain of general delinquency, many adolescents showing SHB also show a pattern of non-sexual offending. It was hypothesised that an early onset of SHB would probably reflect the presence of developmental risk factors associated with a generic and persistent antisocial trajectory. A retrospective file review of cases referred to a national SHB service was conducted. Cases were categorised as early onset (n = 100), with SHB evident prior to the age of 10, or late onset (n = 137), with SHB first evident after the age of 10. The early onset group were found to have higher rates of maltreatment, poor temperament, aggression, hyperactivity, educational difficulties, and mental health problems. They also displayed greater continuity of non-sexual antisocial behaviour across childhood and adolescent periods, and scored significantly higher on a standard psychopathy measure. We propose that an early onset of SHB may act as a clinical marker for a group of children at risk of a general delinquency trajectory. These children require early and multifaceted interventions beyond those addressing sexual behaviour problems alone.

Practitioner review: The victims and juvenile perpetrators of child sexual abuse--assessment and intervention.

BACKGROUND The assessment of victims of child sexual abuse (CSA) is now a recognized aspect of clinical work for both CAMH and adult services. As juvenile perpetrators of CSA are responsible for a significant minority of the sexual assaults on other children, CAMH services are increasingly approached to assess these oversexualized younger children or sexually abusive adolescents. A developmental approach to assessment and treatment intervention is essential in all these cases. METHOD This review examines research on the characteristics of child victims and perpetrators of CSA. It describes evidence-based approaches to assessment and treatment of both groups of children. A selective review of MEDLINE, Psycinfo, Cochrane Library, and other databases was undertaken. Recommendations are made for clinical practice and future research. FINDINGS The characteristics of CSA victims are well known and those of juvenile perpetrators of sexual abuse are becoming recognized. Assessment approaches for both groups of children should be delivered within a safeguarding context where risk to victims is minimized. Risk assessment instruments should be used only as adjuncts to a full clinical assessment. Given high levels of psychiatric comorbidity, assessment, treatment, and other interventions should be undertaken by mental health trained staff. CONCLUSIONS Victims and perpetrators of CSA present challenges and opportunities for professional intervention. Their complex presentations mean that their needs should be met by highly trained staff. However, their youth and developmental immaturity also give an opportunity to nip problem symptoms and behaviors in the bud. The key is in the earliest possible intervention with both groups. Future research should focus on long-term adult outcomes for both child victims and children who perpetrate CSA. Adult outcomes of treated children could identify problems and/or strengths in parenting the next generation and also the persistence and/or desistence of sexualized or abusive behavior.

Reliability of video taped interviews with children suspected of being sexually abused.

OBJECTIVE--To determine the reliability of judgments about the likelihood of child sexual abuse based only on video recorded interviews. DESIGN--Blinded rating of likelihood of abuse by seven professional groups and comparison with consensus rating. SETTING--Child and adolescent psychiatry centre. SUBJECTS--Four people from each of seven professional disciplines: specialist psychiatrists, general psychiatrists, experimental psychologists, trainee social workers, trainee clinical psychologists, lawyers, and police. MAIN OUTCOME MEASURE--Rating of 12 recorded interviews. RESULTS--Agreement between the consensus panel and professional groups was 83% (151/183) for high likelihood cases (seven cases) and 89% (118/132) for low likelihood cases (five). Specialist psychiatrists and the police were better able to identify high likelihood cases than were other groups with less experience of interviewing sexually abused children (91% (48/53) v 79% (102/129); p = 0.05). CONCLUSIONS--Raters could accurately distinguish children with low likelihood of abuse on interview evidence alone, but those with more experience of dealing with sexual abuse were better at identifying high likelihood cases.