How might sexual behaviour by a child be connected to the child’s exposure to violence?

Dale Tolliday

A/Clinical Advisor New Street Adolescent Services & Pre-Trial Diversion Program The Children’s Hospital at Westmead NSW Health

[email protected]

Pat

• 11yo boy referred as had sexually abused his sister many times over a period of over 12 months • Also noted for sexual behaviours at school towards girls • Lives with mother, step-father and two younger sisters • Has moved between father and mother’s care over 10 times (each time intention was for the move to be permanent) • Changes of home and family movements resulted in 28 different school enrolments for Pat • Parents and step-father have experienced alcohol and drug problems over a long period • Pat has witnessed his mother being physically assaulted by his step-father on a number of occasions. And verbal violence frequently.

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Pat (continued)

• • • When Pat threatened his step-father with the knife he was standing in the kitchen between his step-father and his mother His mother was on the floor having just been hit and knocked from her feet by her partner (Pat’s step-father) This was the first time Pat had witnessed his mother being assaulted by his step father …….. since she had returned from hospital having been injured when he had pushed her down a staircase • • Many aspects of the incident in the kitchen surprised me. One being that Pat could not recall anyone asking him about himself. He was in trouble for the dangerousness of his action (using the knife) Pat said while he thinks he was angry, most of all he remembers being “shit scared” Domestic & Family Violence Forum Springwood 3

Fay

• Is 10yo and has moved to live with her father and step-mother after being sexually abused by her step father (Fay’s mother’s new partner) • As well as having been sexually abused she has been exposed to domestic violence over a long period of time • Fay has sexually harmed her step-brother Domestic & Family Violence Forum Springwood 4

Hugh & Mark

• Are brothers aged 11 and 13 • They live with their grandparents • Previously they lived with their parents who fought often. They were exposed to frequent verbal violence.

• They never witnessed physical violence but saw their mother’s injuries after. They could hear the physical violence • From a young age they shared the same bed • In the year before moving to their grandparents and in the time since “

they have engaged in sexual behaviour with each other

showed that Mark led the way and the dynamic of the sexual behaviour was abuse, not mutual conduct ”. At least this is how it was initially presented. Closer assessment Domestic & Family Violence Forum Springwood 5

New Street Services

• NSW Health services for children and young people aged 10 17yrs and their families, where those young people have sexually abused another • Services operate from sites in Nth Parramatta, Newcastle, Tamworth and Dubbo (currently establishing) • An interagency response for substantiated cases in relation to which criminal prosecution will not take place • An expanding network of services related to need (eg the Nth Parramatta service has received 3-4 times the number of referrals it can manage) and evaluation of service impact Domestic & Family Violence Forum Springwood 6

Sexual Abuse by children and Young People

• Historically minimised • Adolescents account for more than 30% of all sexual assaults • A child is more likely to be sexually abused by another young person than by a person of any other age category or by relationship to the person who sexually abused them • Children and young people who have sexually abused typically have abused other children or young people closely connected to them • New Street consistently reports at least 50% of referrals are for sibling sexual abuse Domestic & Family Violence Forum Springwood 7

Errors

This is a relatively new area of research and work. A number of errors have been broadly recognised including: • Adult interventions are not appropriate for children • Children are developmentally incapable to take full responsibility for every aspect of their conduct and lives • Children who have sexually abused are not limited to human beings who present risk to others • Sexual Abuse behaviours do not arise as a result of a single or narrow pathway Domestic & Family Violence Forum Springwood 8

Do they do it again (the recidivism question)

• Apparently this is the only thing people want to know about children who have sexually abused • There is a significant rate of subsequent harm experienced by children who have sexually abused Domestic & Family Violence Forum Springwood 9

But do they do it again?

Yes and No

• Most do not continue or re-appear as adults sexually abusing • A significant minority sexually abuse again in the months after disclosure or first detection. Safety planning which is non punitive is critical. At all times strategies undertaken must be care based while not underestimating risk • Counselling (specialised treatment) reduces re-abusing by 2/3 Domestic & Family Violence Forum Springwood 10

So what has happened in the lives of these children and young people?

Witnessed Domestic Violence

Most likely single prior experience present • Gray et al (1998) • Ryan (1996) • Rich (2002) 70.2% (children) 63% (adolescents) 68% ( “ ) 82% (10-12 yo) • Bailey (2000) Experiencing or witnessing Domestic Violence a risk factor for developing aggressiveness and violence Domestic & Family Violence Forum Springwood 11

New Street

No Abuse Identified

09/10

28% Sexual Abuse Physical Abuse 45% 41% Emotional Abuse/Neglect 52% Exposure to Domestic Violence 41% More than one form of abuse 31%

Average

(12 yrs) 31.6% 33.9% 31.6% 39.2%

31.3%

35.5% Domestic & Family Violence Forum Springwood 12

Complex Trauma

“The experience of multiple, chronic and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature … and early life onset”

Bessel van der Kolk (2005) Quoted by Howard Bath in “The Three Pillars of Trauma-Informed Care” (2008) Domestic & Family Violence Forum Springwood 13

Trauma responses

Complex trauma can predispose children to dysregulatory stress responses A long term effect of complex trauma is related to adaptive responses and ability to move between them…..often hyperarousal or dissociation Perry 2010 How a child or young person manages is individually unique and should be recognised as such and managing this is also recognised as survival strategies at work Domestic & Family Violence Forum Springwood 14

?Causal

• Possibly, depends on definition of causation • Complex trauma does not explain all • There are multiple pathways to sexual abuse behaviour • Are young people who have experienced complex trauma less responsible? • Is counselling/treatment different?

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In exposure to domestic violence, aside from the neurobiological impacts, the child or young person is being provided, through their lived experience, with a dominant and gendered script for how they are expected to ‘be’ in the world. The expectations others do and will have of them and their developing expectations of and for themselves. For males in particular this typically involves a personal engagement with notions of privilege and entitlement.

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So why sexual behaviour?

• It is self-reinforcing due to the intimacy and closeness experienced as well as sexual elements • Sexual abuse also includes being in control which is particularly appealing to children exposed to complex trauma • Being in control generally means feeling safe(r) • Physiological responses in sexual behaviour can attend to some of the neurobiological impacts of trauma such as hypervigilance and elevated heart rates Domestic & Family Violence Forum Springwood 17

• • • • • • •

How to conclude?

Exposure to DV is present for a substantial proportion of young people who have sexually abused …as is exposure to other forms of abuse There are multiple pathways to sexual abuse Complex trauma is appearing as a current explanation. Important for children who have experienced complex trauma but there is a danger of believing it explains all Management including counselling or treatment should always include safety planning relevant to the child or young person’s needs The child or young person’s safety must always be a consideration Intervention must be based upon safety and connecting the child or young person with family and their unique social ecology. When this is done the child or young person should have a base of safety and security from which to practise managing their emotional states in ways which are not abusive of others and do not place themselves at risk of abuse or harm Domestic & Family Violence Forum Springwood 18