paraphilic disorder
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childhoodtrauma.pdf
The Influence of Childhood Trauma on Sexual Violence and Sexual Deviance in Adulthood
Jill S. Levenson Barry University
Melissa D. Grady The Catholic University of America
The purpose of this study was to determine the influence of various types of childhood adversity on later sexual deviance and sexually violent behavior. Data were collected from more than 700 convicted sexual offenders in outpatient and confinement-based treatment programs throughout the U.S. Using the 10-item Adverse Childhood Experiences (ACE) Scale, participants were surveyed about childhood maltreatment and family dysfunction. For male sex offenders, factors that significantly predicted sexual deviance included childhood sexual abuse, emotional neglect, and having unmarried parents. Factors that significantly predicted violent sexual offending included child physical abuse, substance abuse in the childhood home, mental illness in the home, and having an incarcerated family member. ACE scores were significantly higher for generalist offenders than for those specializing in sexual crime. The results underscore the need for clinicians to assess the existence of early adversity, to understand the role of traumatic events in the development of criminality and abusive behaviors, and to utilize trauma-informed counseling practices. In terms of policy, investing in prevention services for maltreated children and at-risk families is an important step in disrupting the cycle of interpersonal violence and crime in our communities.
Keywords: ACE, adverse childhood experiences, sex offender, sexual deviance, sexual violence, trauma- informed care
The largest study to examine the role of adverse childhood expe- riences (ACE) and adult outcomes surveyed over 17,000 people and found that at least two thirds of adults reported at least one type of childhood maltreatment or household dysfunction, and nearly 13% reported four or more (Centers for Disease Control & Prevention, 2013b). Though these numbers are staggering, the rates of early trauma in poor, disadvantaged, clinical, and criminal populations are even higher (Christensen et al., 2005; Eckenrode, Smith, McCarthy, & Dineen, 2014; Larkin, Felitti, & Anda, 2014; Levenson, Willis, & Prescott, 2014; Wallace, Conner, & Dass-Brailsford, 2011). As ACEs accumulate, the risk for numerous health, mental health, and behav- ioral problems in adulthood has been observed to increase in a dose–response fashion (Felitti et al., 1998). Among the negative sequelae of early trauma is increased risk for criminal behavior, including sexual perpetration (Marshall, 2010; Mersky, Topitzes, & Reynolds, 2012; Patterson, DeBaryshe, & Ramsey, 1989). The pur- pose of this study is to explore the influence of different types of childhood adversity on adult sexual violence and sexual deviance.
Developmental Theory and Criminality
Understanding the complexities of an individual’s psychosocial history is a vital component in assessing how the seeds of criminal
behavior may be planted early in life and flourish into adulthood (Dudley & Leonard, 2007; Guin, Noble, & Merrill, 2003). Devel- opmental psychopathology theorists propose that emotional and behavioral adaptations stem from a reciprocal interaction of affec- tive and cognitive processing; individuals attach meaning to their experiences and this is how we “establish a coherence of function- ing as a thinking, feeling human being” (Rutter & Sroufe, 2000, p. 265). Developmental theories of antisocial behavior argue that inept parenting, harsh or arbitrary punishment, poor supervision, and limited positive parental involvement raise the risk for conduct problems and delinquency (Cicchetti & Banny, 2014; Kohlberg, Lacrosse, Ricks, & Wolman, 1972; Patterson et al., 1989; Rutter, Kim-Cohen, & Maughan, 2006). The pathways from early adver- sity to psychosocial problems are complex, but early toxic stress creates hyper-arousal, increasing the production of hormones as- sociated with fight-or-flight responses and inhibiting the growth and connection of neurons (Anda et al., 2006; van der Kolk, 2006). Over time, these changes in the brain can compromise emotional regulation, social attachment, impulse control, and cognitive pro- cessing (Anda, Butchart, Felitti, & Brown, 2010; Anda et al., 2006; Whitfield, 1998).
This bio-psycho-social trajectory is further complicated by ac- cumulating cascade effects by which early deficiencies in one domain of functioning obstruct mastery of skills in other develop- ing areas (Masten & Cicchetti, 2010; Rutter et al., 2006). For example, traumatic childhood experiences can lead to self- regulation deficits which then interfere with academic perfor- mance and social competencies. Consequently, the child may elicit negative reactions from schoolmates and teachers, increasing the risk for delinquency when needs for acceptance are met by asso- ciations with other nonconforming peers (Rutter et al., 2006).
This article was published Online First February 25, 2016. Jill S. Levenson, School of Social Work, Barry University; Melissa D.
Grady, National School of Social Service, The Catholic University of America.
Correspondence concerning this article should be addressed to Jill S. Levenson, School of Social Work, Barry University, Miami Shores, FL 33161. E-mail: [email protected]
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Traumatology © 2016 American Psychological Association 2016, Vol. 22, No. 2, 94 –103 1085-9373/16/$12.00 http://dx.doi.org/10.1037/trm0000067
94
Clinicians taking psycho-social histories in justice-involved set- tings often seek to explore the role of child maltreatment and chaotic family environments on later criminal behavior.
Childhood adversity is very common in the histories of criminal offenders. Prospectively collected data from the Chicago Longi- tudinal Study (N � 1,539 low-income minority children) identified child maltreatment as a predictor of criminal behavior for both boys and girls (Mersky et al., 2012). In addition, child abuse and neglect were found to be much more common among 64,000 juvenile delinquents in Florida than in the general population (Baglivio et al., 2014). Among adult offenders, greater exposure to early trauma is significantly associated with mental health disor- ders, drug abuse, and serious crime (Harlow, 1999; Messina, Grella, Burdon, & Prendergast, 2007). Although individuals vary in their response to toxic stress, and many people exhibit resilience following adversity, traumagenic environments may be most del- eterious for those with negative personality traits and limited intellectual or social resources (Patterson et al., 1989). Pathogenic parenting and deprivational environments impede family function- ing and model maladaptive coping, and are often exacerbated by impoverished socioeconomic conditions (Patterson et al., 1989).
Attachment theory is helpful in conceptualizing the link be- tween early adversity and adult psychosocial problems. Attach- ment theory postulates that primary caregivers’ interactions with a child must be nurturing, consistent, reliable, and responsive to needs in order for youngsters to learn that the world is safe place (Bowlby, 1977, 2005). Children who experience maltreatment and family dysfunction are exposed to unpredictable parenting patterns that compromise the development of secure attachments to care- takers, and these youngsters often witness chaotic conditions that fail to exemplify healthy interpersonal functioning across the life span (Carlson & Sroufe, 1995; Cicchetti & Banny, 2014; Rutter et al., 2006). Abused and neglected children are socialized within relationships characterized by betrayal and invalidation, which can then produce distorted cognitive schema, boundary violations, disorganized attachment patterns, and emotional dysregulation (Chakhssi, de Ruiter, & Bernstein, 2013; Loper, Mahmoodzade- gan, & Warren, 2008; J. E. Young, Klosko, & Weishaar, 2003). Poor quality of early attachment has been associated with a num- ber of long-term negative effects including deficient relational skills, self-regulation problems, and psychopathology (Bowlby, 1977; Jovev & Jackson, 2004; Loper et al., 2008). Sexually abu- sive behaviors seem to have some roots in early attachment dis- ruptions, whereby attempts are made to satisfy unmet emotional needs and to connect with others through sexual or aggressive means (Beech & Mitchell, 2005; Bushman, Baumeister, & Phil- lips, 2001; Grady, Levenson, & Bolder, 2016; Hudson & Ward, 1997; Hudson, Ward, & McCormack, 1999; Smallbone & Dadds, 1998; Vondra, Shaw, Swearingen, Cohen, & Owens, 2001).
ACE and Sex Offenders
The ACE scale was developed by the CDC to measure child- hood adversity and was used in the 1990s to collect normative data from over 17,000 adults in California; it has become a useful and well-researched tool for measuring the accumulation of traumatic events related to child maltreatment and family dysfunction (Anda et al., 2010). One’s ACE score (1–10) reflects the number of dichotomous items endorsed and higher scores represent a more
pervasive and diverse history of adversities. Both male and female sexual offenders have significantly higher ACE scores than indi- viduals in the general population (Levenson et al., 2014; Levenson, Willis, & Prescott, 2015; Reavis, Looman, Franco, & Rojas, 2013; Weeks & Widom, 1998). A study of adult male sexual offenders (N � 679) found that, compared to males in the general popula- tion, they had more than three times the odds of child sexual abuse (CSA), nearly twice the odds of physical abuse, 13 times the odds of verbal abuse, and more than four times the odds of emotional neglect or having unmarried parents (Levenson et al., 2014). Weeks and Widom (1998) also found that the rates of child maltreatments for male sex offenders exceeded those of males in the general population, with 26% revealing child sexual abuse, 18% reporting neglect, and two thirds stating that they were victims of physical abuse. Likewise, the prevalence of adverse childhood experiences is higher for female sexual abusers than for nonoffending women (Gannon, Rose, & Ward, 2008; Levenson et al., 2015; Turner, Miller, & Henderson, 2008; Wijkman, Bijleveld, & Hendriks, 2010). Emotional abuse early in life is a robust risk factor for both sexual victimization and sexual perpetration behav- ior, whereas physical neglect and family violence emerged as significant risk factors for sexual victimization (Jennings, Zgoba, Maschi, & Reingle, 2014).
It appears that many sex offenders were raised in chaotic or disordered social environments by caregivers who were ill- equipped to protect their children from harm (Levenson et al., 2014, 2015). For instance, less than 16% of male sex offenders reported no adverse experiences, compared with 38% of the males in the CDC study, and almost half endorsed four or more (com- pared with about 9% of the male CDC sample, Levenson et al., 2014). In a similar analysis, 48% of male interpersonal violence offenders (child abusers, domestic violence assaulters, sex offend- ers, and stalkers) reported four or more adverse experiences (Rea- vis et al., 2013).
Some scholars have hypothesized that insecure attachments lead to intimacy deficits and that some individuals attempt to connect with others through coercive, violent, or deviant sexual behavior (Bushman et al., 2001; Marshall, 2010; Ward, 2014). Sex offenders with insecure attachments demonstrate higher levels of aggression in sexual relationships, have a higher tolerance for violence in relationships in general, and have more instability in their adult romantic relationships (Lyn & Burton, 2005). Furthermore, recent research suggests that there is a positive correlation between measures of insecure attachment and the number and severity of risk factors associated with criminal behavior, including sexual crimes (Grady, Swett, & Shields, under review).
It is perhaps not unexpected that early adversity is linked to sexually abusive behavior. Incompetent parenting activates and reinforces dysfunctional interaction styles and reduces oppor- tunities for exposure to (and rehearsal of) effective communi- cation and intimacy skills (Rutter et al., 2006). A lack of healthy attachment in a childhood environment can contribute to subsequent impersonal, selfish, combative, or adversarial relationship patterns, including tolerant attitudes toward bound- ary violations such as sexual abuse (Beech & Mitchell, 2005; Hanson & Morton-Bourgon, 2005). Violent or sexually deviant behavior may be among the coping responses that emerge from early traumatic experiences.
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95ACE AND SEX OFFENSE PATTERNS
Additional research has revealed a relationship between early family experiences and sex offenders’ types of offenses (Levenson et al., 2014; Lyn & Burton, 2004; Smallbone & Dadds, 1998; Ward, 2014). Sexualized coping may provide a way of soothing distress and/or meeting needs for intimacy, affection, attention, power, or control, and this may be especially true for sex offenders with a childhood history of molestation (Seto, 2008). Sexual deviance, as evidenced by paraphilic preference for children, seems to be linked with early adversity; higher ACE scores were correlated with younger victim age (Levenson et al., 2014). Sex offenders have higher rates of child sexual abuse than nonsex offenders (Jespersen, Lalumière, & Seto, 2009), and those with a sexual abuse history are more likely to have younger victims and pedophilic interests (Nunes, Hermann, Renee Malcom, & Lavoie, 2013). Higher ACE scores have also been correlated with use of force or violence in the commission of a sex crime (Levenson et al., 2014).
Sexual deviance and antisocial criminality are important ar- eas to study and understand, as they are both associated with increased risk for recidivism (Hanson & Bussiere, 1998; Hanson & Morton-Bourgon, 2005; Quinsey, Harris, Rice, & Cormier, 1998). The most dangerous sex offenders are those who are afflicted not only with deviant sexual preferences, but who also possess the capacity to act on those interests with little regard for the consequences to others. Early meta-analyses (Hanson & Bussiere, 1998; Hanson & Morton-Bourgon, 2005) observed that childhood abuse was not associated with sexual recidivism, but more recent and refined findings point to a link between CSA and sexual recidivism for high-risk sex offenders (Nunes et al., 2013), and to a correlation between ACE scores and risk scores (Levenson et al., 2014). Patterns of sexual deviance and violence are also different for generalist and specialist sex offenders; specialists are defined as those for whom sexual offenses constitute more than half of their total number of arrests (Harris, Knight, Smallbone, & Dennison, 2011). For instance, child molesters are more likely to engage only in sexual offending (specialists), whereas rapists of adults display tendencies toward criminal diversity (generalists) (Har- ris et al., 2011; Harris, Smallbone, Dennison, & Knight, 2009; Lussier, LeBlanc, & Proulx, 2005). Higher ACE scores have been associated with greater versatility and persistence of crim- inal behavior in male sexual offenders (Levenson & Socia, 2015).
Purpose of the Current Study
The purpose of this study was to explore the influence of adverse childhood experiences on offense characteristics in a sam- ple of convicted sexual offenders. Based on developmental theo- ries of criminality and sexual offending, it was hypothesized that higher ACE scores would be associated with higher levels of sexual deviance and sexual violence. An additional exploratory aim was to determine the influence of various types of childhood adversity on sexually abusive and violent behavior. This study is the first to investigate the relationship between childhood adversity and the two outcome variables in this particular fashion, attempt- ing to fill a gap in knowledge about the etiology of sexual perpe- tration patterns.
Method
Data Collection
A nonrandom convenience sample of sexual offenders was surveyed in outpatient (72%) and civil commitment (28%) treat- ment programs in the United States. An invitation was posted on the e-mail list-serv of the Association for the Treatment of Sexual Abusers (ATSA) to find treatment programs who could recruit sex offender client participants. The data collection sites were located in New Jersey, Illinois, Texas, Florida, Georgia, Maryland, Mon- tana, Washington, and Maine. All clients attending treatment in the programs (approximately 1,000) were invited to participate by staff and therapists. Presumably because of these trusting relation- ships between clients and staff, a strong response rate (approxi- mately 74%) was obtained, and a total of 740 sex offenders voluntarily agreed to complete the survey. Outpatient sex offender treatment programs usually serve clients who have been court ordered to treatment as part of their parole following a criminal conviction, or as part of a family court plan related to a child protective services investigation, and in this sample 2.9% reported no arrest history and voluntarily sought treatment. Civilly com- mitted sex offenders receive treatment in a secure facility follow- ing their incarceration.
Federal guidelines for human subject protection were followed and the project was approved by an Institutional Review Board. Clients were invited to voluntarily complete the anonymous survey during a regularly scheduled group therapy session at their respec- tive participating data collection sites. Clients were instructed not to write their names on the survey, and to place the completed survey in a sealed box with a slot opening. Informed consent was provided in writing and explained verbally. To further ensure anonymity, participants were not required to sign a consent doc- ument. Completion of the survey was considered to imply in- formed consent to participate in the project.
Participants
The sample for the current study was comprised of 740 male (93.5%) and female (6.5%) adult sex offenders. Sample demo- graphics are displayed in Table 1. Most participants were white (68%) and the majority (71%) were between 31 and 60 years of age, with 20% age 30 or younger and 9% over age 60. Nearly two thirds (62%) of the sample had completed high school or obtained a Graduate Equivalency Diploma (GED) as their highest educa- tional achievement, and one in five identified themselves as col- lege graduates. More than half (59%) grossed less than $30,000 in the last year they earned income. Almost half (46%) of the sex offenders had never been married, with 16% currently married, 35% divorced or separated, and 3% widowed.
Instrumentation
The first section of the survey consisted of the Adverse Child- hood Experiences (ACE) Scale (Centers for Disease Control & Prevention, 2013b), a 10-item dichotomous (yes/no) scale in which participants endorse whether or not they had experiences prior to 18 years of age that included: abuse (emotional, physical, and sexual), neglect (emotional and physical), and household dysfunc-
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96 LEVENSON AND GRADY
tion (domestic violence, unmarried parents, and the presence of a substance-abusing, mentally ill, or incarcerated member of the household). One’s total ACE score is the sum of the number of items endorsed by that individual (range � 0 –10).
The ACE categories were originally developed by adapting items from instruments that demonstrated validity and reliability in earlier studies: the Conflict Tactics Scale (Straus, Gelles, & Smith, 1990), the Child Trauma Questionnaire (Bernstein et al., 1994), and questions from a survey about sexual abuse (Wyatt, 1985). The test–retest reliability of the ACE scale has been examined by administering the survey twice to over 600 participants, and re- searchers found that Kappa coefficients ranged from good to excellent, indicating that retrospective reports of early abuse and household dysfunction are normally stable over time (Dube, Wil- liamson, Thompson, Felitti, & Anda, 2004). Though no validity data are available on the ACE scale itself, a review of 40 studies assessing the validity of retrospective reports found that underre- porting of child maltreatment was common, but false positives were rare, and researchers should not be dissuaded from using well-defined self-report measures of childhood adversity (Hardt & Rutter, 2004). Finkelhor et al. (2013) attempted to improve the ACE scale by modifying some items and adding additional do- mains (e.g., peer victimization, community violence, illnesses and injuries, socioeconomic status), and then testing the new version on a nationally representative sample. They concluded that the adjustments led to more robust effects when measuring distress by trauma scores, but that the child maltreatment items in the original ACE scale remained important contributors to the cumulative stress of early adversity (Finkelhor, Shattuck, Turner, & Hamby, 2013). Noteworthy is that the ACE scale has become a widely used measure of childhood adversity and many researchers have relied
on this brief instrument in hundreds of studies (Centers for Disease Control & Prevention, 2013a).
The second section of the survey collected information about offense characteristics, which were used to measure the constructs of interest in this study (sexual deviance and sexual violence) and can be seen in Table 4. No information that could potentially identify offenders or victims was sought.
Variables
The primary purpose of the study was to explore the influence of adverse childhood experiences on sexual deviance and sexual violence, and two dependent variables were created for this pur- pose. The Sexual Deviance Scale (possible score range � 0 – 4) comprised four dichotomous (yes/no) items including male victim, stranger victim, victim under 12, and multiple victims (Cronbach’s alpha � .61). The scale was devised using known risk factors for sex offense recidivism and indicators of paraphilic preference patterns; a higher score (endorsement of multiple categories) in- dicated a higher degree of sexual deviance. The other variable, the Sexual Violence Scale, was intended to capture the use of violence in the commission of a sexual crime, as measured by endorsement of “yes” to questions asking whether the offender had ever used force, weapons, or caused injury during a sexual crime (range � 0 –3; Cronbach’s alpha � .73). All of these variables were ob- tained via self-report in the survey.
Independent variables included the 10 dichotomous ACE items (yes/no; see Table 2) and the total ACE score, by which a higher score reflects a wider scope of childhood maltreatment and expo- sure to household dysfunction.
Analyses
Descriptive statistics are reported for each of the ACE items and constructs of interest. Group comparisons (t tests and chi-square) and bivariate correlations were used to examine relationships between variables. Multivariate regression was used to examine the influence of individual ACE factors in explaining sexual de- viance and violent sexual offending.
Results
Table 2 displays the endorsements of ACE items and distribu- tion of ACE scores for the current sample. It should be noted that these results have been published elsewhere (Levenson, Willis, & Prescott, 2014, 2015) but are included here for readers’ conve- nience.
Participants answered a series of questions about victim char- acteristics, taking into account their index offense, any prior ar- rests, and any undetected offending, and endorsed whether they had ever had a victim in any of the gender, age, or relationship categories listed in Table 3. There were significant differences between males and females in most of the categories. Importantly, males were more likely to have stranger victims, more victims, more sex crime arrests, and more general arrests. Males were more likely to use force or weapons. Nearly three-quarters of the females were specialist offenders (compared to half the males), for whom sexual offenses constituted more than half of their total arrests.
t tests were used to test mean differences between groups in ACE scores (see Table 4). Though males and minorities had
Table 1 Sample Demographics
Demographic categories Percent (N � 740)
Race White 68 Minority 32
Gender Male 93.5 Female 6.5
Age (years) 18–30 20 31–40 22 41–50 30 51–60 19 Over 60 9
Marital status Never married 46 Married 16 Divorced/separated 35 Widowed 3
Education Not high school graduate 18 High school graduate or GED 62 College graduate or higher 20
Income Under $20,000 41 $20,000–$29,999 18 $30,000–$49,999 20 $50,000� 21
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97ACE AND SEX OFFENSE PATTERNS
slightly higher ACE scores than females and Whites, these differ- ences were not significant. However, sex offenders with male, stranger, prepubescent, and multiple victims had significantly higher ACE scores, as did those who had used force or weapons or caused injury during a sex offense. Specialists whose sex offenses constituted more than half of their arrests were found to have significantly lower ACE scores than generalist offenders.
Bivariate correlations revealed that higher ACE scores were significantly correlated with higher scores on the scales measuring sexual deviance, r � .30, p � .01 and sexual violence, r � .28, p � .001. Sexual deviance and sexual violence were significantly cor- related with each other, r � .41, p � .01.
Multiple regression techniques were used to further examine the influence of childhood adversity on sexual deviance and sexual violence for male offenders only (see Table 5). The decision to
exclude females was made because there is less consensus in the conceptualization of sexual deviance for female sex offenders, and therefore the use of factors to devise this construct would be speculative. Paraphilic sexual deviance indicators are much more well-established in the research literature about male sex offend- ers. Missing data reduced the sample size in all models by case- wise (listwise) deletion, however power analysis determined that
Table 2 ACE Item Endorsement and Score Distribution (Valid n � 689)
Measure Total
(n � 681) Male
(n � 635) Female
(n � 46)
ACE item endorsement Childhood experience with
. . . % responding ‘yes’ Chi-square
(male/female comparison) Verbal abuse 52 53 38 3.982�
Physical abuse 42 42 34 1.209 Child sexual abuse 38 38 50 2.847 Emotional neglect 37 38 40 .150 Physical neglect 16 16 11 .942 Parents not married 54 54 47 1.003 DV in home 24 24 23 .010 Substance abuse in home 46 47 40 .706 Mental illness in home 26 26 21 .486 Incarcerated family member 23 23 17 .804
Distribution of ACE scores Total ACE score % with ACE score Chi-square
0 15.7 16 20 ns 1 13.8 14 11 ns 2 12.8 13 15 ns 3 12.5 12 13 ns 4� 45.3 45 41 ns
Mean ACE score (SD) 3.51 (2.71) 3.54 (2.7) 3.2 (2.6) t � .816
Note. ACE Scores ranged from 0 to 10. ns � not significant. � p � .05.
Table 3 Offense and Victim Characteristics by Gender of Offender
Characteristic Male
%/mean Female %/mean
Male victim� 27% 42% Stranger victim�� 35% 11% Victim under 12 52% 40% Ever used force�� 23% 4% Ever used weapon� 9% 0% Ever caused injury 10% 2% Total sex crime arrests� 1.47 1.09 Total nonsex arrests�� 2.99 1.87 Multiple (2 or more) victims��� 58% 30% Specialist�� 50% 73%
Note. Chi-Square Significant differences between groups. � p � .05. �� p � .01. ��� p � .001.
Table 4 Group Comparisons of Mean ACE Scores
Variable
Groups
Sig.Mean ACE score
Gender Male Female ns 3.5 3.2
Race Minority White ns 3.7 3.5
Male victim Yes No .000 4.3 3.2
Stranger victim Yes No .000 4.1 3.2
Victim under 12 Yes No .000 4.2 2.9
Ever used force Yes No .000 4.9 3.1
Ever used weapon Yes No .000 5.3 3.4
Ever caused injury Yes No .000 5.4 3.3
Multiple victims Yes No .000 3.9 2.9
Specialist (versus generalist) Yes No .000 3.1 4.1
Note. ns � not significant.
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98 LEVENSON AND GRADY
to detect a medium effect size with 10 predictors, the reduced sample size of 609 was more than sufficient (Faul, Erdfelder, Lang, & Buchner, 2007). Preliminary analyses were conducted to check for normality, outliers, and collinearity. Residuals were observed in the probability plots and revealed no major deviations. Standardized residuals were checked and few cases had values above 3.0 or below �3.0. The maximum Cook’s Distance was .015, indicating that outliers were not a significant problem. The variance inflation factors were all below 10, and tolerance was well above .10, indicating that multicollinearity was not problem- atic.
ACE items were entered into the multiple regression model with the sexual deviance scale score as the dependent variable. The model explained about 15.7% of the variance in the dependent variable, F(10, 609) � 11.150, p � .001.Within the model, child- hood sexual abuse, emotional neglect, mental illness in the home, and parents not married were significant (p � .05) predictors of increased sexual deviance. The strongest contributors were child sexual abuse and emotional neglect.
ACE items were entered into a new multiple regression model with sexual violence as the dependent variable, explaining 9.7% of the variance, F(10, 616) � 6.540, p � .001.Within the final model, childhood physical abuse, substance abuse in the childhood home, and an incarcerated family member were significant predictors of in- creased sexual violence. Incarcerated family member was the stron- gest contributor, followed by physical abuse and substance abuse.
Discussion
The results revealed that childhood adversity was associated with sexual deviance and sexual violence for male sex offenders, suggesting that the accumulation of early trauma can increase the likelihood of sexual and general self-regulation difficulties later in
life. The regression models examining the influence of the ACE items were statistically significant, however the effect sizes were not substantial and explained only a minority of the variance in the outcomes of interest. This implies that there are other factors, not contained in these models, which provide explanatory power about the overall etiology of sexual deviance and sexual violence. It appears that adverse childhood experiences do contribute to these negative adult outcomes, but obviously they do so in combination with other variables, not available in these analyses, that mediate risk and resilience. Consistent with developmental and attachment theories of criminality and sexual offending, the findings sup- ported the hypothesis that higher ACE scores would be associated with indicators of sexual deviance and sexual violence.
The findings offer some insight into the different pathways leading to sexually deviant and sexually violent behaviors. Predic- tors of deviance included childhood sexual abuse, emotional ne- glect, mental illness in the home, and unmarried parents. It is known that children with single or unmarried parents are at higher risk for CSA (Finkelhor & Baron, 1986) because of less attentive supervision and exposure to multiple caretakers on whom an unmarried parent might rely for child care assistance. At the same time, an overwhelmed single parent might be physically absent and/or emotionally unavailable, increasing the child’s vulnerability to a sexually abusive adult who grooms the child by providing attention and nurturing. Sexually abused children may grow up to use sex to compensate for feelings of invalidation or powerless- ness, they may replicate their own abuser’s behavior and distorted thinking, or they may come to associate sexual arousal with adult-child sexual activity (Seto, 2008). Sexualized coping can offer a way of soothing distress and/or meeting needs for intimacy, affection, attention, and control (Bushman et al., 2001; Levenson et al., 2014). The abused or neglected child, as an adult, may tend to seek out younger individuals whom he perceives as looking up to him and who will not hurt him. His victim choices are “safe” and therefore he feels less vulnerable.
On the other hand, predictors of violence included physical child abuse, substance abuse in the home, and having an incarcerated family member. Sexual violence in adulthood might be shaped by earlier observations of aggression via harsh corporal punishment or arbitrary discipline practices. The effects of physically abusive parenting can be exacerbated when substance abuse interferes with a parent’s anger management and further models poor self- regulation (Dube et al., 2001). Having incarcerated family mem- bers may reinforce criminal modeling, and may also generate feelings of hopelessness and helplessness for children witnessing such conditions in their own homes. Disempowerment and a view of the world as unfair might lead to a distorted sense of entitle- ment, and violence can become a way to seize a sense of power and control. As well, the chaotic familial dynamics characterized by aggression and addiction may offer few opportunities to ob- serve and establish healthy intimate attachments, paving the way for affective and behavioral dysregulation as well as maladaptive coping (Ford, Chapman, Connor, & Cruise, 2012).
Deficits in interpersonal functioning and coping are commonly found among individuals with insecure attachments. Research shows that individuals without a secure attachment are more likely to struggle with affect regulation (Ford et al., 2012), have a mental health diagnosis (DeKlyen & Greenberg, 2008; Mikulincer & Shaver, 2012), and have higher rates of violence across the life
Table 5 ACE Items Predicting Sexual Deviance and Sexual Violence (Male Offenders)
ACE items Beta t Sig.
Model 1: ACE items predicting sexual deviance Verbal abuse .072 1.363 .173 Physical abuse �.010 �.187 .852 Child sexual abuse .257 6.092 .000 Emotional neglect .118 2.626 .009 Physical neglect �.057 �1.295 .196 Parents not married �.095 �2.341 .020 DV in home .057 1.288 .198 Substance abuse in home .026 .606 .545 Mental illness in home .099 2.329 .020 Incarceration family member .021 .526 .599
Model 2: ACE items predicting sexual violence Verbal abuse .022 .405 .686 Physical abuse .108 2.005 .045 Child sexual abuse .077 1.776 .076 Emotional neglect .066 1.434 .152 Physical neglect �.020 �.454 .650 Parents not married �.009 �.204 .839 DV in home .008 .177 .860 Substance Abuse in home .097 2.179 .030 Mental illness in home .009 .202 .840 Incarceration family member .126 3.073 .002
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span (Crittenden, 1992). It is therefore possible that sexual vio- lence and deviance, in many cases, can be traced back to insecure attachments that were formed through adverse childhood experi- ences (Grady, Levenson, & Bolder, 2016). The link between child abuse and neglect and later offending behavior is well established (Abbiati et al., 2014; Lee, Jackson, Pattison, & Ward, 2002; Simons, Wurtele, & Durham, 2008).
Implications for Practice and Policy
Trauma-informed practitioners recognize the prevalence of childhood adversity in the general population, expect the majority of clients to have experienced early trauma, and understand the biological, social, psychological, cognitive, and relational impact of traumatic events on adult functioning and high-risk behavior (Larkin et al., 2014; Levenson, 2014; D. S. Young, 2014). Clini- cians assessing and treating sex offenders should be well-versed in knowledge related to trauma and how it contributes to problematic sexual behaviors. Though cognitive– behavioral interventions are the conventional treatment of choice for sex offenders, such pro- grams can be informed by the literature on attachment, develop- mental psychopathology, and trauma-informed care.
Trauma-informed clinicians recognize that relational patterns in adulthood often mimic those learned early in life. That sexual deviance was significantly associated with sexual abuse, and that sexual violence was associated with physical abuse, reinforces the notion of isomorphism between early victimization and later per- petration. Isomorphism as a psychological construct refers to a symbolic representation that generates behavior and decision- making based on anticipated events and relations in the environ- ment (Gallistel, 2001). In other words, expectations associated with past encounters are triggered when similar environmental conditions exist in the present, and thus adult perpetration patterns may replicate victimization experiences. Helping sex offender clients understand the impact of traumatic childhood experiences on their adult functioning might lead to improved therapeutic outcomes that diminish future risk (Abbiati et al., 2014; Levenson, 2014) and provide reparative opportunities for anxious and inse- cure attachment styles (Grady, Swett, & Shields, 2016).
The therapeutic alliance itself can have a profound positive impact on outcomes for sex offenders through exposure to trauma- informed corrective emotional experiences that model empathy and effective relational skills (Connors, 2011; Marshall, Burton, & Marshall, 2013; Marshall et al., 2003; Marshall et al., 2002). Research indicates that through the curative nature of a trauma- informed counseling relationship, clients’ attachment styles can shift and become more secure (Mikulincer & Shaver, 2012). Re- cent research specifically with sex offenders demonstrated that they can and do become more securely attached with a strong therapeutic bond, even in a CBT-based program (Grady et al., 2016). Furthermore, as attachment becomes more secure, dynamic risk factors associated with criminality are reduced (Grady et al., under review). Clinical practitioners can advance social justice through the application of trauma-informed service delivery (Mas- chi & Killian, 2011; Sheehan, 2012; D. S. Young, 2014).
Moreover, it is crucial that social policies be responsive to the lasting and substantial impacts of early adversities and their role in the development of criminal and abusive behaviors. Adverse child- hood experiences are now viewed as a public health crisis (Anda
et al., 2010; Felitti, 2002; Larkin et al., 2014). There is a robust body of research documenting the significant impact of childhood adversity on risk for poly victimization as well as pervasive and profound posttraumatic stress symptoms (Cloitre et al., 2009; Finkelhor, Turner, Hamby, & Ormrod, 2011). Unfortunately, pri- mary prevention of child maltreatment has been somewhat ne- glected in favor of American social policies focused predomi- nantly on offender punishment and child placement (Larkin et al., 2014; Levenson & Socia, 2015). Youth growing up in disadvan- taged communities and society as a whole would benefit from prioritizing preventive interventions.
Household dysfunction and chronic maltreatment put children at a higher risk for becoming addicted to substances and committing crimes (DeHart et al., 2009; DeHart, Lynch, Belknap, Dass- Brailsford, & Green, 2014; Harlow, 1999; Jennings et al., 2014; Mersky et al., 2012; Topitzes, Mersky, & Reynolds, 2012; Widom & Maxfield, 2001). Multiple public health and primary prevention implications are clear: we need to provide victims of all forms of child maltreatment with immediate and appropriate therapeutic services, to intervene early with at-risk parents to help them develop skills that foster attachments and healthy family function- ing, and to alter the culture of the criminal justice system to utilize a more trauma informed approach to incarceration and reentry (Baglivio et al., 2014; Larkin et al., 2014; Mendelson & Letour- neau, 2015; Miller & Najavits, 2012). To halt the cycle of inter- personal violence in communities, it is critical that the mental health, child protective, and criminal justice systems invest in comprehensive prevention programs for high risk families and treatment for child victims (Anda et al., 2010; Baglivio et al., 2014; Miller & Najavits, 2012).
Limitations
There are several limitations to this study. First, all information was provided by offender self-report, and the design of the study did not allow for review of official documentation to verify responses. The responses may reflect impression management bias, a desire to hide embarrassing behaviors or experiences, or exaggeration of early trauma experiences in a maneuver to gain sympathy or justify behav- ior. On the other hand, it is plausible that some offenders do not readily recognize early adversity as pertaining to themselves, perhaps underreporting childhood trauma. Another limitation of self-report is that we were unable to obtain DSM diagnoses made by a clinician to determine whether a participant met criteria for a paraphilic disorder, which might have provided an additional and important measure of sexual deviance. Second, the participants were all in treatment pro- grams and therefore the findings might not generalize to the full population of sexual offenders. Third, the ACE scale as a measure of early adversity is imperfect. Clearly there is an array of traumatic experiences beyond child maltreatment and family dysfunction that shape adult behavior. Moreover, the ACE scale measures only intra- familial experiences and its dichotomous nature does not allow for unmeasured heterogeneity in the frequency, duration, or severity of childhood traumas. This study does not account for extrafamilial or environmental factors such as community violence, poverty, discrim- ination, microaggression, death, illness, natural disasters, or bullying. The ACE scale is not intended to be an exhaustive measure of trauma, nor does it fully capture the scope of variables that contribute to
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sexually abusive behavior. Finally, given the retrospective and cross- sectional research design, causality cannot be inferred.
Conclusions
Adverse childhood experiences were associated with sexual deviance and sexual violence. Clinicians should recognize the prevalence of early trauma in the lives of clients and consider the role of childhood adversity to inform treatment planning for both offenders and victims. Because self-regulatory deficits are often a consequence of ACEs and should be viewed as dynamic risk factors for reoffending, practitioners should integrate trauma- informed forensic counseling methods that individualize and de- liver services in a way that is relevant to risk, criminogenic needs, and responsivity factors (Andrews & Bonta, 2010; Hanson, Bour- gon, Helmus, & Hodgson, 2009; Levenson, 2014). Social policies that prioritize primary prevention programs, child protection ser- vices, and early interventions for at-risk families and maltreated youth can disrupt the trajectory toward criminal and sexually abusive behavior in adulthood. Trauma-informed practitioners must address the micro, mezzo, and macro issues that perpetuate the cycle of sexual violence in our communities.
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Received October 3, 2015 Revision received December 30, 2015
Accepted January 18, 2016 �
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103ACE AND SEX OFFENSE PATTERNS
