Part II: The Hidden Crisis of Sibling Sexual Abuse
Part I of “The Hidden Crisis of Sibling Sexual Abuse” shone a rare spotlight on the silent epidemic of sibling sexual abuse (SSA) that affects a staggering number of families in our nation. In last week’s blog post, we examined the prevalence, patterns, and vulnerability of SSA and why it must be considered a family rather than an individual problem. This week, we explore the existing gaps in intervention and address the need to make effective prevention a priority across systems so that we may begin to tackle this public health crisis.
Evidence-Based Interventions for Families Experiencing Sibling Sexual Abuse Are Under-Evaluated
The family response to SSA is critical to the recovery of both the victim-child and the child with sexually abusive behaviors, which is why most experts agree that therapeutic intervention that engages the whole family in treatment, as early as possible is essential.[i] Unfortunately, interventions with families who have experienced SSA are under-evaluated, and treatment is largely informed by clinical, rather than empirically tested, approaches to the problem.[ii] These interventions include helping the offending child to manage their problematic sexual behaviors, helping the victim-child overcome feelings of shame and guilt, and supporting healthy parenting practices and family functioning that promotes emotional, physical, and sexual safety.[iii]
When it is discovered that a sibling is engaging in sexually abusive behaviors, a number of critical questions arise. Should the offending child be removed from the family home? If so, for how long? And under what circumstances might reunification be possible? Responding to these questions requires assessing risk of re-abuse, a task that is complicated by the lack of scientific knowledge related to SSA, juvenile offenders, treatment, and reunification. Most of the clinical approaches are based on a comparatively greater body of evidence regarding adult perpetrators and may not be appropriate for juvenile offenders who represent a population distinct from their adult counterparts, with unique challenges.[iv] For example, children who sexually abuse a sibling often have experienced abuse and trauma themselves, and therefore require support and specialized services through the legal and treatment systems accordingly; separation of the juvenile offender and a criminal justice response alone are largely ineffective.[v] Rather, effective intervention must consider the complex sibling dynamic, the broader family dynamic, and the unique demands on parents post-disclosure and surrounding removal and reunification, and effectively balance the needs of individual family members in the context of the child protection, law enforcement, and juvenile justice systems.[vi]
Sibling Sexual Abuse Must Be Addressed More Seriously Across Systems at the Intervention and Prevention Levels
SSA cases are, without a doubt, some of the most complex and difficult for individuals, families, and systems to effectively identify and address. Child protection and judicial procedures for identifying and responding to cases of SSA are inadequate, and very few mental health practitioners have specialized knowledge and understanding of the challenges unique to SSA. Likewise, our understanding of the factors underlying SSA is not sufficient to inform evidence-based, preventive interventions. However, we do know that SSA tends to emerge in the context of dysfunctional family systems.
To that end, legal, child welfare, and mental health systems must approach the problem of SSA using a family-systems framework. The responsibility for addressing SSA and ensuring safety should be shared by the family and include multi-agency support not only for the victim-child, but for all individual family members. Legal and mental health/social services systems need to find a way to build upon the strengths of the family to the likelihood of a full recovery.
Beyond the meaningful provision of services to families experiencing SSA, prevention is critical to tackling the public health issue of SSA. Collective rejection of the enduring myth that SSA is somehow less harmful than other forms of sexual assault and closing the existing gaps in our knowledge and understanding of SSA are vital steps toward development of effective prevention practices. To that end, professionals should work together to refine existing laws to better reflect the realities of SSA and, ultimately, to develop a single, universally accepted, statutory definition of SSA. This could prove an important tool for child protection agencies to then develop agreed-upon practice-standards for responding to SSA. Child protection workers can then focus their attention on early identification of and intervention for children at risk of sexually abusive behaviors.
Overall, effective prevention of SSA must be prioritized under a multi-systems approach, with families, child protection and juvenile justice systems, and mental health and social service providers working collaboratively to protect children from the pervasive and traumatizing effects of SSA and to ensure the best possible outcomes for families.
[i] Kramer, L., & Kowal, A. K., Sibling relationship quality from birth to adolescence: the enduring contributions of friends, 19(4) J. of Family Psych. 503 (2005); Lynne White, Sibling Relationships Over the Life Course: A Panel Analysis, 63(2) J. of Marriage & Family 555 (2001).
[ii] U.S. Dep’t. Health & Human Serv., What is child abuse or neglect? What is the definition of child abuse and neglect?, available at https://www.hhs.gov/answers/programs-for-families-and-children/what-is-child-abuse/index.html
[iii] John Caffaro, Sibling abuse of other children, Handbook of Interpersonal Violence Across the Lifespan at 7 (2020).
[v] Caffaro, J. V., & Conn-Caffaro, A., Treating sibling abuse families, 10(5) Aggression & Violent Behavior 604 (2005); Carlson, B.E., et. al., Sibling incest: Reports from forty-one survivors, 15(4) J. of Child Sexual Abuse, 19 (2006); John Caffaro, Sibling abuse trauma, 2nd ed., New York (Routledge, 2014).
[vi] Margaret Ballantine, Sibling incest dynamics: Therapeutic themes and clinical challenges, 40(1) Clinical Social Work J., 56 (2012); Krienert, J. & Walsh, J., Sibling sexual abuse: an empirical analysis of offender, victim, and event characteristics in National Incident-Based Reporting System (NIBRS) Data, 2000-2007, 20(4) J. of Child Abuse, (2011).
[vii] Tener D., Tarshish N, & Turgeman S., Victim, Perpetrator, or Just My Brother? Sibling Sexual Abuse in Large Families: A Child Advocacy Center Study, 35(21-22) J. of Interpersonal Violence, 4887 (2020).
[ix] Supra n.5.
[x]Alaggia, R & Kirshenbaum, S., Speaking the unspeakable: exploring the impact of family dynamics on child sexual abuse disclosure, 86 Families in Society, 227 (2005) (noting that victims of SSA are more likely to feel like they were co-conspirators and take responsibility for post-disclosure disruptions to the family including any removal or punishment of the abusive sibling).
[xi] Amy Meyers, Notes from the Field: Understanding Why Sibling Abuse Remains Under the Radar and Pathways to Outing, Faculty Works: Social Work at 2 (2015).
[xii] Supra n.6.
 See, e.g., 42 Pa.C.S. § 6302 (defining a “delinquent child” as one who is 10 years old or older); see also, Roper v. Simmons, 543 U.S. 551 (2005) (relying on scientific evidence which finds juveniles, as a group, are inherently more susceptible to immaturity, recklessness, and irresponsible behavior because they are underdeveloped biologically, socially, and emotionally to hold that capital punishment for juvenile offenders amounts to cruel and unusual punishment).
[xiii] For an overview of the potential psychological effects associated with childhood sexual abuse see, Merricka, M., et. al, Unpacking the impact of adverse childhood experiences on adult mental health, Child Abuse & Neglect (2017); for an overview of the potential health effects of the same see, Maniglio, R., The impact of child sexual abuse on health: A systematic review of reviews, 29(7) Clinical Psychol. Rev. 647-657 (2009); see also, Sachs-Ericsson, et al., A Review of Childhood Abuse, Health, and Pain-Related Problems: The Role of Psychiatric Disorders and Current Life Stress, 10(2) J. Trauma & Dissociation 170-188 (2009).
[xv] Morrill, M., Sibling Sexual Abuse: An Exploratory Study of Long-term Consequences for Self-esteem and Counseling Considerations, 29 J. Fam. Vio.l, 205 (2014).
[xvi] Rudd, J. M., & Herzberger, S. D., Brother-sister incest-father-daughter incest: A comparison of characteristics and consequences, 23(9) Child Abuse & Neglect, 915 (1999).
[xviii] Shaw, J. A.,et. al., Child on child sexual abuse: Psychological perspectives, 24(12)
Child Abuse & Neglect, 1591 (2000).
[xix] Phillips-Green, M. J., Sibling incest, 10(2) The Family J: Counseling & Therapy for Couples & Families, 195 (2002)
[xx] Tener, D., et. al., Parental attitudes following disclosure of sibling sexual abuse: A child advocacy center intervention study, 88(6) American J. of Orthopsychiatry, 661 (2018).
[xxiii] Walsh, W. A., Cross, T. P., & Jones, L. M., Do parents blame or doubt their child more when sexually abused by adolescents versus adults?, 27(3) J. of Inter. Viol., 453 (2012).
[xxiv] Tener, D., et. al., Child Advocacy Center intervention with sibling sexual abuse cases: Cross-cultural comparison of professionals’ perspectives and experiences, Child Abuse & Neglect (Jul., 2020).
[xxvi] Supra n.5.
[xxvii] Finkelhor, D., Ormrod, R., & Turner, H, Poly-victimization: A neglected component of child victimization, 31(1) Child Abuse & Neglect, 7 (2007); Haskins, C., Treating sibling incest using a family systems approach, 25 J. of Mental Health Counseling, 337 (2003); Margolin, G., & Gordis, E. B., The effects of family and community violence on children, 51 Annual Review of Psychology, 445 (2000); Straus, M., et. al., Identiﬁcation of child maltreatment with the Parent-Child Conﬂict Tactics Scales: Development and psychometric data for a national sample of American parents, 22 Child Abuse & Neglect, 249 (1998).
[xxviii] Tener D., et. al., How does COVID-19 impact intrafamilial child sexual abuse? Comparison analysis of reports by practitioners in Israel and the US., 116(2) Child Abuse & Negl. (Oct. 2020).