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In recent decades, studies investigating the perpetrators of child and adolescent sexual abuse (CSA) and their characteristics described in the literature concluded that these individuals comprise a very distinct group. Hence, it is more coherent to refer to it considering various profiles than a single one (Serafim et al., 2009). The heterogeneous characteristics of CSA perpetrators are better explained by the interaction of multiple cognitive, situational, and cultural factors in these individuals’ development. The reason is that the interaction between these factors favors aggressive behaviors even when the individuals present no psychopathological disorders (Costa, Pensa, Conceição & Carreteiro, 2017). This aspect has increased interest in studying social and family circumstances recognized as factors associated with the manifestation of this form of aggression.
Using a contextual perspective to investigate life experiences, especially those concerning the childhood of these individuals, may help understand the ecological characteristics of the environments influencing their trajectories and how these relate to the manifestation of violent sexual behavior. This perspective implies the investigation of situational variables related to the immediate circumstances in which aggressions occurred, associated with those related to a more remote and retrospective context, marked by individual development risk factors, and the socialization contexts in which these individuals were raised (McKillop, Rayment-McHugh, Smallbone, & Bromham, 2018).
Hence, to consider such a perspective, this study proposes to discuss the theoretical construct referring to Adverse Childhood Experiences (ACEs) (Organização Mundial da Saúde, 2011; Felitti et al., 1998). ACEs are potentially traumatic experiences occurring up to 18 years old. It becomes a source of chronic or toxic stress if experienced continuously and without the support of an adult who plays a protective role. This process may include adverse developmental outcomes later in life, and there is some agreement regarding the duration and severity of such effects (Center On The Developing Child, 2007).
More recent studies (Merrick, Ford, Ports & Guinn, 2018) argue that the mechanism by which ACEs influence health and well-being throughout life is explained by a pyramid structure in which generational and historical problems within the family and precarious social conditions are at the base. Such factors may facilitate the occurrence of ACEs and trigger neurodevelopmental disruptions, influencing the emergence of social, emotional, and cognitive difficulties. Hence, these difficulties would lead individuals to adopt risky behaviors that may result in the development of diseases and social disabilities, triggering early death as the final product.
Studies associating early exposure to adversity with engaging in aggressive behavior, violent conduct, and criminal practices have been performed by Drury, Elbert, and DeLisi (2019), Reavis, Looman, Franco, and Rojas (2013) and Levenson, Willis, and Prescott (2014). These studies report a high prevalence and co-occurrence of ACEs among CSA perpetrators, with males being more likely to have experienced abuse and neglect than the general population. However, few studies address this relationship, considering its particular aspects in the Brazilian context. Thus, this study aimed to describe adverse childhood experiences (ACEs) and their relationship with personal and situational factors in a local sample of child and adolescent sexual abuse (CSA) perpetrators.
Method
This is an empirical and descriptive study with a retrospective and quantitative approach. Data were treated using content analysis. This study used interviews conducted between 2015 and 2016 by the research team in the institution that hosted the study, with a non-probabilistic sample of CSA perpetrators. Hence, the interviews were analyzed according to thematic categories. Data were collected in three prison units located in cities in a state in the northern region of Brazil. The Institutional Review Board regulating research with human subjects approved the project (Opinion Report No. 650.210). After that, access to these prison units was granted through an official letter issued by the penitentiary administration department.
Participants
The database contained the verbatim transcription of the semi-structured interviews with thirty men judged for having committed sexual crimes against children and adolescents, i.e., raping a vulnerable person. These participants were accessed in three different prison units in different cities in the same state. Eighteen interviews were conducted in the first unit, though one interview was lost due to problems with the audio recording. Seven interviews were held in the second prison and six in the third. Hence, thirty interviews were audio recorded and later transcribed and checked. All the participants were male, between 27 and 70 years old at the time of the interview and had been judged in the Courts of Crimes against Children and Adolescents in a capital city in the north of Brazil.
The participants were selected using a non-probabilistic strategy (convenience sample); that is, the technicians of the prison units nominated the participants according to the criminal typology of interest. The inclusion criteria were being a man, not having psychotic disorders (e.g., antisocial, schizophrenia, or severe depression, among others), and the absence of organic brain syndrome or any serious medical condition. These criteria followed the main statistics concerning the crime of raping a vulnerable person. Such indicators show that men without a pathology described by the DSM are primarily responsible for crimes involving sexual abuse against children and adolescents (Serafim et al., 2009).
Instruments
The instrument that guided the definition of the thematic categories for the content analysis of the interviews consisted of the Brazilian version of the Adverse Childhood Experiences International Questionnaire (ACE-IQ Test) (Silva, 2017). This version presents 13 categories that unfold into 31 questions distributed between direct and indirect experiences within the context of family, school, and neighborhood. In addition, this questionnaire enables calculating the ACEScore or Total Adversity Index, serving as a parameter to conclude that the higher the number of ACEs experienced during the first 18 years of life, the more likely is the development of a detrimental outcome. The categories composing the instrument address physical, sexual, and emotional abuse; physical and emotional neglect; and various family dysfunctions, such as alcohol consumption and drug use by family members at home; incarceration of a family member; family history of mental illness, domestic violence; divorce, separation or death of one or both parents; moral violence or bullying, community violence, and collective violence.
In this study, the ACE-IQ was not directly applied to the surveyed population. However, instead, it guided the analysis of the interview transcripts through thematic categories based on its items. For this reason, the ACE-Score was calculated based on the presence or absence of each descriptor category of the experiences addressed.
Procedures
First stage – Exploratory reading of the interviews database
Initially, an exploratory reading of the secondary database containing the thirty semistructured interviews was performed. The interviews contained data about biopsychosocial information and the participants’ life trajectories. Content analysis, according to Bardin (1977), was used in the initial reading, which was followed by the floating reading of the textual content, from which categories of analysis emerged and was grouped according to themes to answer the study’s objective, i.e., to identify the participants’ adverse childhood experiences.
The exploratory reading enabled identifying excerpts containing reports addressing the subject. These experiences’ conceptual definition was based on the Adverse Childhood Experiences International Questionnaire (ACE-IQ Test). At this point, personal factors (i.e., age, education, religion, marital status, and race) and situational factors (e.g., the victim’s age and gender, relationship with the victim, consumption of alcohol/drugs at the time of the aggression, recurrence, and severity of the aggression) were also identified.
Second stage – Constructing the database
Next, a database was built on a spreadsheet in the Microsoft Excel® Software containing the thirteen categories concerning adverse childhood experiences listed in the ACE-IQ Test and the questions intended to describe each of the ACEs, totaling thirty-one. Text excerpts indicating the presence of ACEs were then selected and placed in a column. The identified and categorized ACE was placed next to each question. Finally, the following codes were used to quantify the results: 1 = evidence of the presence of ACEs in the interview analyzed, and 0 = absence.
Third stage – Panel of evaluators
A panel of four judges, including the author, conducted the assessment that indicates correspondence between the categories contained in the instrument and the excerpt in the participants’ reports where ACEs appeared. A spreadsheet containing the categories was submitted to the panel, and the agreement index was calculated using the Kappa statistic. Regarding the dependent variables, the Kappa (K) coefficient used to rate inter-rate agreement was above 0.61, which is considered substantial, except for two items concerning physical abuse and domestic violence, for which K coefficients were >0.41 and <0.61, respectively, which indicate moderate agreement. The general inter-rater agreement was 95.56%.
Fourth stage – Descriptive and inferential statistics using the JASP Software
The items describing the ACEs categories and the perpetrators’ personal and situational factors identified in the interviews’ excerpts were quantified and submitted to descriptive statistics to verify their relationship with the study variables. These analyzes were performed using the JASP® Software. The Fisher’s Exact Test was used to test the association between the variables considering a p ≤ 0.05. This test was adopted because it is recommended for nonparametric samples considered small, i.e. when n is ≤30. The Relative Risk Ratio (RR) was used to verify the magnitude of the association between the ACEs reported by the CSA perpetrators and compare the proportions of risk of experiencing a given ACE when in the presence of another ACE; RR>1.5 and P≤ 0.05 were the conditions to identify a significant risk change.
Results
The biopsychosocial characterization of the CSA perpetrators was based on data obtained from the participants (n=30) and is summarized in Table 1. In general, most (n=24) were over 30 years old. Note that the sample comprises men aged between 27 and 70 at the time of the interview, not when they committed the aggression. Hence, the participants were 40.8 years old on average, and the standard deviation is 10.8 years, which shows a considerably ample age range. Regarding personal characteristics, most participants had complete or incomplete elementary school (n=20), considered themselves Evangelical (n=18), and reported being of mixed race (n=19).
Table 1 Distribution of the frequency of personal and situational factors of CSA perpetrators
| Personal and Situational Factors | % (n=30) |
|---|---|
| Age | |
| ≤ 30 | 6 (20%) |
| > 30 | 24 (80%) |
| x | 40.8 |
| Education | |
| Illiterate | 1 (3.33%) |
| Complete or Incomplete Middle School | 20 (66.67%) |
| Complete or Incomplete High School | 8 (26.66%) |
| Incomplete College Education | 1 (3.33%) |
| Religion | |
| Evangelical | 18 (60%) |
| Catholic | 8 (26.70%) |
| MD | 4 (13.3%) |
| Marital Status | |
| Married or stable union | 14 (46.7%) |
| Single | 14 (46.7%) |
| MD | 2 (6.7%) |
| Race | |
| Afro-descendant | 4 (13.33%) |
| Mixed-race | 19 (63.3%) |
| Caucasian | 5 (16.7%) |
| MD | 2 (6.7%) |
| Victim’s sex | |
| Male | 5 (16.70%) |
| Female | 25 (83.33%) |
| Victim’s age | |
| Child (≤12) | 13 (43.33%) |
| Adolescent (>12) | 16 (53.33%) |
| MD | 1 (3.3%) |
| Bonds | |
| Intrafamiliala | 16 (53.33%) |
| Extrafamilialb | 14 (46.67%) |
| Severity | |
| Hands onc | 18 (60. %) |
| Hands offd | 5 (16.7%) |
| MD | 7 (23.3%) |
| Recurrence | |
| Yes | 11 (36.7%) |
| No | 14 (46.7%) |
| MD | 5 (16.7%) |
| Alcohol/Drug use | |
| Yes | 11 (36.7%) |
| No | 15 (50%) |
| MD | 4 (13.3%) |
Note. MD = Missing data
aIntrafamily = 7 stepfathers; 6 fathers; 1 godfather; 1 uncle; 1 stepfather’s father
bExtrafamily = 9 acquaintances; 4 neighbors; 1 unknown
cHands on = sexual abuse with penetration and/or severe coercion
dHands off = sexual abuse without the use of force or penetration
Regarding situational factors, most victims are female (n=25), adolescents over 12 years of age (n=16), 12.51 years old on average, and a standard deviation of 3.05 years. Those with a family bond represented most cases analyzed (n=16); stepfathers and fathers prevail. When the aggression occurred outside the family, acquaintances were among the most prevalent in this group (n=9). Most aggressions were considered severe (n=18), defined here as the use of force or severe coercion at the time of the aggression and/or with the occurrence of sexual penetration, not necessarily co-occurring. Finally, a considerable portion of these aggressions (n=11) occurred recurrently, at least twice. In the same proportion, CSA perpetrators were under the influence of alcohol and/or drugs at the time of the aggression.
Regarding the ACE-Score, or childhood adversity index, 96.67% (n=29) of the participants reported having experienced at least one category of ACE, while more than half (60%, n=18) scored four or more ACEs. The mean in this group is equivalent to 5.94 (Md= 5.5; sd= 1.86). The mean ACE-Score in the entire sample was equal to 4.36 (Md= 4; sd=2.45), while 17% (n=5) and 13% (n=4) of the respondents obtained an ACE-Score equal to 2 and 3, respectively. Only 7% (n=2) of the CSA perpetrators scored only one ACE, and one (3%) reported not having experienced any ACE. In the analysis of the prevalence of ACEs subtypes, physical abuse is the most frequent ACE, being reported by 70% (n=21) of the CSA perpetrators, followed by moral violence, which includes bullying and involvement in physical fights (63.67%, n=20), the death and/or separation of parents (56.67%, n=17), the consumption of alcohol or drugs by family members at home (53.33%, n=16), and sexual abuse (43.33%, n=13).
The most frequent associations were selected to verify whether exposure to a given ACE would be a risk factor for experiencing another ACE. Differences were tested using the comparative measure of Relative Risk (RR). The results in Table 2 indicate that exposure to death and/or separation from parents during childhood is a significant risk factor for sexual abuse among the CSA perpetrators in this sample (RR= 4.21; p= 0.0099), increasing by 321% the probability of its occurrence. In addition, exposure to emotional neglect (RR= 3.2; p= 0.0067) and domestic violence (RR= 1.57; p= 0.02875) also revealed significant risk changes for sexual abuse, increasing by 220% and 57%, respectively, the risk of experiencing sexual abuse.
Relative Risk (RR) of CSA perpetrators reporting sexual abuse in the presence of the death and/or separation from parents, emotional neglect, and domestic violence
| Sexual Abuse | |||||
|---|---|---|---|---|---|
| Present | Absent | Total | RR (CI) | P Value | |
| Death and/or separation from parents | |||||
| Present | 11 | 6 | 17 | 4.21 (1.12-15.78)* | .0099* |
| Absent | 2 | 11 | 13 | ||
| Total | 13 | 17 | 30 | ||
| Emotional Neglect | |||||
| Present | 8 | 2 | 10 | 3.2 (1.41-7.27)* | .0067* |
| Absent | 5 | 15 | 20 | ||
| Total | 13 | 17 | 30 | ||
| Domestic Violence | |||||
| Present | 6 | 5 | 11 | 1.57 (.61-4.02)* | .02875* |
| Absent | 7 | 12 | 19 | ||
| Total | 13 | 17 | 30 | ||
The Fisher’s Exact Test was used to verify associations between the variables because it is a small sample with two categories; cases without information were disregarded. The analysis showed a significant association between the CSA perpetrators’ ACE-Scores, higher recurrence of aggression (p = 0.04), and lower occurrence of alcohol and/or drug use at the time of aggression (p = 0.03).
Discussion
The results indicate that the profile of the CSA perpetrators outlined in this sample comprises non-Caucasian adult men with a low educational level who profess the evangelical religion. Part of these results confirms the findings from a previous study addressing men who committed sexual aggression (Teixeira, Resende & Perissinotto, 2020), which reported the same profile of individuals aged 30 to 50 years with poor education. Additionally, the profile found in this local sample also reflects the penal selectivity evident in the most frequent characteristics of the prison population in Brazil, composed of 65.88% of non-Caucasian individuals and 45% of people with incomplete primary education, according to the last National Survey of Penitentiary Information (National Penitentiary Department, 2019).
Regarding the characteristics of aggression, such as the bond established with the victims and the severity of the aggression, the results reaffirm the hypothesis raised by McKillop et al. (2018), who compared data from 166 adult and 212 adolescent sexual abusers of children and adolescents in Australia. The results showed that it is more common for adults, predominantly fathers and stepfathers, to use strategies that do not include severe coercion since they are in a position of generational power and have more complex cognitive resources to convince victims.
The investigation of ACEs shows multiple occurrences in the trajectory of CSA perpetrators, suggesting an accumulation of challenges interposed in their primary contexts of development. The results found by Reavis et al. (2013) are similar, indicating that almost half of the CSA perpetrators investigated obtained an ACE-Score equal to 4 or more co-occurring ACEs. The same study comparing the control group showed that CSA perpetrators would be four times more likely to obtain higher scores. Levenson, Willis, and Prescott (2014) also identified low levels of CSA in perpetrators who reported that they had not experienced any ACE and higher levels of ACE-Score in approximately half of the sample (CSA perpetrators), with a total mean of 3.5, lower to that found in this study.
Regarding physical abuse, which is the most frequently reported by this sample, BecerraGarcia (2014) revealed that its occurrence in the childhood of sexual abusers was associated with significant impairment in cognitive skills, especially psychomotor skills, and speed information processing and flexibility. These findings are in line with the basic premise of studies addressing ACEs: that the experience of these adverse experiences can cause neurodevelopmental disruptions, triggering potential social, emotional, and cognitive impairments that favor the adoption of immediate and long-term risk behaviors.
It should be noted that moral violence, which includes bullying and involvement in physical fights, was frequent in this sample, corroborating the results of Teixeira, Resende, and Perissinotto (2020), who identified the experience of peer victimization in 76.6% of CSA perpetrators investigated in the Midwest of Brazil. These results suggest that this subtype of ACE plays a crucial role in the development of perpetrators of child sexual abuse, especially in Brazilian sample groups, where social, economic, cultural, and personal circumstances aggravate exposure to violence and the harmful consequences arising from it.
Sexual abuse, the definition of which in this study includes when someone is only approached to perform such an act, was present in the CSA perpetrators’ trajectories of life until they were 18 years old in almost half of the sample. Levenson and Socia (2015) also identified sexual abuse among male and female CSA perpetrators as the fifth most reported ACE (38%). Drury, Elbert, and DeLisi (2019) found a significant association between experiencing sexual abuse during childhood and later perpetrating sexual abuse, even when controlling for clinical and criminological variables.
The theoretical study by Plummer and Cossins (2016) discusses the hypothesis that the experience of sexual abuse during childhood could increase the probability of committing a sexual assault in the future. According to the authors, this phenomenon seems to lead to conflicts concerning the construction of one’s sexuality when the victim is male. Furthermore, this perception seems to contribute to naturalizing abusive sexual behavior (Plummer & Cossins, 2016). Thus, abused boys possibly learn that sexuality is linked to power and control, a conception that tends to be culturally reinforced.
This sample frequently reported the death and/or separation of parents. However, Merrick et al. (2018) investigated the prevalence of ACEs in 23 US states in a random sample and found that divorce or separation of parents and substance abuse at home are among the problems most frequently faced during the participants’ childhood. This information suggests that the prevalence of these two ACEs subtypes in the general population does not differ significantly from the prevalence found among CSA perpetrators. It means that the separation of parents experienced during childhood may not strongly predict the outcome analyzed here, as it is an increasingly common experience in the lives of Western children, with less potential for children to perceive it as a traumatizing event.
However, data on the risk of experiencing specific ACEs when other ACEs are present suggest that such experiences tend to co-occur so that the occurrence of one ACE triggers others. For example, Turner, Vanderminden, Finkelhor, and Hamby (2019) used data from 7,852 children and adolescents aged 2 to 17 and identified that physical and/or emotional neglect during childhood imposed children a greater risk of sexual abuse. Likewise, Levenson, Willis, and Prescott (2014) identified a correlation between all ACEs subtypes among CSA perpetrators, especially with emotional neglect.
An association between the highest ACE-Scores and the recurrence of aggression episodes was found in this study, which is in line with the findings of Levenson, Willis, and Prescott (2014), who reported that the highest scores were associated with more recurrent aggression events. A potential explanation for this association is that the combination of specific ACEs in these individuals’ life trajectories can potentially affect their perceptions of experiences, including violent acts. Thus, an individual would perceive continuous strategies of aggression as less severe. This hypothesis is supported by studies in which previous experiences of abuse, lack of attachment, and isolation during childhood are thought to favor socially dysfunctional or inappropriate behaviors. Furthermore, these behaviors would be activated mainly during stressful situations, where maladaptive cognitive systems would be expressed, such as beliefs of denial and minimization of sexual aggression and limited empathy for victims (Henriques, 2016).
An association between the highest ACE-Scores and less frequent consumption of alcohol or drugs at the time of the assault was also identified. From the perspective of preexisting cognitive distortions, using drugs to encourage aggression would become ‘less’ necessary, considering prior cognitive naturalization of its severity and recurrence. Zuo et al. (2019) discuss the potential neurological effects of ACEs, such as modifying the prefrontal cortex, which is responsible for executive functions, judgment, decision-making, and self-regulation of emotions. Thus, ACEs possibly trigger greater biological susceptibility to developing these cognitive distortions.
Therefore, to understand how CSA perpetrators engage in such behaviors, we need to consider that their experiences in interpersonal relationships and a lack of resources to deal with adverse situations may severely interfere with the development processes throughout life. Hence, it is possible that engaging in sexually abusive behavior is among these potential effects.
This study’s primary objective was to describe adverse childhood experiences (ACEs) and their relationship with personal and situational factors in a sample of Child and Adolescent Sexual Abuse (CSA) perpetrators. This objective was achieved as this investigation enabled an understanding of the relationship between ACEs categories, the ACE-Score, and the characteristics of such aggression, such as its recurrence and the consumption of alcohol or other drugs at the time of the event. However, it is essential to highlight that the results obtained here are descriptive rather than explanatory; i.e., these results do not allow for establishing a causal relationship between ACEs and sexual abuse in the future. Nonetheless, data analysis enables us to conclude that ACEs were present, frequent, and significantly associated with the aggression characteristics in this sample of CSA perpetrators.
This study’s limitations include the small number of participants, considering that quantitative studies directly applying the ACE-IQ usually address considerably larger samples. In addition, note that the impossibility of establishing a control group and the indirect application of the instrument using secondary data may have impacted the scope of the responses collected, which restricts the generalization of results. Finally, memory bias may also have influenced the reports collected, considering that they are retrospective descriptions of past experiences. Thus, future studies are suggested to directly apply the ACE-IQ in larger samples, if possible, with a post-test to ensure greater reliability and consistency in the reports.
This study’s contribution to the field addressing Sexual Abuse and Childhood Adverse Experiences permeates the expansion of knowledge produced in Brazil, considering that few studies address the Brazilian population with samples composed of CSA perpetrators, a population that is difficult to access. Additionally, this study is expected to contribute to planning public health policies that include CSA perpetrators to more effectively prevent potential recurrences and future occurrences of violence/sexual abuse, contributing to the development of instructional materials discussing the importance of ACEs and their potential adverse effects on human development.
It is an especially relevant objective, given the current Covid-19 pandemic and its repercussions on the experiences of children and adolescents under the social and economic restrictions imposed by this global context. Such a context tends to intensify inequalities and the chronic stress contained in experiences of isolation, unemployment, loss of a parent, and various forms of violence. Therefore, discussing childhood adverse experiences is expected to encourage people to look at potentially protective factors that can promote resilience in the face of difficulties. Indeed, such adverse consequences are expected to be mitigated and more severe outcomes avoided, such as the sexual abuse of children and adolescents.
