Council of Europe - Conference on Preventing

Child Sexual Abuse

Madrid
10-11 December, 2013

"Treating Adolescents who sexually abuse - the ATURA'T Project"

Kieran McGrath
Child Welfare Consultant, Ireland

INTRODUCTION
This paper will address the question of adolescents who sexually abuse and, in
particular, will outline a summary of the ATURA'T1 programme which operates
under the auspices of the Menors i Familia section of the Autonomous Region of the
Balearic Islands2. The importance of addressing sexual offending by adolescents will
be outlined due to that about one third of all Child Sexual Abuse (CSA) is
perpetrated by teenagers and they commit the full range of sexual offences and not
just those on the minor end of the scale. Likewise, there is ample evidence that most
people who sexually abuse begin while they are very young, in adolescence or even
earlier. Intervening with adolescents also has the advantage that it is a form of early
intervention and, thus, the potential for prevention is obvious. Adolescents, by
definition, are in a stage of transition and patterns of behaviour are not yet fully
formed. They can, in this way be diverted away from developing more serious
patterns of abusive behaviour.

The ATURA'T Programme consists of both evaluation and treatment. The program
uses the AIM2 Assessment Instrument (Print et 2007) developed in Manchester,
England, which assesses both a young person strengths and concerns in relation to
the risk of re-offending. The question of examining strengths, positive protective
factors has been shown to be of great importance in terms of its preventative value.
The program is fortunate to have been given permission of the AIM2 authors to have
it translated into Spanish, as the lack of material in Spanish is an obstacle for Spanish
professionals working with this population.

In terms of treatment the ATURA'T Program uses a multi-dimensional approach,

which includes among other elements, an adapted version of the Good Lives Model
(Ward et al, 2007)

1
Atura't is Catalan for "Stop that" or "You stop that".
2 BOIB nº111/9/Agosto, Orden 14676

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The extent of sexual offending by young people

The importance of sexual offending as a social problem has become increasingly

acknowledged since the 1980s. As will be demonstrated later, a high proportion of

sexual offences are committed by adolescents, however, in the first instance it is

necessary to acknowledge the full extent of the problem generally. This has been

empirically documented by various studies. In Spain, López Sánchez y Del Campo

Sánchez (1997) highlighted the fact that a high proportion of Spanish adults had

experiences of being sexually abused in childhood. Similar studies were conducted

elsewhere. For example, in Ireland, McGee et al. (2002) conducted a national

telephone survey of 3,118 adults. This study revealed that 42.1% of adult women and

28.6% of adult men reported that they had been subjected to some form of sexual

assault during the course of their lifetime. The rates of various forms of contact and

non-contact abuse within these findings are summarised in Table 1-1.

Table 1-1: Lifetime prevalence of sexual abuse in Ireland (adapted from McGee et al., 2002)
Type of abuse Men % (number) Women % (number)

No abuse reported 71.4% (1,074) 57.9% (917)

Some form of abuse reported 28.6% (431) 42.1% (666)
Non-contact abuse 7.0% (106) 9.8% (155)
Contact abuse (without penetration) 16.4% (247) 19.2% (304)
Attempted penetration 2.0% (30) 2.8% (45)
Penetration/oral sex 3.2% (48) 10.2% (162)
Total 100% (1,505) 100% (1,583)

The extent of adolescent sexual offending

It is generally accepted within international research literature that 1/3 of those who

sexually assault others are aged less than 18 years of age. For example, Rich (2003)

summarises the international research literature as follows. Young people aged

between 7 to 17 years are responsible for 40% of sexual assaults against children

aged less than 6 years; 34% of sexual assaults against children aged between 7 and

11 years; and 24% of sexual assaults against children aged from 12 to 17 years. The

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same author goes on to suggest that among juvenile offenders 14-year-old boys

perpetrate the greatest number of sexual offences. Young people are most likely to

use threats or violence when offending against older rather than younger children.

In instances where the child victim is under 6 years of age, statistically, the juvenile

offender is most likely to be a sibling, or other close family member. Most children

who are sexually victimised know the person responsible for their abuse, and in the

case of a juvenile offender, it is statistically most likely to be a sibling, close-relative,

baby-sitter, neighbour, or some other person known to the victim (Rich, 2003).

Two Irish surveys were contrasted by O’ Reilly and Carr (1999) based on confirmed

cases of child sexual abuse. The first of these concerned all 512 confirmed cases of

child sexual abuse within what was then the Eastern Health Board for the calendar

year 1988 (McKeown, & Gilligan, 1991). The second study reported information

from all 408 cases of confirmed child sexual abuse within Northern Ireland for the

calendar year 1987 (The Research Team, 1990).

Table 1-2: Perpetrator age in confirmed cases of child sexual abuse in one calendar year
within the Eastern Health Board (McKeown & Gilligan 1991) and Northern Ireland (The
Research Team, 1990).
Northern Ireland
Age EHB Study Age
Study

15 years or less 21% of cases 15 years or less 20.5% of cases

16-20 years 16% of cases 16-19 years 16.2% of cases
21-35 years 24% of cases 20-39 years 34.4% of cases
36-45 years 17% of cases 40-59 years 18.5% of cases
46-66 years 9% of cases 60 years or more 11% of cases

Table 1-2 outlines the age range of those who were responsible for the sexual assault

of the children concerned, and confirms that between one-quarter to one-third of

children reported that the offender was a juvenile. More recently, from the data

collected as part of McGee et al.’s (2002) survey of the national adult population, it

was apparent that 25.7% of people who reported childhood sexual victimisation

indicated that the perpetrator was 17 years of age or less.

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The serious nature of offending by adolescents

The research literature also indicates that juveniles engage in sexual offending
behaviour which is not only frequent but also of a serious nature. O’Reilly et al.
(1998) report data from 23 young people who were among the first to attend a
specialist treatment service in Dublin. Their average age at the time of their first
known offence was 14.2 years. In total they sexually assaulted 41 children. The
majority were acting as a baby-sitter at the time of their offence. Sixteen (69.9%)
were responsible for sexually abusive behaviour which included some kind of
penetrative act. Only six of the young people had engaged in a single abusive
behaviour, while 14 had perpetrated between 5 and 50+ sexual offences.

Problems with definitions

In this area there are frequently problems connected with definitions. This can
include debates about what is 'normal' sexual behaviour in children and
adolescents? How should one define what constitutes 'experimentation'? Another
issue is to do with the fact that frequently young people who sexually abuse are
themselves victims of some form of abuse, if not sexual, then emotional or physical.
Some professionals are uncomfortable treating both aspects and prefer to do one or
the other. There is an understandable and appropriate reluctance to label young
people as 'offenders' or 'high risk'. However, these problems can be overcome and
professionals should not let them get in the way of developing services.

In Spain a problem that professionals have is a lack of appropriate materials in

Spanish, as most of it is in English. In this regard the writer arranged to have a
booklet he had previously published in English (McGrath, 2010)3 on distinguishing
normal, problematic and abusive sexual behaviours in children and adolescents,
translated into Spanish (McGrath 2011)4.

PREVENTION

A key motivation for working with adolescents with sexually harmful behaviours is

the potential for prevention and in that context the need for an evidence based

method to assess risk has been highlighted. In the UK this was highlighted by what

is known as the case of "DM". This was a young man who was in a residential unit

3
This booklet can be downloaded, free of charge, from the following site:
http://www.cari.ie/images/uploads/pictures/Understanding%20%26%20Managing%20Sexualised%20Behavio
ur%20in%20Children%20%26%20Adolescents.pdf
4
This can be obtained free of charge from <[email protected]>

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for young people, due to a history of sexually abusive behaviour. Although there

were clearly identifiable risk factors in his case, the professionals involved placed

more emphasis on their own clinical judgement of the his likelihood of reoffending

rather than evidence-based factors pointing to the risk of re-offending.

A short time after he left the residential centre DM raped and murdered an 11 year

old boy. This led to setting up of a formal inquiry into DM's circumstances and the

various interventions that had been carried out with him. The resulting inquiry

report (Bridgewater Project, 2001) was very influential in the development of

practice in the UK with young people who exhibit sexually harmful behaviours. In

particular, the need to ensure that practice is guided by research on those factors

suggesting that a young person if likely to re-offend. In the case of DM the

information was known that he had certain characteristics linked to indicators of

high risk but the professionals relied more on how he presented to them, which was

of a pleasant, ostensibly cooperative youth who did not cause problems in the

residential unit.

In Spain one of the most well known and controversial cases in recent years is what

is known as "El Caso Mari Luz". This concerns a 5 year old child, Mari Luz Cortés

who was murdered in January 2008. It subsequently emerged that the man convicted

of her murder, Santiago de Valle, should have been in prison at the time of her death

because he had been convicted of sexually abusing his own daughter, beginning at

the age of 5. It also emerged that his younger sister reported that when de Valle was

a teenager he started to abuse her when she was 5 years old.

While most of the controversy centred on the judicial errors that allowed him to be at

large when he should have been in prison, almost no attention was focused on the

fact that if he had been treated appropriately, as a teenager, for his sexually abusive

behaviour, there would have been much less chance that he would have abused his

daughter and, of course, that he would have gone on to kill Mari Luz.

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RISK ASSESSMENT EVALUATION

Current approaches within the literature to assessment and intervention with young

people who sexually abuse which suggest that clinical assessment should be

comprehensive, leading to a formulation concerning the developmental experiences

and therapeutic needs covering the domains of

 Sexual offending behaviour

 Development aspects
 Family functioning
 Environmental aspects

Intervention typically builds on the formulation reached during a comprehensive

assessment and addresses. Many programmes also incorporate therapeutic work

with families as a central component to intervention (Thomas, 2004) as does the

ATUTA'T program.

Risk assessment is an attempt to evaluate the likelihood that someone who has

already abused will do the same thing, or something similar, again. The ATURA'T

program uses the Spanish version of the AIM25 assessment model developed in

Manchester by the AIM Project (Print et al, 2007). This instrument not only addresses

the question of "concerns" (risk) but also an individual's "strengths" (protective

factors) which has been shown to more linked to reducing the likelihood of re-

offending that risk factors (Griffin et al, 2008). This study compared youth with

similar risk profiles but differing strength profiles and found that those with low

strengths were much more likely to re-offend.

All the factors that are included are based on the available research linking that

factor to the likelihood of re-offending. Both the concerns and strengths examined by

the AIM2 framework include static factors, those that cannot change (e.g. age at first

5
In 2009 the author was given permission by the authors of AIM2 to translate it into Spanish exclusively for
use in the ATURA'T programme. The lack of resources in Spanish is an obstacle encountered by Spanish
professionals working in this area and, in part at least, accounts for the scarcity of programmes in Spain
compared to other developed countries.

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offence) and dynamic factors (those that can change) e.g. whether the young person

has positive interests or hobbies.

Theories that explain sexual offending

The first unified theory to explain sexual offending was published by Finkelhor
(1984). This four-factor theory argues that child sexual abuse is caused by a
combination of four factors which consist of:

1. Motivation to Abuse/ sexual interest in children

2. A lack of internal controls
3. A lack of external controls
4. Overcoming the resistance of the child

FINKELHOR'S Four Factor Theory:

From: Kahn, T. J. (2001) Pathways - A Guide for youth starting treatment. (3rd Ed)
Brandon, VT: Safer Society Press.

Finkelhor's theory was a very useful development as it overcame some of the

difficulties by previous attempts to explain sexually offence behaviour. For example,

Family Systems Theory went some of the way to explain sexual abuse within

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families but it had nothing to say about those who sexually abuse outside the home.

Feminist theories explained the abuse of women and girls in terms of inequalities

between males and females but could not explain the abuse of boys. Earlier theories,

for example, Freudian theories examined incestuous relationships between fathers

and daughters but could offer nothing to explain father-son sexual abuse.

Finkelhor's integrated theory can be applied to males and females, inside or outside

the family and pulled together knowledge from a wide variety of disciplines. It has

been refined since then, however, and in the case of sexual abuse but adolescents the

AIM2 framework uses a model developed by Beech & Ward (2004)

Figure 1 below represents the theoretical model used by the AIM2 framework.

The ATURA'T program

The ATURA'T program began in 2008. It is a multi-disciplinary program that

evaluates and treats young people between the ages 14-186 years who are convicted

of sexual offences in the Balearic Islands. All those involved in the program have

been convicted of a sexual offence and have their attendance included in the list of

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In exceptional circumstances some youths outside this age range are accepted into the program.

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judicial measures set down by the presiding judge. Attendance, therefore, is

compulsory and not voluntary on the part of the young people involve.

The process begins with an assessment using the AIM2 framework and, depending

on the outcome of that, an individually tailor program of intervention is planned.

Thus, the ATURA'T program is not a 'one-size-fits-all' approach, as it recognises that

each individual is unique. Therefore, each young person's needs and strengths are

different and the response must take that into account. With regard to the level of

risk each youth poses, the term used is "Level of Supervision Required". This is

arrived at taking a subset of the AIM2 criteria, both of concerns and strengths to

classify broadly what type of intervention is required. This phrase is not just political

correctness but an accurate description of a young person's circumstances. It

recognises that the level of risk does not lie solely in the young person but also in

their circumstances. For example, a young person who is well supported and

supervised is, obviously, going to pose a lower risk than one who has no such

support and supervision. Thus, one cannot simply label a young person as "High

Risk" or "Low Risk" without reference to his overall circumstances.

Following the evaluation process treatment is based on a combination of individual

work with each young person and intervention with their parents or carers, in the

case of those you who are in State care but are not in contact with their families of

origin. Treatment draws on a variety of sources including the writings of Finkelhor

(1984), Marshall & Barbarie (1990), Hall & Hirschman (1992), Smets & Cebula (1988),

but replies principally on the Good Lives Model (Ward & Siegert, 2002).

Supervision.

The ATURA'T program was designed by the writer who continues to offer the

treatment team periodic supervision. Having external supervision is recommended

as part of best practice in this area. Spanish professionals suffer a disadvantage due a

general lack of materials in Spanish, as much of the literature and materials are in

English.

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CONCLUSION

Sexual abuse is a very serious social problem and given the high level of abuse

perpetrated by adolescents requires that measures be put in place to intervene with

adolescents in the interests of prevention. In recent years instruments for the

evaluation of risk have been developed. However, assessing risk must also examine

strengths or protective factors in each case in planning treatment. In 2008 the

ATURA'T program was developed by the Direction General of the Menors i Familia

section of the Government of the Balearic Islands to address this growing problem.

All young people (14-18 years) with convictions for sexual offences are referred by

judges to the ATURA'T program for assessment and treatment. Evaluation is done

following the AIM2 Framework developed by Print et al (2007). Treatment follows

an eclectic approach but draws strongly on the Good Lives Model (Ward & Siegert,

2002).

Programmes for the treatment of those who sexually abuse are relatively rare in

Spain and Spanish professionals are often hindered by a lack of resources in Spanish.

However, the ATURA'T programme is fortunate to have access to a Spanish

translation of the AIM2 framework, which has facilitated their work in the interests

of developing strategies and interventions with this client population that can help

reduce risk and less the degree of sexual abuse perpetrated by adolescents in the

Balearic region.

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framework. Aggression & Violent Behaviour 10, 31-63
Finkelhor, D. (1984). Child Sexual Abuse: New Theory & Research; New York: Free Press.
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