63 Sexual abuse of children

Transcription

1 63 Sexual abuse of children by Dr Kerry Geritz MAPS, D Psych (Forensic), B Psych Sci (Hons) Dr Scott Harden MBBS (UQ), FRANZCP Cert Child Psych, MAICD Professor Louise Newman AM, BA(Hons), MBBS(Hons), PhD FRANZCP, Cert. Child Psych, RANZCP 63-1 Update: 62

2 EXPERT EVIDENCE Author information Kerry Geritz is an Endorsed Forensic Psychologist with the Australian Health Practitioner Regulation Agency and a member of the College of Forensic Psychology through the Australian Psychological Society. Kerry currently works with the Child and Youth Forensic Outreach Service, Child and Youth Mental Health Service, Children s Health Services Queensland in a senior position. This is a specialist forensic service offering an integrated consultation-liaison, mobile assessment and intervention service targeting children and young people with mental health issues who are involved with, or at risk of involvement in, the juvenile justice system. Part of her role in this service is to conduct comprehensive assessments on young people engaging in problematic sexualised behaviours as well as providing psychological interventions to this group of young people. Kerry has also delivered training packages to key stakeholders regarding young people who engage in problematic behaviours including inappropriate sexualised behaviours, arson and violence and has done this on both a local and international level. Kerry has also previously worked with those admitted into secure forensic in-patient settings, delivering both group and individual interventions as well as completing comprehensive psychological assessments. Kerry has also provided specialist psychological services in the private sector for the Family and Criminal Courts and for the Department of Child Safety and Department of Communities. Kerry s doctoral thesis looked at factors that predict confessions and denials amongst sex offenders, a joint project with the Queensland Police Service and Griffith University. Kerry is also currently involved in a number of research projects focusing on a number of anti-social behaviours carried out by youth including fire-setting, animal cruelty and sexualised behaviours. Dr Geritz may be contacted at: Kerry_Geritz@health.qld.gov.au Scott Harden is a contributing author on child sex offenders. Scott is a psychiatrist with interests and practice in child, adolescent and adult forensic and clinical psychiatry. He has been in private clinical practice since 2000 with particular clinical interests in attention deficit hyperactivity disorder and anxiety disorders. He has a busy private forensic and medicolegal psychiatric practice with cases in the family court, criminal, child protection, juvenile justice, civil and dangerous sex offender areas of practice. Scott is a visiting senior psychiatrist at the Child and Youth Forensic Outreach Service, Child and Youth Mental Health Service, Children s Health Services Queensland. Scott sits on Medical Assessment Tribunals for the Queensland workers compensation regulatory authority. Scott has developed a preoccupation with advancing the specialised area of child and adolescent forensic psychiatry and mental health within Australia and New Zealand. To this end he has run conferences in this area in 2009 and He has also run courses in association with the Queensland Bar Association for psychiatrists and barristers and been an invited Speaker for the Queensland Law Society and the Queensland Family Law Practitioners Association. He initiated and runs two peer review groups for psychiatrists, one in forensic child and adolescent psychiatry and the 63-2 Expert Evidence

3 other for psychiatrists involved in the assessment of individuals under the dangerous sex offenders legislation. He was a founding member of the Child Protection Practitioners Association of Queensland. Scott has had a long and extensive involvement with the Royal Australian and New Zealand College of Psychiatrists including membership of the Queensland branch committee, active involvement in the management of the child and adolescent psychiatry faculty over many years and in recent years on the General Council of the College (governing body) and the governance and risk subcommittee of this council. Scott has interests in quality and safety, particularly with regard to medicolegal reporting and the court evidence of experts, organisational governance and sexual behaviour across the human lifespan. He has some involvement in research. Dr Harden may be contacted at: Amicus Medical Chambers PO Box 527 ASHGROVE QLD 4060 AUSTRALIA Telephone: scott@amicusmedical.com.au Louise Newman is the Professor of Developmental Psychiatry and Director of the Monash University Centre for Developmental Psychiatry & Psychology. Prior to this appointment she was the Chair of Perinatal and Infant Psychiatry at the University of Newcastle and the previous Director of the New South Wales Institute of Psychiatry. In January 2011 she was appointed as a Member in the General Division of the Order of Australia. Louise is a practising infant psychiatrist with expertise in the area of disorders of early parenting and attachment difficulties in infants. She has undertaken research into the issues confronting parents with histories of early trauma and neglect. Her current research is focusing on the evaluation of infant-parent interventions in high-risk populations, the concept of parental reflective functioning in mothers with borderline personality disorder and the neurobiology of parenting disturbance Louise has published in the areas of infant mental health, attachment disorders trauma, and prevention of child abuse. She is co-author of the textbook Clinical Skills in Infant Mental Health and the forthcoming Contemporary Approaches in Child and Adolescent Mental health. Louise is the Convenor of the Alliance of Health Professions for Asylum Seekers and an advocate for the rights of asylum seekers and refugees. She is the Chair of the Detention Expert Health Advisory Group an independent body providing advice to the Department of Immigration and Citizenship on the heath needs of asylum seekers. She has been involved in research into the impact of immigration detention on child asylum seekers. Professor Newman may be contacted at: Centre for Developmental Psychiatry & Psychology C/- ELMHS Monash Medical Centre 63-3 Update: 62

4 EXPERT EVIDENCE 246 Clayton Road CLAYTON VIC 3168 AUSTRALIA Chapter 63 K Geritz, S Harden and L Newman Published with permission of the authors 63-4 Expert Evidence

5 TABLE OF CONTENTS INTRODUCTION... [63.100] Developmental and psychological impact of child sexual abuse... [63.100] Child sex offenders... [63.120] DEVELOPMENTAL AND PSYCHOLOGICAL IMPACT OF CHILD SEXUAL ABUSE... [63.140] Definitions... [63.140] Prevalence of abuse... [63.160] Abusive families... [63.180] Implications of being abused as a child... [63.200] Presentations by abused children... [63.220] Mental disorders commonly diagnosed in abused children... [63.240] Child abuse and neglect and the brain... [63.260] Child neglect... [63.280] Long term outcomes... [63.300] Memory and the child witness... [63.320] Interviewing of child victims of alleged abuse... [63.340] PAEDOPHILIC CHILD SEX OFFENDERS... [63.440] Aetiological theories... [63.460] Conditioning... [63.480] Childhood sexual abuse... [63.500] Neurodevelopmental disorder... [63.520] Descriptive characteristics... [63.540] Assessment... [63.560] Unstructured clinical judgements... [63.580] Actuarial risk assessments... [63.600] Structured professional judgements... [63.700] Treatment... [63.760] History of psychological interventions... [63.780] Psychological treatment models... [63.800] Biological treatments... [63.860] Recidivism... [63.880] NON PAEDOPHILIC CHILD SEX OFFENDERS... [ ] Aetiological theories... [ ] Descriptive statistics... [ ] Assessment... [ ] Treatment... [ ] Recidivism... [ ] SPECIAL POPULATIONS... [ ] Females... [ ] Male coerced... [ ] Predisposed... [ ] Teacher/lover... [ ] Clergy and professionals... [ ] Intrapersonal factors... [ ] Interpersonal factors... [ ] Systematic factors... [ ] Adolescents... [ ] Psychosocial deficits... [ ] General delinquency and conduct problems... [ ] Paedophilic interests... [ ] Co-occurring mental health disorder... [ ] Recidivism... [ ] The elderly... [ ] Child sex offenders with an intellectual impairment... [ ] Counterfeit deviance... [ ] Deviant interests and lack of discrimination... [ ] Sexual abuse... [ ] 63-5 Update: 62

6 EXPERT EVIDENCE Personality characteristics and impulsivity... [ ] Mental illness... [ ] Internet mediated offences... [ ] Accidental or curious viewers... [ ] Internet child pornography offenders... [ ] Those who create and upload child pornographic images... [ ] Those using the internet to procure victims to commit contact offences... [ ] QUALIFICATIONS OF EXPERTS... [ ] SPECIAL LEGAL CONTEXTS... [ ] Family Court... [ ] Civil Damages... [ ] Continuing Detention Legislation... [ ] [The next text page is ] 63-6 Expert Evidence

7 INTRODUCTION Developmental and psychological impact of child sexual abuse [63.100] Child maltreatment, sometimes referred to as child abuse and neglect, includes all forms of physical and emotional ill-treatment, sexual abuse, neglect and exploitation that results in actual or potential harm to the child s health, development, or dignity. (World Health Organisation, 2006). Child maltreatment occurs in the context of a relationship of responsibility, trust or power and reflects a fundamental exploitation of this relationship. Commonly, five types of child maltreatment can be defined physical abuse, sexual abuse, neglect and negligent treatment, emotional abuse, and exploitation. Maltreated children frequently experience a range of risk factors that adversely affect their psychological and emotional development. These risk factors include family conflict and exposure to domestic violence, parental substance abuse and mental health problems and social adversity. In all cases of intra-familial abuse, children experience a breakdown of normative attachment relationships and the basic functions of care and protection. This impact on attachment security and the child s developing understanding of relationships can have long-term deleterious effects on development and later functioning; for example in adult interpersonal relationships and intimacy. This chapter will focus on the sexual abuse of children; however this also involves psychological and emotional abuse and often exploitation. The context in which sexual abuse occurs, the relationship of the child to the perpetrator and the response of the social environment to any disclosure of abuse are crucial factors in influencing the outcome for the child. These outcomes both as a child and later as an adult are described below. Child sex offenders [63.120] When legal practitioners and judicial decision-makers encounter individuals in the legal system who have committed sexual offences against children they are eager for data and expert opinion that helps them to answer critical questions. These questions are: What chance is there that this person will commit a further sexual offence against children? Who can accurately assess this risk? Can sex offenders be treated or can the risk they pose change? And, Are there people who will not improve and who will remain a high risk to the community? Unsurprisingly these straightforward questions remain difficult to answer. There is an ongoing explosion of research regarding people who commit sex offences against children; however, results can appear (or be) contradictory and require interpretation. Even common sense Update: 62

8 [63.120] EXPERT EVIDENCE assumptions regarding this group of individuals have at times been demonstrated to be completely untrue when appropriate research has been undertaken. The most surprising fact for those new to the field is that individuals who commit sexual offences against children do not necessarily have a sexual preference for children. Similarly, not all paedophiles (individuals with a sexual preference for prepubertal children) have perpetrated sexual acts on children. The distinction between paedophilic and non-paedophilic child sexual offenders is important as they not only differ in their level of risk of reoffending in the future, but the role of a sexual preference for children has implications for treatment interventions and management strategies to prevent further sexual offences (Seto 2008). Both types are described below, followed by information on other special subgroups of child sex offenders including women, the clergy, adolescents, the elderly, the intellectually impaired and those convicted of internet child pornography offences. This chapter will then describe issues around the qualification of experts to assess and treat such individuals and lastly some issues arising in particular legal contexts such as ongoing detention following completion of sentence, allegations of child sexual abuse in the family court, and applications for damages in civil court proceedings. This area of practice is bedevilled by issues of terminology but so far as practicable we will use terms in a scientifically or clinically applicable sense. [The next text page is ] Expert Evidence