CHILD RAPE & ABUSE
INTELLECTUAL DISABILITY AND CHILD SEXUAL ABUSE: DEVELOPING A TREATMENT PROGRAMME FOR THE INTELLECTUALLY DISABLED OFFENDER

Joan van Niekerk, Childline Family Centre, KwaZulu-Natal Email: joanvn@iafrica.com

Child abuse and intellectual disability has long been a neglected issue in the field of child protection and child abuse. This neglect has been noted in a number of forums by the disability sector. This fact is even more concerning when considered in the light of a number of studies into the incidence of child abuse among disabled children. Around the world these studies have concluded that the disabled child is more vulnerable to abuse – physical, sexual and emotional. This is not surprising considering the more intense and prolonged dependency of the disabled child and the strains and extra pressures on parents and caretakers of disabled children, who not only have to give up their expectations of their child’s “normal” intellectual ability, but also have to come to terms with the possibility of longer term or even permanent dependency on parental care.

In recent training offered to role-players in the criminal justice system, information and limited training has been offered on the management of the child with intellectual disability who has suffered some form of abuse and is a potential witness to that abuse in a criminal justice process. However despite this limited training many role-players find the prospect of working with the disabled abused child daunting – which naturally leads to some reluctance on the part of the Criminal Justice System to take these cases forward.

The lack of adequate response to the abused disabled child and the failure of the criminal justice system to take abuse cases forward to trial leave the child with disability in an even more vulnerable position. It also gives the message to these children themselves, their families, and those who abuse them, that these children are regarded as less valuable and less worthy of society’s interest and protection. It also leaves the offender with the message that abuse of the disabled child can continue with relative impunity.

However even more neglected, both in practice as well as in the literature, both nationally and internationally, is the position of the intellectually disabled offender, child, adolescent and adult.

About five years ago Childline Family Centre in KwaZulu-Natal noted with concern the neglect of this area of practice in the field of child abuse and in order to deal with the problem of child sexual abuse perpetrated by the intellectually impaired, began a pilot programme aimed at the protection of children via improved management of the intellectually disabled offender. There was little assistance and guidance available from literature and research and even less encouragement from many colleagues in the fields of child protection and work with the disabled.

We would like to share with you the learnings from our work with intellectually impaired sexual offenders, their families and caretakers, and also from our work with some of their victims.

What are the possible reasons for this neglect of the intellectually impaired child sex offender?

1. We have no statistical records of the extent of offending by the intellectually disabled. Frequently when reports of sexual offending behaviour against children by the intellectually disabled are made at police stations, the victim’s family are told that nothing can be done because the intellectually disabled person may not be seen as fit/able to stand trial. Reports to police stations may not even be recorded in the station incident book.

2. Often these acts of sexual abuse happen within the family of the intellectually disabled offender or the family circle of close friends. The family may be protective of their disabled family member and therefore reluctant to report. Families are well aware that the intellectually disabled person is indeed more likely to be a target of abuse by the inmates of police and/or prison cells.

3. Generally there is a myth that intellectually disabled persons do not have sexual needs. This blanket denial of the sexuality of disabled persons also contributes to a lack of acceptance that the disabled person could have committed act(s) of sexual abuse that “are really damaging”.

4. Services for assisting corrective behaviour development for the intellectually disabled are generally absent and this prevents the disabled from being involved in programmes aimed at changing behaviour. Many private practitioners in the helping sciences do not accept clients with disability for behaviour change and treatment programmes.

5. Where care of the intellectually disabled person may be transferred to an institution because of the family’s inability to continue to provide care, sexually abusive behaviour will not be reported and will even be concealed as it may exclude the disabled person’s admission to such a care centre.

6. Where the intellectually disabled person has committed the offence within an institution such as a care or training centre for the intellectually disabled, the institution may conceal the offending behaviour as they believe that it may be seen to reflect badly on their care and provision of services.

All of the above conceal the true extent of sexual offending within this category of sexual offenders.

Are there factors that could contribute to the development of sexually offending behaviour in persons with intellectual disability? Would it be true to say that if children with disability are more vulnerable to abuse, are children, adolescents and adults with intellectual disability more vulnerable to developing sexually offensive/abusive behaviour? Frankly because we have no reliable statistics on the extent of sexual offending among the intellectually disabled this question cannot be answered.

However there are some factors that are essential to take into account when considering the question of the possible vulnerability of the intellectually disabled to developing sexually abusive behaviour.

1. Families and caretakers of the intellectually disabled often deny or ignore the sexuality of the intellectually disabled child, adolescent and adult. A consequence of this is that the intellectually disabled child and adult may not receive the appropriate information about their sexual development, sexual needs and therefore develop responsible and acceptable sexual behaviour. Disabled children and adolescents are often left to struggle through the years of sexual awakening and development with little guidance as to how to manage sexual desire and the need for sexual expression in a non-abusive/exploitive way. Clear rules about sexual functioning and behaviour are not established or freely discussed with the child/adolescent or adult.

2. Many intellectually disabled adolescents and adults are sterilised during or after puberty. Some caretakers believe that this reduces sexual desire and deals adequately with the “problem” of the sexual needs of the disabled person. Sometimes these procedures are carried out without discussion with the disabled persons themselves. One can only guess at what these procedures, performed without informed consent, do to the psychological well-being of the intellectually disabled and their sense of control over their own bodies.

3. Institutionalised children, adolescents and adults often find themselves missing the closeness of family life and may seek physical comfort and closeness through sexual behaviour that is unacceptable or abusive. This is true of both intellectually able and disabled people who are in institutional care, but it is possible that the intellectually disabled person may be more likely to sexualise needs for love and affection as they may have more limited opportunities for socialisation and developing appropriate affectionate relationships.

4. When part of a family group, many intellectually disabled persons are often not offered the opportunity to develop close and intimate relationships with others who share similar disabilities, or even with adults without disability. Their opportunities for appropriate sexual expression are thus limited, and yet they have the same need for closeness and emotional and sexual intimacy.

When reviewing the case histories of the intellectually disabled persons referred to Childline Family Centre after committing a sexual offence against a child the following was noted:

1. Many of the offences were committed against children who were approximately at the same intellectual and psycho-social level of functioning as the intellectually disabled offender.

2. The child victims were usually part of the family or part of the family’s social and recreational circle.

3. Where the intellectually disabled offender was in the care of the family, family members, particularly mothers, responded to the abuse with confusion and ambivalent responses. For example the behaviour was often completely denied, or acknowledged in a very limited way. Little encouragement was given to the intellectually disabled person to acknowledge the behaviour. Many family members (appropriately) expressed concern about the safety – both physical and sexual of the disabled person if they were arrested and detained in police cells and prison.

4. Family members frequently expressed the desire to have the offender removed to some sort of institutional care, and expressed concerns about their inability to monitor and supervise the intellectually disabled person’s behaviour on a day to day basis. It must be noted that for many families “parenting fatigue” appeared to be an issue. In families with children without severe disability, parents can look forward to children growing into independence which frees parents from parenting responsibilities and enables them to pursue and enjoy activities without concerns and responsibilities associated with parenting. Parents and caretakers of intellectually disabled adult children frequently expressed the need for an escape from the ongoing responsibility of care.

5. Caregivers of intellectually disabled offenders in institutional or day care, and authorities in charge of these institutions often expressed the desire to have the offender removed from the institution. They expressed concerns about other inmates, especially where children were present in the institution, or concerns about young visitors to other residents in the institution. These concerns should not be regarded as unrealistic.

CHILDLINE FAMILY CENTRE’S RESPONSE TO THE INTELLECTUALLY DISABLED SEXUAL OFFENDER

Staff at Childline identified as a major concern the fact that several children with whom they were working had been abused by intellectually disabled offenders and whose cases were withdrawn from the criminal justice process once their disability became known to the Court. In some instances the offender was referred for a formal assessment process and found unfit to stand trial. Once this decision had been made, charges were withdrawn in Court and then the offender was free to return home and to the community with no consequences attached to their offensive behaviour and no requirement to attend any monitoring and/or treatment programme.

Child victims’ families felt angry and let down by the criminal justice system. Families and communities expressed the sense of being unsafe from further acts of sexual abuse from these persons.

After several instances of the above, staff believed that an attempt should be made to protect the children with whom these offenders might have future contact via adapting the adult sex offenders programme currently used by Childline to address the treatment needs of offenders without disability.

Initially we had little encouragement from colleagues who believed that intellectually disabled adults would not be able to benefit at all from any form of treatment intervention.

THE ASSESSMENT PHASE OF TREATMENT

The Offender

The offenders included in the programme lacked literacy skills and therefore Childline was unable to use the usual assessment tools that assist in identifying treatment potential and needs. The intellectually disabled offenders were thus assessed through clinical interviews with themselves, their families and caretakers, as well as other significant persons, such as teachers, employers and supervisors in sheltered workshops,

This group of offenders used similar defences to offenders without disability to evade responsibility for their behaviour and/ or explain it, For example most of the men/adolescents began with a fixed denial of the sexual offence and sometimes this denial was supported and reinforced by anxious family members. Unlike intellectually able sex offenders, rationalisations around their sexual behaviour tended to be unsophisticated and not well entrenched and often reflected the rationalisations of family members. In fact of great concern were the efforts of family members to minimise the offender’s behaviour and to “excuse” the offender’s behaviour.

Victim empathy was mostly absent – most of the intellectually disabled offenders found it difficult – or even impossible to imagine/understand the impact of their behaviour on the child. Questions around the child and the impact of the sexual act on the child were sometimes evaded.

The offenders also revealed that they had little information about sexuality, appropriate sexual behaviour. They felt embarrassed and uncomfortable talking about any sexual issue, let alone the sexual offence itself. Most embarrassing was the topic of masturbation.

Some offenders viewed their victims as “friends”, and indeed for some the emotional and psychological age of the child victim matched the emotional and psychological age of the offender. On occasion the child victim had been left in the care of the offender.

The offenders appeared socially isolated – although they were exposed to and participated in the social life of the family, none had regular contact with other intellectually disabled adults. The offenders were well aware of their “difference” from other adults and this sense of difference did make them feel isolated and apart.

With one exception the offenders were not employed either in sheltered or open employment. Their daily routines were unstimulating and included watching televisions, wandering around the neighbourhood and sometimes just “sitting around”. Family members made few or no demands in relation to involvement in family chores and tasks. Self-esteem was therefore poor.

Approximately half of the offenders had been engaged in some inappropriate sexual activity and abuse during childhood. Families had found these incidents difficult to deal with and for the most part these incidents had been ignored. Even in the one reported incident of a severe and traumatic rape during childhood, the offender and family reported that the child had been bathed and put to bed without any discussion of what had happened and no reporting to the formal system. The incident had never been mentioned again and yet all family members recalled the incident clearly. The offender when describing the incident wept and obviously still had a deep sense of trauma and hurt even through the incident had occurred 12 years earlier.

The Offender’s Family

Interviews with family members indicated that many of the intellectually disabled offenders struggled to manage anger appropriately. Family members were however reluctant to focus on this as an issue for fear that it would trigger an angry and uncontrolled response from the offender. Families generally appeared unable to assert themselves with the disabled offender as they were anxious about triggering responses that caused some disturbance in the family.

Generally caregivers of the intellectually disabled offenders appeared fatigued with the responsibility of “parenting” and care-giving. Many expressed the need for “a break” or someone/some structure with whom they could share the responsibility of care-taking.

THE PROGRAMME

It was decided to develop a group programme around the treatment needs of the offenders, and supplement this weekly group with individual and family interviews.

It was recognised that the group programme would need to be simple, and should not require literacy skills. Groups would need to be no longer than one hour because of concentration problems experienced by the offenders, and would require clear and simple explanations of concepts and ideas used in the programme.

The themes covered in the programme included:

The importance of being honest about one’s behaviour and taking responsibility for it.

The sexual crime.

The factors that contributed to the sexual crime.

Sexuality – what sexual feelings are, the normality of feeling sexual, responsible sexual behaviour and other aspects of sexuality including masturbation, guilt re sexual feelings, etc.

How to manage sexual feelings, desire and impulses in a socially accepted way.

Self esteem

Getting out socially – the importance of meeting others of one’s own age and disability, activities that were safe and could be enjoyed together or as a group. Social activities – the need for satisfying social contact is discussed and options explored. This is difficult in communities that lack any resources for the intellectually disabled.

Responsibility within the family group – many of the offenders did not take any responsibility in the family group even where the family lived in dire poverty. The use of disability grants was discussed at length as some offenders believed that this money was their sole use and should not be used for any family purpose – not even for board and lodging.

Budgeting

Impulse control – this included learning how to manage anger, frustration, sexual desires and other impulses.

The importance of respecting children and not using them as substitute for adult partnerships.

Getting involved in activities that had value – looking for appropriate employment either in the open labour market or sheltered employment through a workshop.

Managing teasing without withdrawal or loosing ones temper. Many intellectually disabled persons had experienced mocking or teasing which was hurtful and damaging to self-esteem. This contributed to social isolation.

Themes tended to be discussed cyclically and reworked more than once. The themes on anger and sexuality were revisited most frequently and offenders were encouraged to use day-to-day experiences and incidents when re-working these issues.

The offenders began each group with a brief social period, had coffee, tea and some general discussion about themselves and their activities of the previous week. Most group members really enjoyed these opportunities to be social. Social interaction had to be closely monitored for teasing that sometimes went to far. These incidents were always taken into the group session and discussed and the “victim” of the teasing was encouraged to discuss feeling responses. The “aggressors” were encouraged to talk about their feelings and intentions and find alternate and more pro-social ways of interacting with each other. Wherever possible practical and immediate incidents in and outside of the group were used to develop learnings and simple insights into socially adaptive behaviour.

Simple but firm rules of participation were established with the group and for the group and these were very similar to those established for participation in other group programmes at Childline Family Centre. The imposition of the rules during the group sessions had to be constantly attended to – however the group members themselves would assist others in maintaining focus and would reprimand each other for inappropriate/disrespectful language. Maintaining concentration on the group theme was sometimes difficult and the group therapist had to constantly be aware of the need to refocus, allowing enough time for talking about an issue to help the group member who was side-tracking feel part of the group process, but not so much that the theme was lost.

Families were included in the programme on a regular basis in order to inform them of progress, and engage their assistance in facilitating and reinforcing changes in the daily lives and routines of the offenders. Family members were encouraged and supported in developing rules for appropriate behaviour in the home, and also in making reasonable demands of the offender with regard to taking some responsibilities within the home.
Families sometimes had to be helped to be realistic about the capabilities and needs of their intellectually disabled members. Some were reluctant to encourage engagement in certain forms of work. Some feared that any form of independent activity would result in a further sexual offence. Some found it very difficult to give up over-protective monitoring of behaviour and curtailing of activities.
The issue of chemical castration was debated at length with both the offenders and their families. Some offenders and families opted to attempt this as a means of coping with the immediate sexual needs and behaviour of the offender. Some rejected this option outright. For those who used chemical castration, the long term effects caused much concern and even embarrassment. For one offender in particular the feminising result of the medication outweighed the benefit. It must be noted that although the medication dulled sexual desire, it did not remove the offenders’ need for closeness and intimacy. Chemical castration was thus a very limited option for this group.
It must be noted Childline Family Centre came across an instance in a which a school for the intellectually disabled administered chemical castration medication without the permission of the young person concerned and without considering the possible consequences of giving relatively large doses of female hormones to a young sexually acting out adolescent. Given the uncertainty of the positive effects of chemical castration for sexual offenders, as well as the uncertainty around the effects on physical maturation of administering female hormones to adolescent males, Childline staff believe that extreme caution should be applied to this practice.
RESULTS OF THE PROGRAMME

No reoffences were reported by the offenders or their families for the duration of the programme or for a follow up period of a year. However it must be noted that one is dependent on self and family reports for information on the success of the programme.
Family members and offenders also reported other positive changes in behaviour such as greater participation and taking of responsibility in the home. Family members reported more and improved communication on issues at home and felt more comfortable making reasonable demands on their intellectually disabled members.
The offenders and their families noted with concern the lack of resources to assist with the special needs of intellectually disabled adults such as sheltered workshops that would provide some gainful employment, enhance self esteem and a sense of personal value, and facilitate social interaction as well as assist with earning some basic income. The lack of opportunities for meaningful social interaction was also of concern to offenders and families, especially in high risk communities where crimes of violence were common and the intellectually disabled could be considered vulnerable targets.
WHAT NEEDS TO BE DONE/RECOMMENDATIONS

1. There is a need to develop programmes to address the sexual offending behaviour of the intellectually disabled offender. However programmes should take cognizance of the special needs of the disabled person. Existing offender programmes can be simplified, extended and adapted.

2. Programmes should include the caretakers and families of the intellectually disabled offender.

3. The sexual offending behaviour of the intellectually disabled offender needs to be taken seriously and directly addressed. Reports of sexual offences should be accepted at SAPS level and dockets referred for decision to prosecutors who should encourage acceptance of responsibility for the behaviour and participation an appropriate programme, even where prosecutions cannot go forward because of difficulties with the offenders’ ability to stand trial. Perhaps this is an instance in which a diversion process and contract could be utilised.

4. The sexuality of the disabled child and adult should not be ignored. Life skills education should be offered to all children with disability and should include information on responsible management of sexual feelings and impulses.

5. The need of the intellectually disabled for social interaction must be addressed. Families and communities should be encouraged to engage and involve the intellectually disabled in family and community activities.

6. More sheltered employment opportunities need to be developed for the intellectually disabled.

CONCLUSION

Aberrant sexual behaviour of the intellectually disabled person cannot effectively be addressed through a narrow focus on the behaviour itself. The holistic well being of the offender needs to be addressed and therefore responsible management of sexuality needs to occur in the context of improved management of other needs.
Programmes to address sexual behaviour cannot therefore be developed in isolation from other essential programmes. There is a need for workers in the fields of mental health, disability and the employment sector to work co-operatively to minimise the risk of intellectually disabled adults and adolescents developing high risk/ abusive patterns of sexual behaviour via the development of resources that promote the social emotional and psychological well being of the intellectually disabled

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