1. The Development of Sexual Pathology By: Dr. Brad Hedges Dr. Brad Hedges Mid-Ohio Psychological Services Mid-Ohio Psychological Services 624 East Main Street 624 East Main Street Lancaster, Ohio 43130 Lancaster, Ohio 43130 (740) 687-0042 (740) 687-0042 bradhedges@mopsohio.com bradhedges@mopsohio.com bradhedges@mopsohio.com www.bhedges.com/jso

2. WARNINGTV-MA This training is not intended for and should not be attended by immature audiences. The training will contain strong profanity and overt sexual dialogue.

3. Goals  What is abnormal sexual behavior?  Stages of sexual development  Understanding culpability  The etiology of sexual pathology—why they do it

4. What we will not cover  Investigating sexually abusive behavior  How to treat sexually offending behavior  Managing sexual aggression

5. Quiz

6. What is “abnormal” sexual behavior?  Statistical norm?  Community standard?  DSM IV?  Personal value?  Legal Definition?

7. What is the legal definition of sexual abuse?  Prong 1— Touching of the erogenous zone Touching of the erogenous zone  Prong 2— By force/or threat of force/or by substantially impairing By force/or threat of force/or by substantially impairing Or for persons under 18, for the purpose of arousing one or both parties Or for persons under 18, for the purpose of arousing one or both parties

8. Some Numbers  1 in 3 Females and 1 in 5 Males will be sexually abused.  The vast majority of sexual offenses are committed by friends of the family or family members.  Approximately 30% of all sexual offenses are committed by persons under the age of 18. 20% of Rapes and 50% of Molestations 20% of Rapes and 50% of Molestations 7-13% of Juvenile Offenders commit offenses as adults 7-13% of Juvenile Offenders commit offenses as adults Most Juvenile Sexual Offenses occur between 4:00 and 6:00 pm Most Juvenile Sexual Offenses occur between 4:00 and 6:00 pm

9. Some More Numbers  2% of the general population commit sexual offenses  You are about 10 times more likely to be sexually assaulted by someone that has not previously been identified as a sexual offender as someone who has been identified.  What is the recidivism rate for sexual offenders?

10. Recidivism Base Rates

11. From Victim Stats to Offender Stats

12. Distribution of sexual behavior Sexual Offense Offensive Awkward/Pressured Normal

13. Local Numbers  Total population of 58,398 (2005 est.)  Estimated 12,900 Victims of Sexual Abuse  Estimated 1,150 “Offenders”  At least 140 “Juvenile Sexual Offenders”

14. Who are offenders?  Are they Male/Female?  Are they Young or Old?  What is their IQ?  Are they Rich/Poor?  Are they from certain cultural groups?

15. Offenders should be thought of:  Developmentally  Individually  Contextually

16. Exercise: What is “normal” sexual behavior?  What is the developmental task of this age group?  What is the normal overt sexual behavior for this age?  What do they do in secret?

17. What is Normal Sexual Development?

22. What is Normal Sexual Development? (cont.)

27. How do they become deviant? Time Sexual Development Normal

28. How do they become deviant? Time Sexual Development Normal Deviation

29. How do they become deviant? Time Sexual Development Normal Deviation

30. Etiology of Sexual Deviancy Biological Issues Personality Characteristics Developmental Issues Environmental Issues ABUSE Preconditions © 1991 Bradley A. Hedges Hormonal Imbalances Brain Structure Problems Appearance Issues Traumatic Events Family of Origin Structure Deviation from “Normal Sexual Development” Aggression Socialization Addiction Life Stressors Substance Abuse Rejection Other Motivation for Abuse Internal Inhibitors Access to Victims Overcome Victim Resistance

31. Circumplex Model Chaotic Rigid EnmeshedDisengaged David Olson, Candyce Russell, Douglas Sprenkle, 1979

32. Culpability culpable Pronunciation: \’kəl-pə-bəl\ Function: adjective Etymology: Middle English coupable, from Anglo- French cupable, culpable, from Latin culpabilis, from culpare to blame, from culpa guilt 1archaic : guilty criminal 2: meriting condemnation or blame especially as wrong or harmful 2: meriting condemnation or blame especially as wrong or harmful synonyms see blameworthy

33. Culpability  Criminally responsible  Able to appreciate the wrongful nature of the crime at the time of the alleged offense

34. Culpability  Mental Culpability  Physical Culpability  Sexual Culpability

35. Culpability  Mental Culpability Intelligence Intelligence Developmental Status Developmental Status Moral Development Moral Development Amount of planning/grooming used Amount of planning/grooming used Previous condemnation for behavior Previous condemnation for behavior Absence of inhibitors Absence of inhibitors Adapted from Jan Hindman

36. Culpability (cont.)  Physical Culpability Size Difference Size Difference Amount of Force/Coercion Used Amount of Force/Coercion Used Number of Contacts Number of Contacts  Sexual Culpability Sexual Knowledge Sexual Knowledge Personal Victimization Personal Victimization Sexual Behavior Experience Sexual Behavior Experience Variety of Sexual Behavior With “Contact” Variety of Sexual Behavior With “Contact” Adapted from Jan Hindman

37. Evaluating the Sexual Behavior of Children  Read each case as a group  Apply concept of culpability  Review range of sexual behavior  Decide if Normative/Concern/Abusive

38. When to report? [§ 2151.42.1] § 2151.421. Duty to report child abuse or neglect; investigation and follow up procedures. (A) (1) (a) No person described in division (A)(1)(b) of this section who is acting in an official or professional capacity and knows, or has reasonable cause to suspect based on facts that would cause a reasonable person in a similar position to suspect, that a child under eighteen years of age or a mentally retarded, developmentally disabled, or physically impaired child under twenty- one years of age has suffered or faces a threat of suffering any physical or mental wound, injury, disability, or condition of a nature that reasonably indicates abuse or neglect of the child shall fail to immediately report that knowledge or reasonable cause to suspect to the entity or persons specified in this division.

39. Who do you report it to? Except as provided in section 5120.173 [5120.17.3] of the Revised Code, the person making the report shall make it to the public children services agency or a municipal or county peace officer in the county in which the child resides or in which the abuse or neglect is occurring or has occurred. In the circumstances described in section 5120.173 [5120.17.3] of the Revised Code, the person making the report shall make it to the entity specified in that section. Except as provided in section 5120.173 [5120.17.3] of the Revised Code, the person making the report shall make it to the public children services agency or a municipal or county peace officer in the county in which the child resides or in which the abuse or neglect is occurring or has occurred. In the circumstances described in section 5120.173 [5120.17.3] of the Revised Code, the person making the report shall make it to the entity specified in that section. section 5120.173section 5120.173section 5120.173section 5120.173

40. Who has to report? (b) Division (A)(1)(a) of this section applies to any person who is an attorney; physician, including a hospital intern or resident; dentist; podiatrist; practitioner of a limited branch of medicine as specified in section 4731.15 of the Revised Code; registered nurse; licensed practical nurse; visiting nurse; other health care professional; licensed psychologist; licensed school psychologist; independent marriage and family therapist or marriage and family therapist; speech pathologist or audiologist; coroner; administrator or employee of a child day-care center; administrator or employee of a residential camp or child day camp; administrator or employee of a certified child care agency or other public or private children services agency; school teacher; school employee; school authority; person engaged in social work or the practice of professional counseling; agent of a county humane society; person, other than a cleric, rendering spiritual treatment through prayer in accordance with the tenets of a well-recognized religion; superintendent, board member, or employee of a county board of mental retardation; investigative agent contracted with by a county board of mental retardation; employee of the department of mental retardation and developmental disabilities; employee of a facility or home that provides respite care in accordance with section 5123.171 [5123.17.1] of the Revised Code; employee of a home health agency; employee of an entity that provides homemaker services; a person performing the duties of an assessor pursuant to Chapter 3107. or 5103. of the Revised Code; or third party employed by a public children services agency to assist in providing child or family related services. section 4731.15section 5123.171Chapter 3107.section 4731.15section 5123.171Chapter 3107.

41. How do you report? C) Any report made pursuant to division (A) or (B) of this section shall be made forthwith either by telephone or in person and shall be followed by a written report, if requested by the receiving agency or officer.

42. What do you report? The written report shall contain: The written report shall contain: (1) The names and addresses of the child and the child's parents or the person or persons having custody of the child, if known; (1) The names and addresses of the child and the child's parents or the person or persons having custody of the child, if known; (2) The child's age and the nature and extent of the child's injuries, abuse, or neglect that is known or reasonably suspected or believed, as applicable, to have occurred or of the threat of injury, abuse, or neglect that is known or reasonably suspected or believed, as applicable, to exist, including any evidence of previous injuries, abuse, or neglect; (2) The child's age and the nature and extent of the child's injuries, abuse, or neglect that is known or reasonably suspected or believed, as applicable, to have occurred or of the threat of injury, abuse, or neglect that is known or reasonably suspected or believed, as applicable, to exist, including any evidence of previous injuries, abuse, or neglect; (3) Any other information that might be helpful in establishing the cause of the injury, abuse, or neglect that is known or reasonably suspected or believed, as applicable, to have occurred or of the threat of injury, abuse, or neglect that is known or reasonably suspected or believed, as applicable, to exist. (3) Any other information that might be helpful in establishing the cause of the injury, abuse, or neglect that is known or reasonably suspected or believed, as applicable, to have occurred or of the threat of injury, abuse, or neglect that is known or reasonably suspected or believed, as applicable, to exist.

43. What happens if I don’t report?  Possible Criminal Prosecution  Possible Civil Prosecution  Possible Administrative Action

44. General Guidelines on Reporting  Follow agency administrative procedures on reporting.  If in doubt (reasonable standard/in good faith), report it, don’t try to investigate it.  Call Children Services immediately (not enough to report to administration)/don’t call the family  Document that you made the call (who did you speak with, what did you tell them, when)  Report multiple times only if you have additional information  Don’t expect to know what came of the investigation.

45. Exercise  Apply concepts discussed today--  Why did Carl do it?

46. The Development of Sexual Pathology By: Dr. Brad Hedges Dr. Brad Hedges Mid-Ohio Psychological Services Mid-Ohio Psychological Services 624 East Main Street 624 East Main Street Lancaster, Ohio 43130 Lancaster, Ohio 43130 (740) 687-0042 (740) 687-0042 bradhedges@mopsohio.com bradhedges@mopsohio.com bradhedges@mopsohio.com www.bhedges.com/jso