About 300 sex abuse cases involving children are reported to Children's Hospital each year. Almost half of the young victims were abused by adolescents.
Now, for the first time in the District, the sensitive problem of adolescent sex abuse is being tackled in an experimental program that provides treatment for teen-agers who molest other children.
Last October, the National Center for Child Abuse and Neglect (NCCAN) awarded the hospital's Child Protection Center/Special Unit $50,000 a year for three years to conduct the pilot project.
So far, six boys between the ages of 13 and 18, and their families, have come to the program for long-term treatment.
Joyce Thomas, a pediatric nurse and director of the unit, says she wishes the program could have been started early enough to help the many adolescents whose cases convinced the hospital that the new program was needed.
One such case involved a District teen-ager who attempted to rape an 8-year-old relative while she slept. The girl was so hysterical that doctors at Children's Hospital had a difficult time examining her.
Workers from the city's social services department said the child could no longer live in her grandmother's house, where the young offender also lived. But the girl's mother had no place else to go, so the child was sent to an institution for several months.
The 15-year-old boy was charged with carnal knowledge, but the charges were later dropped due to insufficient physical evidence. After many months of psychological treatment at the unit, the girl improved, and she and her mother moved into a new apartment.
If there had been a program to counsel young offenders, Thomas said, "We may have been able to solve (the situation) more easily. Perhaps the child wouldn't have had to leave." The staff of the special unit also worried that the teen-ager was in the home with other children he could potentially abuse.
Adolescents come into the new program voluntarily, and they are not forced by the courts to stay in treatment.
Paul Mitchell, a social worker, and Nancy Horstmann, a psychologist, work with the abusers.
The counseling is designed to help the offenders understand what they did, and the effect of their actions on the victims.
Mitchell said many of the boys come from families where "something's not clicking" in the relationship between father and son. For this reason, Thomas sees advantages in having Mitchell in the program to act as a role model for the adolescents.
Horstmann said she believes the boys' sexual activities are often a reaction to confusion about issues in their own lives. They usually do not exhibit chronic or extremely deviant sexual behavior. She said the children often also suffer from poor self-esteem and don't relate well to their peers.
As Horstmann put it: "They seem more to be confused kids than hard-core criminals."
An adolescent goes through a tremendous amount of change both emotionally and biologically, explained Mitchell. Add to that confusion about sexuality, "and you have a volatile combination. . . . I try to figure out if (the child's behavior) is a natural stage of development," he said. Sometimes, they just don't know an appropriate way to express feelings of affection or curiosity, he added. Mitchell said he sometimes finds that the adolescents are acting out angry feelings about someone else, such as a parent. Sometimes they are just curious, he noted.
Inadequate sex education may be the culprit in some cases, Mitchell said. While adolescents are taught how to identify sexual organs, they do not learn about sexuality. Their confusion manifests itself in exploration with available victims, usually younger children, he said.
Sometimes, the abusers don't even realize they are harming their victims. Staff members recall a particularly bright, street-wise 13-year-old boy who was involved in sexual play with several younger boys in his neighborhood. He attempted to sodomize one of the boys, who became so distraught that his mother brought him to the hospital.
When a case worker talked to the older boy, he said, "I was just fooling around." He told case workers that he didn't think his actions were harmful to others. With counseling, the youth understood that his conduct was inappropriate.
Further discussions indicated the child suffered from a bad image of himself because his relatives continually told him he was a "bad seed" like other members of his family. That label caused him to rebel. He hung out with adults involved in illegal activities and he was exposed to sexually explicit magazines and activity. In addition, when he was quite young, he had been sexually victimized by a female relative.
The youth responded well to treatment. His case, and others, convinced Thomas that treating offenders was a feasible undertaking.
Before entering the program, the offenders -- all of whom have been boys -- are interviewed and given a psychological test to rule out serious mental illness. The most serious cases are sent back to the courts, which decide whether to institutionalize the offender.
Individual counseling is provided through Medicaid or free of charge to the offenders. The length of treatment depends on the severity of the child's problems: six months or more is not unusual.
The offenders will usually admit their actions, unlike adult offenders who go to great lengths to deny wrongdoing, according to staff members. "At some point they will take responsibility for what they did, but they don't empathize with the victim," said David Lloyd, an attorney who also works with the project.
There is no question in Thomas' mind about the nationwide need for treatment of adolescent sex offenders. (The only other program of this type is in Seattle, she said.) She points to a recent story reported in the Washington Star of a teen-aged boy who was arrested for molesting and beating to death his 4-year-old niece while baby-sitting.
"That's the end result for not having intervention," said Thomas.
The problems are real, she said, though they are largely unrecognized or ignored by adults.
Parental attitude is often the greatest hurdle the staff faces. Family members almost always deny that their child was involved in a sexual incident, or they don't perceive the abuse as a sexual act when children are involved, she said.
When asked if they would like their child to participate in the offender program, many parents hesitate, fearing that it will lead to criminal charges against their kids. "Families feel there is a stigma to having a child treated for this kind of problem," Thomas said.
She is quick to add that there are often warning signs and ways for parents to protect children from sexual abuse. Understanding a child's personality and behavior is essential, so that parents can recognize mood changes that suggest something is wrong.
Experts in the field of child abuse say that children who have experienced some sort of sexual impropriety may become withdrawn, easily frightened, secretive or cranky. They may begin wetting the bed, having nightmares or doing poorly in school.
Thomas also said parents should take note of their childrens' relationships with others, especially if they start spending an unusual amount of time with an older child or adult. Promoting a feeling of trust so that children can communicate their concerns is also essential, she said.
She added that children should be taught self-worth and that their body is their private domain. They also "need to know that not all adults are to be trusted." Safety lessons, such as locking the stall in a public restroom or leaving the restroom if someone makes them nervous, can be invaluable, she said.