October 2003

What risk factors increase the development of sexual aggressiveness in youth?

Anecdotal and documented reports indicate that sexual aggressiveness is increasing among youth of all ages. According to David Fago in "Evaluation and Treatment of Neurodelopmental Deficits in Sexually Aggressive Children and Adolescents" ( Professional Psychology: Research and Practice , 34(3), 248-257, June 2003), aggressive sexual behavior is usually defined as behavior that involves, at minimum, nonconsensual, sexual touching ("fondling") of another person. The behaviors can range from touching, fondling, and simulated sexual intercourse to oral and anal sex and attempted and actual genital intercourse. The latter, more aggressive and invasive assaults tend to be perpetrated by older adolescents. Without appropriate interventions, these children could have lifelong problems with sexual intimacy and healthy sexual expression and may be more likely to have antisocial behaviors that persist into adulthood.

Risk Factors

A number of studies?Fago's among them?have documented risk factors for these children, including families in which substance abuse and/or other mental health problems are present; attention deficit/hyperactivity disorders (ADHD); conduct disorder; lack of emotional maturity; dependency on alcohol and illegal substances; a prior history of physical or sexual abuse; a history of peer rejection and/or social skills deficits; difficulty or deficits in setting limits on their own behaviors; formal, documented school history of specific learning disability; and/or evidence of school failure (grade retention or expulsion). Fago has made a number of suggestions that family members, caretakers, and professionals can use to ameliorate or at least reduce the impact of some of these vulnerabilities.

What Can Family Members and Caretakers Do?

Parents must be able and willing to arrange for rigorous supervision, particularly in regard to their children's exposure to sexually provocative media through the Internet, cable television, and videotapes and CDs. To appreciate the importance of close supervision and other interventions, parents often need education and training. Without education and training, parents are also more likely to overestimate their child's competencies and to make the error of interpreting their child's behavior as noncompliant rather than as simply incompetent. After achieving a better understanding of their child, parents are better able to attend to positive behavior and to use praise and reinforcement for increasing their child's compliance. Several effective, evidence-based, and structured parent-training programs teach the principles of behavior management for children who display defiant, externalizing behaviors.

What Can Mental Health Professionals Do?

Comprehensive Evaluations:

"(a) assessment of the aggressive sexual behavior itself; (b) a complete developmental history, including significant pre- and perinatal events (e.g., Minnesota Child Development Inventory); (c) a complete family history regarding diagnosed or suspected problems related to learning, behavior, or psychopathology in blood relatives; (d) parent and teacher ratings of the child's behavior (e.g., Achenbach Child Behavior Checklist or Conners' Rating Scales); (e) a review of school history and records, with particular attention to previously diagnosed learning deficits/disabilities and/or evidence of disruptive school behavior (e.g., evidence of suspensions, expulsions, fighting); (f) an assessment of executive and cognitive function (e.g., Wechsler scales, Continuous Performance Tests, Behavior Rating Inventory of Executive Function); and (g) screening for comorbid psychopathology (e.g., Reynolds Scales [for depression, suicidal ideation, adolescent psychopathology], Beck Inventories [for depression, anxiety, and emotional and social impairment])."

Psychotherapy:

• With older adolescents, individual therapy initially and offense-specific group therapy after the crisis stage has subsided
• Individual cognitive behavior approaches, which might be better for young children or extremely immature adolescents because they allow the youth to be trained to stop and think before acting and he or she might not be cognitively or emotionally ready to do this in a group

School Support:

• Academic and emotional advocacy for the youth with the teachers
• Teacher training on how to respond to the youth's inappropriate sexual and other conduct behaviors

Psychopharmacology

• Psychostimulants?methylphenidate (Ritalin) and dextroamphetamine sulfate (Dexedrine)
• Tricyclic antidepressants?immipramine (Tofranil) and desipramine (Norpramin)
• Serotonin reuptake inhibitors?fluoxetine (Prozac) and sertraline (Zoloft))
• Atypical antidepressants?bupropion (Wellbutrin)
• Mood stabilizers?carbamazepine (Tegretol) and valproic acid (Depakote)