Slow-Walking Sexual Abuse Prevention?

 By David S. Prescott, LISCW

With all the modern technological wonders, artificial intelligence, space tourism, and the like clearly, we live in a fast-paced world, but advances don’t all progress at the same rate, especially where human rights are concerned. For example, The United States became a "free" democracy in 1776, but women didn't get the right to vote until nearly 150 years later and weren't allowed financial independence until the 1970s. Even now their fight for bodily autonomy goes on. Abraham Lincoln’s Emancipation Proclamation abolished slavery at the start of 1863, but it took another two years for many who were enslaved to find out about it, and more than 150 years for their emancipation to be celebrated with an official holiday. Still the struggle for equality goes on.  Examples of slow-walking abound.

Slow-walking is a common tactic in street protests, effective enough, apparently, that last year the UK passed legislation to allow police to restrict any protest that hinders or delays traffic. Merriam-Webster defines “slow-walk” as, “to delay or prevent the progress of (something) by acting in a deliberately slow manner.” Wherever active resistance to the unfolding of human rights wasn’t happening, slow-walking the end of these abuses was there in its stead. Setting aside the other horrors, it grimly reminds us of the power of passive-aggressive behavior and its exhausting toll on us all.

Fast forward to the present and our field, and we see that a simple Google Scholar search on “racial disparities in criminal justice” yields over 300,000 results. Likewise, a search on “racial disparities in child protective services” yields over 235,000 hits. While mainstream media often uses terms like “controversial” in addressing public debates on race, power, and privilege, there is really nothing controversial in the reminder that our society is slow-walking the amelioration of these injustices. They are right in front of us all.

What does this have to do with the prevention of abuse? For starters, a recent investigation claimed that 1,800 law enforcement officers may have sexually abused children and that high-ranking officials are “failing” at protecting minors. Further, prosecutors have given favorable plea deals to officers who have admitted their crimes. This is not even close to the first time that abuse by law enforcement officers has made headline news or even appeared in this blog (for example, see here and here). Over the years, I have worked with and trained many law enforcement officers for whom I have nothing but admiration and respect. The point that I and others have made is that the systems in which many of these officers operate appear to have slow-walked their efforts at preventing further abuses. As Phil Zimbardo observed, it’s often not just the few bad apples, but the bad apple barrels and the bad makers of apple barrels (which are the policies that allow systemic abuses to occur).

Other examples often appear in the news. In the past few days, the pastor of a “megachurch” resigned after it came to light that he had abused a 12-year-old girl in the 1980s. While this happened some 40 years ago, the media coverage quickly noted other recent scandals, such as an expanding probe last month into New Orleans Catholic church leaders. Decades after the first sexual abuse scandals in churches, Kansas is now considering requiring church leaders to report suspected child abuse in most cases. Utah has also only recently pursued a similar policy.

Sexual abuse does exist everywhere, and I am highlighting easily identified cases of abuse within law enforcement and religious institutions because they are in positions of trust in society. No profession is free from it, as one can see in reviewing the minutes of state professional licensing and regulatory boards for psychologists, social workers, and clinical counselors.

The question for all of us engaged in prevention efforts is whether we can see and stay focused on the systemic slow-walking of efforts to prevent sexual abuse.

In the end, contrary to what many in the public may believe, sexual abuse, like other forms of violence, is preventable. Professionals in our field have many reasons to be hopeful, take pride, and find joy in our work! However, it is not enough to limit our activities to assessing and treating individuals. We need to identify and call attention to slow-walking by institutions when it occurs.

Responsivity and Reading in Adolescents

By Norbert Ralph, PhD, MPH

Best practices for the treatment of youth with problematic sexual behavior (YPSB) include the use of the principles of risk, need, and responsivity. The last of these, the responsivity principle, is described by ATSA (2017) as interventions that take into account personal strengths, developmental stage, education, and motivation. As a neuropsychologist who assesses learning disabilities, I believe that an important part of assessment and also treatment planning is to understand the reading level of a youth. Written materials are routinely part of treatment including consents, worksheets, and workbooks. Some relevant information was provided by a survey of California adolescent treatment providers (Ralph, 2013) which identified that 41.9% used, for example, Pathways by Kahn (Kahn, 2011).

What are reading levels in YPSB? Lewis, Shanok, and Pincus (as cited in Ferrara and McDonald, 1996) compared juveniles who had sexually offended with another juvenile population with violent but nonsexual offenses. They found the two groups did not differ on IQ testing regarding full-scale, verbal, or performance measures. However, they found that juveniles with sexual offenses scored 5.59 years below grade level and the comparison group 3.95 years.

In my clinical experience reading levels can be readily assessed using reading tests in less than 10 minutes. As an administrator for psychological testing for the juvenile courts in San Francisco, I found few psychologists in court-ordered testing would choose to assess reading levels. They didn't view this as part of their role even though this information wasn't available readily in any records. I found many youth that I assessed as having a reading disorder that had not previously been identified through the school system. I was careful to make sure such youth were referred for an IEP assessment and possibly specialized services to help promote their educational and prosocial development.

Reading level has profound implications not only in a youth's ability to use written curriculum but their academic and life experiences. Many occupational and even social opportunities are limited due to reading levels and this also has an impact on the youth's self-image and view of future life possibilities. One study found that youth identified with a reading disorder at age 7 were 56% less likely to obtain a higher income than those with average or above reading skills (McLaughlin, Speirs, & Shenassa, 2014). Authoritative guidelines for youth specifically recommend an assessment that includes reading level (California Sex Offender Management Board, 2022).

Understanding the reading level of materials for youth is important in several respects. Reading levels can be estimated using such measures as the Flesch–Kincaid Grade Level (FKGL) which can be calculated using a computer. This measure gives an estimate of the grade reading level of documents and was used by the U.S. Army to rate the difficulty of technical manuals (Wikipedia, 2023).

The readability of written materials is relevant in several areas. Youths routinely sign consent to treatment or release of information forms. These forms should be comprehensible to most youth. For example, one California County's consent form had an FKGL of 11.0 and the authorization for the release of protected health information was 11.5. A private practice group's adolescent consent form had an FKGL of 12.7.

It's also important to consider the reading level of workbooks or materials for juveniles since this will be an indicator of how well they can be understood and used. For illustrative purposes, several workbooks were analyzed using this methodology. One well-designed workbook available as a PDF online had an FKGL of 7.5. A sample chapter on controlling impulses from a widely used workbook had an FKGL of 7.1. A workbook by the author, Being a Pro, (Ralph, 2016) had a FKGL of 5.5. For comparison, the reading level of this document is 12.7.

Let's use the upper and lower limits of this very modest sample, with a FKGL of 5.5 and 7.5 grade levels to consider comfortable reading levels for the average 14-year-old juvenile on probation whose approximate grade level would be 8.0. Using the data from Ferrara and McDonald (1996) and the estimate of juveniles on probation being four years below grade level in reading, then the average reading grade level of the 14-year-old on probation would be 4.0. According to broader educational research, such as Chall and Conard (1991), students who are proficient readers can read at a level one to one and a half grades above their current grade. So if treatment reading material had an FKGL of 5.5, the average probation youth in this hypothetical scenario could comprehend this material but not one with an FKGL of 7.5.

In summary, an important part of the responsivity principle is assessing the reading level of youth in treatment and also additionally the reading level required by consent and treatment methods. A mismatch in these areas would likely lead to less successful outcomes.

References

Association for the Treatment of Sexual Abusers. (2017). ATSA practice guidelines for assessment, treatment, and intervention with adolescents who have engaged in sexually abusive behavior. Retrieved from ATSA.

California Sex Offender Management Board. (2022). Guidelines for treating and supervising youth who have committed a sexual offense. Retrieved from https://casomb.org/pdf/CASOMB_Guidelines_for_Youth_2022_v1.pdf.

Chall, J. S., Conard, S. S., & Harris-Sharples, S. (1991). Should textbooks challenge students? The case for easier or harder textbooks. New York: Teachers College Press.

Ferrara, M.L., and McDonald, S. 1996. Treatment of the Juvenile Sex Offender: Neurological and Psychiatric Impairments. Northvale, NJ: Jason Aronson.

Kahn, T. J. (2011). Pathways: A guided workbook for youth beginning treatment (4th ed.). Safer Society Press.

McLaughlin, M. J., Speirs, K. E., & Shenassa, E. D. (2014). Reading disability and adult attained education and income: Evidence from a 30-year longitudinal study of a population-based sample. Journal of Learning Disabilities, 47(4), 374-386.

National Center for Educational Statistics. (2024). Nation’s report card. https://nces.ed.gov/nationsreportcard/

Ralph, N. (2013). An online survey of JSO practice characteristics and methods. California Coalition on Sexual Offending. Retrieved from https://ccoso.org/sites/default/files/CCOSO%20JSO%20Survey%2010%208%2012.pdf

Ralph, N. (2016). Being a Pro: Promoting prosocial development in youths. Safer Society Press.

Wikipedia. (2023). Flesch–Kincaid readability tests. In Wikipedia, The Free Encyclopedia. Retrieved from https://en.wikipedia.org/wiki/Flesch%E2%80%93Kincaid_readability_tests

Sex and Autism Spectrum Disorder: Deeper insights into complex relationships (NL-ATSA webinar)

By Minne De Boeck (Stop it Now! Flanders, University Forensic Centre, University Antwerp, Belgium) & Kasia Uzieblo (Helpline 1712, Vrije Universiteit Brussel, Belgium)

An essential goal of the Dutch-speaking affiliation of ATSA, NL-ATSA, is to bring science closer to local professionals, and thus, to strengthen the bridge between theory and practice. Therefore, NL-ATSA, hosts webinars and conferences on various topics relevant to our daily practice. Many professionals indicated that they increasingly encounter people with developmental disabilities, such as autism spectrum disorder, who conduct sexually transgressive behavior. Autistic traits seem to have a substantial impact on the experience of sexuality, sexual identity and sexual behavior. In addition, developing a healthy and safe sexuality can be challenging for people with autism. In times of social media and easy access to online sexual content, things only seem to get more complex for them. These challenges call for an autism-sensitive approach. The question that arises, then, is how to bring about such an approach in our practice? To shape such an approach, we obviously need, first, to understand how these individuals experience sexuality and where the concrete challenges lie.

For these reasons, NL-ATSA aimed to gain -and share- insights about the impact of autism on. NL-ATSA invited several (inter)national experts for an online webinar to discuss autism and (deviant) sexuality.

The first lecture was given by Dr. Wenn Lawson and Maree Crabbe (Australia). Dr. Wenn Lawson is an autism expert and Maree Crabbe is a pornography-education expert. Their presentation focused on the role of pornography on people with autism. Before explaining the role of pornography and technology, the meaning of the term ‘autism’ was briefly touched upon. Different terms are used to describe autism; hence, it is always necessary to check which term is preferred by people with autism. Today, pornography is more readily available than ever before. Also, it increasingly depicts more aggressive forms of sexuality. Since pornography is normalized by many people, pornography is a sexual educator for many. This has serious implications for young people's ability to appreciate and give meaning to concepts such as ‘free consent’ and ‘mutual respect’. The impact of pornography can be even more challenging for young people with autism. Throughout the presentation, the term ‘monotropism’ was strongly emphasized. Monotropic minds tend to have their attention pulled more strongly towards a smaller number of interests at any given time. This characteristic can lead to young people with autism being particularly vulnerable to the effects of pornography. Moreover, there is a risk of forming unrealistic and unhealthy sexual attitudes and expectations. For example, themes such as strangulation, violence, incest, etc. are becoming prevalent in pornography. Even though these themes clearly do not reflect normal and safe sexual behavior, this can be very confusing for young people with autism. These can create doubts about sexual identity, sexuality experience and sexuality (within relationships). This is partly because of their difficulties in interpreting facial expressions and body language, and the fact that the sensory systems of people with autism can be more easily overwhelmed. These characteristics may increase the likelihood of young people with autism becoming victims or even perpetrators of sexual crime, partly because of their distorted perception of what normal sexuality entails. Dr. Wenn Lawson and Maree Crabbe also gave various tips on how to deal with individuals with autism and the impact of pornography. Think about engaging in dialogue, offering adequate sex education, offering healthy alternatives but also posing certain restrictions. 

The second expert was Robert de Hoog (the Netherlands), physical therapist specialized in sensory information processing. His presentation focused on autism and sensory information processing. As humans we are confronted with an almost innumerable number stimuli from the environment and from our own bodies, through our senses. People differ in what kind of stimuli they find pleasant or unpleasant, that certainly applies to persons with autism as well. Furthermore, some people become under- or overstimulated. Understimulation involves barely reacting to a touch and may involve obsessive behavior. Overstimulated people may experience anxiety upon physical arousal and may perceive stimuli (e.g., touch) as painful. Since persons with autism often face under- or over-stimulation in sexual experiences, it is important to understand these processes when working on healthy sexuality with this target audience.

The next speaker of the webinar was Manon Heyndrickx (Belgium), a forensic psychologist at the forensic inpatient treatment centre PC Sint-Jan Baptist. She discussed how sexuality is experienced by people with autistic spectrum disorder and this from a theoretical standpoint as well as from her clinical practice. She portrayed this by showing the video ‘Mind My Mind’. The functioning of the brain of people with autism and how this functioning affects their view on sexuality was explained. Among other things, problems with central coherence in individuals with autism were addressed. Central coherence refers to people’s tendency to process information globally and in context. However, people with autism tend to focus on local rather than on global processing. Consequently, their processing of information is too detailed, too specific, too context-dependent and/or too absolute. In addition, sexual contacts tend to involve unwritten (social) rules, there is a lot of nonverbal communication and limited predictability. This is precisely what makes it so difficult for people with autism, partly as the result of a lack of social insight and skills, limited empathy, and a lack of inhibitions and knowledge. Preoccupations, sensory preferences and persistent, repetitive, behavior are also mechanisms that could explain their (deviant) sexual behavior.

Hence, although autism per se may not be a risk factor for the development of sexually deviant behavior, it is clearly important for clinicians to gain insight into how certain autistic characteristics influence their (deviant) sexual behavior. The numerous attendance during the webinar and the numerous questions NL-ATSA receives about autism in clients who commit sexual offenses, illustrate how important it is not only to discuss scientific insights, but also to give adequate attention to sharing good practices and clinical experiences.

The last speaker was Professor Kieran McCartan (United Kingdom). This presentation provided an opportunity to learn about the Prevent Through Support Project (2PS), a European Commission-funded project that aims to map and understand secondary prevention programs in Europe for (potential) perpetrators of sexual abuse of minors. The session introduced the project, discussed how professionals in our field can get involved and debated some of the challenges and opportunities for secondary prevention right now. Even though this presentation was not about sexuality and autism, this was an excellent opportunity to make our field aware of the necessary prevention initiatives currently underway.