Early exposure to abuse, neglect, and household dysfunction is linked to long-term detrimental effects on mental and physical health. In the mid-1990s, Kaiser Permanente and the CDC surveyed adults in the community and found a strong and cumulative relationship between the degree of exposure to adverse childhood experiences (ACEs) and risk factors for leading causes of death in adulthood. At present, most research using ACE survey methodology examines community-based adult samples, and populations who experience the greatest number of adversities are largely ignored. An additional factor indicative of household dysfunction that has not been thoroughly explored in the context of ACE survey methodology is foster care placement. Further, little is understood regarding the impact of out-of-home placement on persons with disproportionately high ACE scores and subsequent difficulties with sexual and aggressive behavior. Studies investigating differential risk factors and outcomes could inform prevention, policy, and treatment. As such, the current study seeks to investigate the impact of childhood adversity and out-ofhome placement on the onset of aggression and problem sexual behavior using ACE survey methodology in a sample of juveniles receiving residential treatment for sexual misconduct. Data for this study were collected from archival records of children and adolescents who have received sexual offender treatment at a treatment center for male youth (N=120; 88% Caucasian) for periods ranging from one month to more than four years (M=13.68 months, SD=10.96). These participants have a mean age of 14.63 years (SD=1.56; Range: 11 to 17 years) at the time of first admission into the facility. As expected, the adolescents in this study have experienced higher rates of adverse childhood experiences than the general adult population and male adolescents involved in the juvenile justice system previously reported in the literature. Only 2.5% of the current sample experienced no ACEs and 74.2% faced four or more adversities, which is considered to be high risk in the literature. Participants had a mean age at first out-of-home placement of 9 years (SD=5.21) and had an average of 3.7 out-of-home placements at time of admission to the facility. The association of childhood adversities, the number of non-psychiatric out-of-home placements, and age at first out-of-home placement with earlier onset of aggressive and sexual offending behaviors will be investigated using Cox proportional hazard analyses. Behavioral outcomes (e.g., onset of sexual and aggressive behavior problems; substance use; arrest history; and, treatment length) between individuals who were placed in family members’ homes versus those placed in non-familial foster care will also be explored. Implications for prevention and environmental responsiveness will be addressed.

Early exposure to abuse, neglect, and household dysfunction is linked to long-term detrimental effects on mental and physical health. In the mid-1990s, Kaiser Permanente and the CDC surveyed adults in the community and found a strong and cumulative relationship between the degree of exposure to adverse childhood experiences (ACEs) and risk factors for leading causes of death in adulthood. At present, most research using ACE survey methodology examines community-based adult samples, and populations who experience the greatest number of adversities are largely ignored. An additional factor indicative of household dysfunction that has not been thoroughly explored in the context of ACE survey methodology is foster care placement. Further, little is understood regarding the impact of out-of-home placement on persons with disproportionately high ACE scores and subsequent difficulties with sexual and aggressive behavior. Studies investigating differential risk factors and outcomes could inform prevention, policy, and treatment. As such, the current study seeks to investigate the impact of childhood adversity and out-of- home placement on the onset of aggression and problem sexual behavior using ACE survey methodology in a sample of juveniles receiving residential treatment for sexual misconduct. Data for this study were collected from archival records of children and adolescents who have received sexual offender treatment at a treatment center for male youth (N=120; 88% Caucasian) for periods ranging from one month to more than four years (M=13.68 months, SD=10.96). These participants have a mean age of 14.63 years (SD=1.56; Range: 11 to 17 years) at the time of first admission into the facility. As expected, the adolescents in this study have experienced higher rates of adverse childhood experiences than the general adult population and male adolescents involved in the juvenile justice system previously reported in the literature. Only 2.5% of the current sample experienced no ACEs and 74.2% faced four or more adversities, which is considered to be high risk in the literature. Participants had a mean age at first out-of-home placement of 9 years (SD=5.21) and had an average of 3.7 out-of-home placements at time of admission to the facility. The association of childhood adversities, the number of non-psychiatric out-of-home placements, and age at first out-of-home placement with earlier onset of aggressive and sexual offending behaviors will be investigated using Cox proportional hazard analyses. Behavioral outcomes (e.g., onset of sexual and aggressive behavior problems; substance use; arrest history; and, treatment length) between individuals who were placed in family members’ homes versus those placed in non-familial foster care will also be explored. Implications for prevention and environmental responsiveness will be addressed.

Youth, between the ages of 12 and 17, account for the majority of sexual assaults in the United States. Counselors who work with youth with problem sexual behaviors need to have appropriate clinical skills to the degree to which clinical services increase the probability of effective results and are consistent with current professional knowledge. The purpose of this transcendental phenomenological study was to explore the lived experiences of counselors who work with youth with problem sexual behaviors. A purposeful sample of 8 licensed professional clinical counselors employed at a mental health agency in one city in Ohio shared their experiences through semi structured, in-person interviews in their natural settings. The data were collected, transcribed and analyzed using NVivo. The analysis of data conducted through horizontialzation, cluster of meanings, and coding for emergent themes. Transcendental phenomenological approach helped to uncover dominant and influential emotions, which counselors identified as frustration, tension, anger, and fear. The findings for this study revealed that self-care strategies reaffirmed their importance in wellness for appropriate job performance. Furthermore, the participants felt their school program was successful in teaching on various theories however, they indicated a need for more training in working effectively with this specific population. Academic institutions and mental health programs can use the results of this study to amend certification areas on the requirements and clinical skills necessary for counselors working with youth with problem sexual behaviors.

Persons with traumatic brain injuries (TBI) who have engaged in problematic or illegal sexual behavior present with complex assessment and intervention needs yet remain understudied within the empirical literature. In the current exploratory analysis, important differences in adaptive and clinical functioning, adverse childhood experiences, and criminal offense history are examined in 25 persons with previous brain injury, 118 persons with intellectual disability but no known TBI, and 103 persons with no history of brain injury or intellectual disability, all of whom have engaged in problematic sexual behavior and who were residing in secure forensic inpatient care. Group differences were examined using comparisons of means and chi-squares. Results highlight important differences in education and employment experiences, diagnostic presentation, exposure to childhood maltreatment, and justice system involvement and characteristics of their sexual offense victims. Associations with prior literature and future research directions are discussed.

Résumé : En protection de la jeunesse, les enfants ayant des comportements sexuels problématiques (CSP) suscitent l’incompréhension des intervenants et provoquent de l’inquiétude en raison des torts qu’ils peuvent causer. Prenant appui sur un modèle explicatif, cette étude visait à identifier les facteurs qui distinguent les enfants présentant des CSP des autres enfants pris en charge en protection de la jeunesse. Des analyses secondaires ont été réalisées à partir des données de l’Étude d’incidence québécoise de 2008 sur les situations évaluées en protection de la jeunesse. L’échantillon comprenait 1020 enfants ayant fait l’objet d’un signalement retenu et fondé. Les enfants avec CSP (n = 72) ont été comparés aux enfants sans CSP (n = 948) sur un ensemble de variables personnelles et familiales au moyen d’analyses univariées, puis multivariées. Le modèle final de régression logistique révèle que les enfants avec CSP sont plus susceptibles de manifester une variété de problèmes de fonctionnement, d’avoir fait l’objet d’un signalement fondé pour agression sexuelle et d’avoir un parent qui a vécu un placement dans l’enfance. À l’inverse, ils sont moins susceptibles d’avoir fait l’objet d’un signalement fondé pour mauvais traitements psychologiques. La discussion traite de l’implication des résultats pour l’intervention en contexte de protection. / Abstract : Sexual behavior problems (SBP) generate a lack of understanding from child protective services workers and is a source of concern as they can potentially harm children. Based upon an exploratory model, this study aimed to identify the factors differentiating children with SBP from other children cared for by protective services. Secondary analysis were realised with data obtained from the Étude d’incidence québécoise, with a sample of 1020 children aged from 2 to 12 years old and the subject of a substantiated report to the child protective services. Children with SBP (n = 72) were compared to children without SBP (n = 948) on several personal and familial variables using univariate, then multivariate analysis. The final model of the logistic regression reveals that children with SBP are more likely to show a variety of functioning problems, as well as more likely to be reported for sexual abuse and having a parent who has been the subject of a placement episode during his youth. Conversely, they are less likely to be reported for psychological maltreatment. The discussion covers the results implication for psychosocial intervention in a protective services context.

L’émergence de la sexualité chez certains enfants peut se faire de façon inquiétante. C’est le cas lorsqu’ils présentent des comportements sexuels problématiques (CSP) envers d’autres enfants et que ces comportements sont caractérisés par la présence d’indices de sévérité comme la coercition, la persistance malgré les interventions et lorsqu’ils causent de la détresse émotionnelle, etc. Parmi d’autres, la littérature scientifique soutient que deux facteurs représentent des défisimportants : 1) la présence de difficultés concomitantes; 2) la mobilisation dans l’intervention qui se manifeste par un taux d’attrition élevé. Toutefois, peu d’études ont porté sur les dimensions qui évoluent dans le cadre d’une intervention spécialisée, particulièrement sur les autres difficultés qui se manifestent souvent chez ces enfants de façon concomitante. Ainsi, considérant les différentes difficultés vécues par ces enfants, il apparait important de noter si elles diminuent en intensité, tout comme les CSP, à la suite de la psychothérapie. De surcroît, considérant le taux d’attrition élevé dans les programmes destinés aux jeunes en difficulté, il s’avère pertinent de comprendre quels éléments sont susceptibles de prédire la non-complétion. La présente étude vise trois principaux objectifs : 1) décrire l’échantillon étudié, de même que les difficultés vécues par les enfants se manifestant en parallèle à leurs CSP ; 2) évaluer si les CSP et les difficultés concomitantes diffèrent à la suite de la thérapie ; 3) identifier les facteurs associés à la non-complétion de la psychothérapie. Cette recherche permet donc d’avoir une vision plus globale des différences entre le début et la fin de la thérapie quant aux difficultés éprouvées par ces enfants provenant de milieux variés. Elle permet également d’avoir une compréhension plus approfondie des enfants, mais plus globalement des familles qui ne complètent pas la thérapie leur étant destinée. L’échantillon initial est composé de 67 dyades parents-enfants référées dans un service de psychothérapie spécialisée en CSP. La psychothérapie adoptée étant d’approche cognitive comportementale, elle impliquait la participation d’une figure parentale et visait la gestion des CSP et la communication parent-enfant. Ces dyades ont été évaluées selon un devis à deux temps de mesure, impliquant des entrevues individuelles avant et après la psychothérapie. Les enfants, de même que les parents ont rempli différents questionnaires standardisés, portant notamment sur le développement de l’enfant et sur son comportement. Les résultats de la recherche révèlent des effets bénéfiques de la psychothérapie. Les enfants qui complètent la psychothérapie vivent davantage en situation de placement et ne sont pas accompagnés d’un parent biologique lors des rencontres, en comparaison à ceux qui ne la complètent pas. Aucune variable retenue dans la présente étude ne permet toutefois de prédire la non-complétion de la thérapie. Ces résultats sont discutés en considérant les implications pour la recherche et les interventions. / Sexual development can be worrisome in certain children, in particular when sexual behavior problems toward others are manifested. Such behaviors are characterized by the presence of severity indexes such as coercion, emotional distress, persistence despite interventions, etc. Among others, the scientific literature highlights two important challenges in children with SBP: 1) the presence of concomitant difficulties; 2) mobilization during the intervention as manifested by a high dropout rate. However, few studies have examined the outcomes of specialized intervention on difficulties manifested in conjunction to SBP. Considering the variety of concomitant difficulties experienced by these children, it seems important to assess the influence of psychotherapy on the intensity of these problems. Moreover, given the high rate of attrition in intervention behavior problems in children, it is important to understand the factors that might predict dropout. The aim of this study is : 1) to describe the sample, as well as difficulties that are manifested in conjunction to SBP; 2) assess changes in SBP as well as in other difficulties after psychotherapy (internalizing and externalizing behaviors problems, post-traumatic symptoms, dissociation, self-esteem, depression, anxiety and social problems); 3) to identify factors associated with the dropout of psychotherapy. This research provides a more holistic comprehension of the differences between the beginning and the end of therapy with respect to the difficulties experienced by children with SBP, which are coming from a variety of backgrounds. It also allows for a deeper understanding of those children, but more generally their families who do not complete the therapy. The initial sample is composed of 67 parent-child dyads referred to a specialized cognitive behavioral psychotherapy for children with SBP. The psychotherapy required the participation of a parental figure and aimed the management of SBP as well as parent-child communication. Data were obtained during individual interview prior and post psychotherapy. The children as well as the parents both completed different standardized questionnaires, regarding the child’s development and his behavior. The results of the research indicate beneficial effects of psychotherapy on SBP and on other indicators of distress. Furthermore, the study has shown that children who complete psychotherapy are more likely to live in foster homes and to be accompanied by their biological parents when attending appointments as compared to those who drop out. However, no variables used in this study predict dropout during psychotherapy. These results are discussed while considering the implications for research and practice.

Le développement de comportements sexuels problématiques (CSP) pendant l’enfance est un sujet de plus en plus étudié. Les chercheurs et les cliniciens ont souvent fait référence à l’agression sexuelle (AS) pour l’expliquer. Bien que le lien entre les CSP et l’AS soit bien documenté dans la littérature scientifique, il reste que la présence de CSP semble liée à plusieurs autres facteurs. Les auteurs s’intéressent de plus en plus à la relation entre les CSP et l’exposition à d’autres types de victimisation, incluant la maltraitance. La cooccurrence de différentes formes de victimisation s’avère donc être un angle important à explorer, en raison de sa relation avec différents indices de détresse psychologique incluant les comportements extériorisés. Objectif. L’objectif principal de ce mémoire est d’identifier les facteurs qui permettent d’estimer la probabilité qu’un enfant victime d’agression sexuelle (VAS) présente des CSP. Méthode. L’échantillon est composé de 372 enfants VAS (M âge enfant = 9,4 ans ; É-T = 2,2 ; 32,3% garçons) ayant fait l’objet d’une évaluation des besoins, dans un centre de services d’intervention spécialisés entre 2007 et 2016. Des analyses bivariées (chi-carré, anova, U de Mann-Whitney) et un modèle d’analyse de régression logistique hiérarchique ont été réalisés. Résultats. Les résultats des analyses bivariées révèlent que les enfants VAS manifestant des CSP se distinguent des enfants VAS n’ayant pas de CSP sur plusieurs variables : ils présentent plus de symptômes de dissociation, de dépression et d’anxiété; ils ont une plus faible estime de soi; ils perçoivent aussi recevoir moins de soutien à la suite de l’AS et présentent davantage des troubles de comportement extériorisés, de même que des stratégies de résolution de problème extériorisées; ils sont aussi plus souvent polyvictimes, ils sont notamment plus souvent exposés à la violence conjugale, plus susceptibles de vivre de la violence psychologique et d’avoir vécu une AS plus grave. Alors qu’ils reçoivent des services pour leur victimisation sexuelle; ils sont aussi plus susceptibles d’avoir un dossier actif en vertu de la Loi de la Protection de la Jeunesse (LPJ), ils vivent plus de placements, puis une médication leur est plus souvent prescrite. Lorsque l’ensemble de ces variables est considéré dans le modèle de régression logistique, l’analyse révèle que les facteurs suivants augmentent la probabilité qu’un enfant VAS présente des CSP : être un garçon (2,2 fois plus de risque), avoir une médication prescrite (2,2 fois plus de risque) et présenter un niveau de dissociation atteignant le seuil clinique (2,5 fois plus de risque). À l’inverse, la perception d’avoir reçu du soutien à la suite de l’AS diminue le risque que l’enfant VAS présente des CSP (0,8 fois moins de risque). Conclusion. Les résultats révèlent que l’apparition de CSP chez les enfants VAS semble liée à une accumulation de facteurs de vulnérabilité parmi lesquels la détresse psychologique (médication, dissociation) et la victimisation s’avèrent être des composantes particulièrement importantes. / The development of sexual behavior problems (SBP) during childhood is increasingly studied. While researchers and clinicians have often associated SBP to child sexual abuse (SA), the presence of SBP also seems to be linked to several other factors. Most recent works are exploring, among other factors, the frequent association between SBP and exposure to other forms of victimization, including child maltreatment. The cooccurrence of different forms of violence therefore turns out to be an important angle to explore because of its relationship with different indices of psychological distress, including externalizing behaviors. Objective. The main objective of this Masters’ thesis is to identify factors allowing to estimate the probability that a sexually abused child presents inappropriate sexual behaviors and SBP (referred to as SBP). Method. The sample was composed of 372 SA children (M child’s age = 9.4 years; SD = 2.2; 32.3% boys) who were assessed in a specialized intervention center between 2007 and 2016. Bivariate analysis (chi-square, one-way ANOVA, Mann Whitney U) and a hierarchical linear regression analysis were performed. Results. Bivariate analyses reveal that SA children with SBP show more symptoms of dissociation, depression, and anxiety than SA children without SBP. They also report receiving less support with regard to their SA experience and show more externalized behaviors and externalized problem solving strategies than SA children without SBP. Further, SA children with SBP are more frequently polyvictimized. For instance, compared to children without SBP more children in this group have been exposed to domestic violence, to psychological abuse and to more severe SA. While they are receiving services for their SA experience, they were are also more likely to have an active file under the Youth Protection Act (YPA), to experience placement, and to be prescribed medication for ADHD or behavior and emotion regulation problems. Taken together, multivariable analyses conducted with the regression model reveals that the following factors increase the probability of presenting SBP in SA victims: the child's gender (being a male, 2,2 times more likely to present SBP), being prescribed medication (2,2 times more likely to present SBP) and presenting a level of dissociation reaching the clinical threshold (2,5 times more likely to present SBP). Conversely, perceiving to have received less support in relation to the sexual abuse experienced decreases the risk that the AS child will present SBP (0,8 times less likely to present SBP). Conclusion. The results reveal that the development of SBP in child victims of SA appears associated to an accumulation of vulnerability factors, among which psychological distress (e.g.: dissociation and medication) and victimization prove to be particularly important components.

Les comportements sexuels problématiques (CSP) chez les enfants représentent une problématique complexe tant sur le plan de la recherche que de l’intervention clinique. L’hétérogénéité des enfants qui présentent des CSP est un défi sur les plans conceptuel et méthodologique. Alors que la recherche sur les facteurs associés aux CSP présentés par les enfants apparaît quelque peu limitée, plusieurs indices laissent supposer une association entre les CSP et les traits d’insensibilité émotionnelle. Ces traits sont caractérisés par un affect superficiel ainsi qu’un manque d’empathie et de remords. Seulement quelques études à ce jour ont exploré cette association et aucune n’a porté spécifiquement sur les enfants âgés de 6 à 12 ans. Les traits d’insensibilité émotionnelle sont importants à considérer puisqu’ils sont associés à la gravité des gestes d’agression chez les jeunes et à une résistance accrue à l’intervention. Objectifs. L’objectif général de ce mémoire est de mieux comprendre les facteurs associés à la variété des CSP. Plus précisément, nous voulons comprendre si et dans quelle mesure les traits d’insensibilité émotionnelle sont associés aux CSP. Nous avons donc proposé un modèle conceptuel adapté qui tient compte des traits d’insensibilité émotionnelle. Méthode. Notre échantillon est constitué de 90 dyades parent-enfant (M âge enfant = 9,1 ans ; É-T = 2,2 ; 36,7% filles) ayant reçu des services de psychothérapie pour leurs CSP au Centre d’expertise Marie-Vincent entre 2006 et 2010. Les participants ont complété une batterie d’évaluation incluant plusieurs instruments de mesure qui permettent de refléter l’ensemble des dimensions du modèle conceptuel. Un score de traits d’insensibilité émotionnelle a été dérivé à partir de divers instruments mesurant le comportement des enfants. Un modèle de régression linéaire hiérarchique a été élaboré afin d’estimer l’influence des traits d’insensibilité émotionnelle, en prenant en compte l’influence des autres variables individuelles et familiales. Résultats. Les résultats ont révélé que les traits d’insensibilité émotionnelle ne sont pas associés aux CSP des enfants lorsque leurs comportements extériorisés sont également pris en compte. Par ailleurs, la présence de comportements extériorisés et l’exposition à un cumul d’expériences de victimisation, excluant la victimisation sexuelle, étaient des facteurs associés à la variété des CSP. Il n’y avait également pas d’association significative entre la victimisation sexuelle et la variété des CSP. Conclusion. Les résultats appuient en partie le modèle conceptuel proposé. Des recherches reposant sur de plus grands échantillons devraient être effectuées pour mieux comprendre l’association entre les traits d’insensibilité émotionnelle et les CSP. Les résultats suggèrent néanmoins que les comportements extériorisés et les expériences de victimisation non sexuelles contribuent davantage à expliquer la variété des CSP chez les enfants référés pour une intervention que la victimisation sexuelle. / Sexual behavior problems (SBP) in children represent a complex issue both in terms of research and clinical intervention. The heterogeneity of children with SBP is a conceptual and methodological challenge. While research on the factors associated with SBP presented by children appears somewhat limited, there is some ground of belief in an association between SBP and callous-unemotional traits (e.g., superficial affect and lack of empathy and remorse). Few studies to date have explored this association, and none has focused specifically on children aged between 6 and 12 years old. These traits are important to consider because they are associated with the severity of aggression behaviors in youth and an increased resistance to intervention. Objectives. The main objective of this Masters’ thesis is to foster our understanding of the factors associated with the variety of SBP. Specifically, we want to understand if and to what extent callous-unemotional traits are associated with SBP. We have therefore proposed an adapted conceptual model that takes into account callous-unemotional traits. Method. Our sample consists of 90 parent-child dyads (M child’s age = 9.1 years ; SD = 2.2 ; 36.7% girls), who received psychotherapy services for SBP at the Marie-Vincent Center between 2006 and 2010. Participants completed an assessment battery including several instruments that reflect all the dimensions of the conceptual model. A score of callous-unemotional traits was derived from various instruments measuring children's behavior. A hierarchical linear regression model was developed to estimate the influence of callous-unemotional traits, taking into account the influence of the individual and family variables. Results. Results revealed that callous-unemotional traits were not associated with children's SBP when their externalized behaviors were taken into account. In addition, the presence of externalized behaviors and exposure to a combination of victimization experiences, excluding sexual victimization, were associated with the variety of SBP. There was also no significant association between sexual victimization and the variety of SBP. Conclusion. The results partially support the proposed conceptual model. Research with larger samples should be done to better understand the influence of callous-unemotional traits on SBP. The results suggest, however, that externalized behaviors and non-sexual victimization experiences are more important in explaining the variety of SBP of children referred for an intervention than sexual victimization.

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