Traumatology © 2016 American Psychological Association

2016, Vol. 22, No. 2, 94 –103 1085-9373/16/$12.00

http://dx.doi.org/10.1037/trm0000067

The Influence of Childhood Trauma on Sexual Violence and Sexual

Deviance in Adulthood

Jill S. Levenson Melissa D. Grady

Barry University The Catholic University of America

The purpose of this study was to determine the influence of various types of childhood adversity on later
sexual deviance and sexually violent behavior. Data were collected from more than 700 convicted sexual
offenders in outpatient and confinement-based treatment programs throughout the U.S. Using the 10-item
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Adverse Childhood Experiences (ACE) Scale, participants were surveyed about childhood maltreatment and
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family dysfunction. For male sex offenders, factors that significantly predicted sexual deviance included
childhood sexual abuse, emotional neglect, and having unmarried parents. Factors that significantly predicted
violent sexual offending included child physical abuse, substance abuse in the childhood home, mental illness
in the home, and having an incarcerated family member. ACE scores were significantly higher for generalist
offenders than for those specializing in sexual crime. The results underscore the need for clinicians to assess
the existence of early adversity, to understand the role of traumatic events in the development of criminality
and abusive behaviors, and to utilize trauma-informed counseling practices. In terms of policy, investing in
prevention services for maltreated children and at-risk families is an important step in disrupting the cycle of
interpersonal violence and crime in our communities.

Keywords: ACE, adverse childhood experiences, sex offender, sexual deviance, sexual violence, trauma-
informed care

The largest study to examine the role of adverse childhood expe-
riences (ACE) and adult outcomes surveyed over 17,000 people and
found that at least two thirds of adults reported at least one type of
childhood maltreatment or household dysfunction, and nearly 13%
reported four or more (Centers for Disease Control & Prevention,
2013b). Though these numbers are staggering, the rates of early
trauma in poor, disadvantaged, clinical, and criminal populations are
even higher (Christensen et al., 2005; Eckenrode, Smith, McCarthy,
& Dineen, 2014; Larkin, Felitti, & Anda, 2014; Levenson, Willis, &
Prescott, 2014; Wallace, Conner, & Dass-Brailsford, 2011). As ACEs
accumulate, the risk for numerous health, mental health, and behav-
ioral problems in adulthood has been observed to increase in a
dose–response fashion (Felitti et al., 1998). Among the negative
sequelae of early trauma is increased risk for criminal behavior,
including sexual perpetration (Marshall, 2010; Mersky, Topitzes, &
Reynolds, 2012; Patterson, DeBaryshe, & Ramsey, 1989). The pur-
pose of this study is to explore the influence of different types of
childhood adversity on adult sexual violence and sexual deviance.
Developmental Theory and Criminality
Understanding the complexities of an individual’s psychosocial
history is a vital component in assessing how the seeds of criminal
This article was published Online First February 25, 2016.
Jill S. Levenson, School of Social Work, Barry University; Melissa D.
Grady, National School of Social Service, The Catholic University of
America.
Correspondence concerning this article should be addressed to Jill S.
Levenson, School of Social Work, Barry University, Miami Shores, FL
33161. E-mail: jlevenson@barry.edu
behavior may be planted early in life and flourish into adulthood
(Dudley & Leonard, 2007; Guin, Noble, & Merrill, 2003). Devel-
opmental psychopathology theorists propose that emotional and
behavioral adaptations stem from a reciprocal interaction of affec-
tive and cognitive processing; individuals attach meaning to their
experiences and this is how we “establish a coherence of function-
ing as a thinking, feeling human being” (Rutter & Sroufe, 2000, p.
265). Developmental theories of antisocial behavior argue that
inept parenting, harsh or arbitrary punishment, poor supervision,
and limited positive parental involvement raise the risk for conduct
problems and delinquency (Cicchetti & Banny, 2014; Kohlberg,
Lacrosse, Ricks, & Wolman, 1972; Patterson et al., 1989; Rutter,
Kim-Cohen, & Maughan, 2006). The pathways from early adver-
sity to psychosocial problems are complex, but early toxic stress
creates hyper-arousal, increasing the production of hormones as-
sociated with fight-or-flight responses and inhibiting the growth
and connection of neurons (Anda et al., 2006; van der Kolk, 2006).
Over time, these changes in the brain can compromise emotional
regulation, social attachment, impulse control, and cognitive pro-
cessing (Anda, Butchart, Felitti, & Brown, 2010; Anda et al., 2006;
Whitfield, 1998).
This bio-psycho-social trajectory is further complicated by ac-
cumulating cascade effects by which early deficiencies in one
domain of functioning obstruct mastery of skills in other develop-
ing areas (Masten & Cicchetti, 2010; Rutter et al., 2006). For
example, traumatic childhood experiences can lead to self-
regulation deficits which then interfere with academic perfor-
mance and social competencies. Consequently, the child may elicit
negative reactions from schoolmates and teachers, increasing the
risk for delinquency when needs for acceptance are met by asso-
ciations with other nonconforming peers (Rutter et al., 2006).

94
 ACE AND SEX OFFENSE PATTERNS
Clinicians taking psycho-social histories in justice-involved set-
tings often seek to explore the role of child maltreatment and
chaotic family environments on later criminal behavior.
Childhood adversity is very common in the histories of criminal
offenders. Prospectively collected data from the Chicago Longi-
tudinal Study (N ⫽ 1,539 low-income minority children) identified
child maltreatment as a predictor of criminal behavior for both
boys and girls (Mersky et al., 2012). In addition, child abuse and
neglect were found to be much more common among 64,000
juvenile delinquents in Florida than in the general population
(Baglivio et al., 2014). Among adult offenders, greater exposure to
early trauma is significantly associated with mental health disor-
ders, drug abuse, and serious crime (Harlow, 1999; Messina,
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Grella, Burdon, & Prendergast, 2007). Although individuals vary
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in their response to toxic stress, and many people exhibit resilience
following adversity, traumagenic environments may be most del-
eterious for those with negative personality traits and limited
intellectual or social resources (Patterson et al., 1989). Pathogenic
parenting and deprivational environments impede family function-
ing and model maladaptive coping, and are often exacerbated by
impoverished socioeconomic conditions (Patterson et al., 1989).
Attachment theory is helpful in conceptualizing the link be-
tween early adversity and adult psychosocial problems. Attach-
ment theory postulates that primary caregivers’ interactions with a
child must be nurturing, consistent, reliable, and responsive to
needs in order for youngsters to learn that the world is safe place
(Bowlby, 1977, 2005). Children who experience maltreatment and
family dysfunction are exposed to unpredictable parenting patterns
that compromise the development of secure attachments to care-
takers, and these youngsters often witness chaotic conditions that
fail to exemplify healthy interpersonal functioning across the life
span (Carlson & Sroufe, 1995; Cicchetti & Banny, 2014; Rutter et
al., 2006). Abused and neglected children are socialized within
relationships characterized by betrayal and invalidation, which can
then produce distorted cognitive schema, boundary violations,
disorganized attachment patterns, and emotional dysregulation
(Chakhssi, de Ruiter, & Bernstein, 2013; Loper, Mahmoodzade-
gan, & Warren, 2008; J. E. Young, Klosko, & Weishaar, 2003).
Poor quality of early attachment has been associated with a num-
ber of long-term negative effects including deficient relational
skills, self-regulation problems, and psychopathology (Bowlby,
1977; Jovev & Jackson, 2004; Loper et al., 2008). Sexually abu-
sive behaviors seem to have some roots in early attachment dis-
ruptions, whereby attempts are made to satisfy unmet emotional
needs and to connect with others through sexual or aggressive
means (Beech & Mitchell, 2005; Bushman, Baumeister, & Phil-
lips, 2001; Grady, Levenson, & Bolder, 2016; Hudson & Ward,
1997; Hudson, Ward, & McCormack, 1999; Smallbone & Dadds,
1998; Vondra, Shaw, Swearingen, Cohen, & Owens, 2001).
ACE and Sex Offenders
The ACE scale was developed by the CDC to measure child-
hood adversity and was used in the 1990s to collect normative data
from over 17,000 adults in California; it has become a useful and
well-researched tool for measuring the accumulation of traumatic
events related to child maltreatment and family dysfunction (Anda
et al., 2010). One’s ACE score (1–10) reflects the number of
dichotomous items endorsed and higher scores represent a more
95
pervasive and diverse history of adversities. Both male and female
sexual offenders have significantly higher ACE scores than indi-
viduals in the general population (Levenson et al., 2014; Levenson,
Willis, & Prescott, 2015; Reavis, Looman, Franco, & Rojas, 2013;
Weeks & Widom, 1998). A study of adult male sexual offenders
(N ⫽ 679) found that, compared to males in the general popula-
tion, they had more than three times the odds of child sexual abuse
(CSA), nearly twice the odds of physical abuse, 13 times the odds
of verbal abuse, and more than four times the odds of emotional
neglect or having unmarried parents (Levenson et al., 2014).
Weeks and Widom (1998) also found that the rates of child
maltreatments for male sex offenders exceeded those of males in
the general population, with 26% revealing child sexual abuse,
18% reporting neglect, and two thirds stating that they were
victims of physical abuse. Likewise, the prevalence of adverse
childhood experiences is higher for female sexual abusers than for
nonoffending women (Gannon, Rose, & Ward, 2008; Levenson et
al., 2015; Turner, Miller, & Henderson, 2008; Wijkman, Bijleveld,
& Hendriks, 2010). Emotional abuse early in life is a robust risk
factor for both sexual victimization and sexual perpetration behav-
ior, whereas physical neglect and family violence emerged as
significant risk factors for sexual victimization (Jennings, Zgoba,
Maschi, & Reingle, 2014).
It appears that many sex offenders were raised in chaotic or
disordered social environments by caregivers who were ill-
equipped to protect their children from harm (Levenson et al.,
2014, 2015). For instance, less than 16% of male sex offenders
reported no adverse experiences, compared with 38% of the males
in the CDC study, and almost half endorsed four or more (com-
pared with about 9% of the male CDC sample, Levenson et al.,
2014). In a similar analysis, 48% of male interpersonal violence
offenders (child abusers, domestic violence assaulters, sex offend-
ers, and stalkers) reported four or more adverse experiences (Rea-
vis et al., 2013).
Some scholars have hypothesized that insecure attachments
lead to intimacy deficits and that some individuals attempt to
connect with others through coercive, violent, or deviant sexual
behavior (Bushman et al., 2001; Marshall, 2010; Ward, 2014).
Sex offenders with insecure attachments demonstrate higher
levels of aggression in sexual relationships, have a higher
tolerance for violence in relationships in general, and have more
instability in their adult romantic relationships (Lyn & Burton,
2005). Furthermore, recent research suggests that there is a
positive correlation between measures of insecure attachment
and the number and severity of risk factors associated with
criminal behavior, including sexual crimes (Grady, Swett, &
Shields, under review).
It is perhaps not unexpected that early adversity is linked to
sexually abusive behavior. Incompetent parenting activates and
reinforces dysfunctional interaction styles and reduces oppor-
tunities for exposure to (and rehearsal of) effective communi-
cation and intimacy skills (Rutter et al., 2006). A lack of
healthy attachment in a childhood environment can contribute
to subsequent impersonal, selfish, combative, or adversarial
relationship patterns, including tolerant attitudes toward bound-
ary violations such as sexual abuse (Beech & Mitchell, 2005;
Hanson & Morton-Bourgon, 2005). Violent or sexually deviant
behavior may be among the coping responses that emerge from
early traumatic experiences.
 96 LEVENSON AND GRADY
Additional research has revealed a relationship between early
family experiences and sex offenders’ types of offenses (Levenson
et al., 2014; Lyn & Burton, 2004; Smallbone & Dadds, 1998;
Ward, 2014). Sexualized coping may provide a way of soothing
distress and/or meeting needs for intimacy, affection, attention,
power, or control, and this may be especially true for sex offenders
with a childhood history of molestation (Seto, 2008). Sexual
deviance, as evidenced by paraphilic preference for children,
seems to be linked with early adversity; higher ACE scores were
correlated with younger victim age (Levenson et al., 2014). Sex
offenders have higher rates of child sexual abuse than nonsex
offenders (Jespersen, Lalumière, & Seto, 2009), and those with a
sexual abuse history are more likely to have younger victims and
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pedophilic interests (Nunes, Hermann, Renee Malcom, & Lavoie,
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2013). Higher ACE scores have also been correlated with use of
force or violence in the commission of a sex crime (Levenson et
al., 2014).
Sexual deviance and antisocial criminality are important ar-
eas to study and understand, as they are both associated
with increased risk for recidivism (Hanson & Bussiere, 1998;
Hanson & Morton-Bourgon, 2005; Quinsey, Harris, Rice, &
Cormier, 1998). The most dangerous sex offenders are those
who are afflicted not only with deviant sexual preferences, but
who also possess the capacity to act on those interests with little
regard for the consequences to others. Early meta-analyses
(Hanson & Bussiere, 1998; Hanson & Morton-Bourgon, 2005)
observed that childhood abuse was not associated with sexual
recidivism, but more recent and refined findings point to a link
between CSA and sexual recidivism for high-risk sex offenders
(Nunes et al., 2013), and to a correlation between ACE scores
and risk scores (Levenson et al., 2014). Patterns of sexual
deviance and violence are also different for generalist and
specialist sex offenders; specialists are defined as those for
whom sexual offenses constitute more than half of their total
number of arrests (Harris, Knight, Smallbone, & Dennison,
2011). For instance, child molesters are more likely to engage
only in sexual offending (specialists), whereas rapists of adults
display tendencies toward criminal diversity (generalists) (Har-
ris et al., 2011; Harris, Smallbone, Dennison, & Knight, 2009;
Lussier, LeBlanc, & Proulx, 2005). Higher ACE scores have
been associated with greater versatility and persistence of crim-
inal behavior in male sexual offenders (Levenson & Socia,
2015).
Purpose of the Current Study
The purpose of this study was to explore the influence of
adverse childhood experiences on offense characteristics in a sam-
ple of convicted sexual offenders. Based on developmental theo-
ries of criminality and sexual offending, it was hypothesized that
higher ACE scores would be associated with higher levels of
sexual deviance and sexual violence. An additional exploratory
aim was to determine the influence of various types of childhood
adversity on sexually abusive and violent behavior. This study is
the first to investigate the relationship between childhood adversity
and the two outcome variables in this particular fashion, attempt-
ing to fill a gap in knowledge about the etiology of sexual perpe-
tration patterns.
Method
Data Collection
A nonrandom convenience sample of sexual offenders was
surveyed in outpatient (72%) and civil commitment (28%) treat-
ment programs in the United States. An invitation was posted on
the e-mail list-serv of the Association for the Treatment of Sexual
Abusers (ATSA) to find treatment programs who could recruit sex
offender client participants. The data collection sites were located
in New Jersey, Illinois, Texas, Florida, Georgia, Maryland, Mon-
tana, Washington, and Maine. All clients attending treatment in the
programs (approximately 1,000) were invited to participate by
staff and therapists. Presumably because of these trusting relation-
ships between clients and staff, a strong response rate (approxi-
mately 74%) was obtained, and a total of 740 sex offenders
voluntarily agreed to complete the survey. Outpatient sex offender
treatment programs usually serve clients who have been court
ordered to treatment as part of their parole following a criminal
conviction, or as part of a family court plan related to a child
protective services investigation, and in this sample 2.9% reported
no arrest history and voluntarily sought treatment. Civilly com-
mitted sex offenders receive treatment in a secure facility follow-
ing their incarceration.
Federal guidelines for human subject protection were followed
and the project was approved by an Institutional Review Board.
Clients were invited to voluntarily complete the anonymous survey
during a regularly scheduled group therapy session at their respec-
tive participating data collection sites. Clients were instructed not
to write their names on the survey, and to place the completed
survey in a sealed box with a slot opening. Informed consent was
provided in writing and explained verbally. To further ensure
anonymity, participants were not required to sign a consent doc-
ument. Completion of the survey was considered to imply in-
formed consent to participate in the project.
Participants
The sample for the current study was comprised of 740 male
(93.5%) and female (6.5%) adult sex offenders. Sample demo-
graphics are displayed in Table 1. Most participants were white
(68%) and the majority (71%) were between 31 and 60 years of
age, with 20% age 30 or younger and 9% over age 60. Nearly two
thirds (62%) of the sample had completed high school or obtained
a Graduate Equivalency Diploma (GED) as their highest educa-
tional achievement, and one in five identified themselves as col-
lege graduates. More than half (59%) grossed less than $30,000 in
the last year they earned income. Almost half (46%) of the sex
offenders had never been married, with 16% currently married,
35% divorced or separated, and 3% widowed.
Instrumentation
The first section of the survey consisted of the Adverse Child-
hood Experiences (ACE) Scale (Centers for Disease Control &
Prevention, 2013b), a 10-item dichotomous (yes/no) scale in which
participants endorse whether or not they had experiences prior to
18 years of age that included: abuse (emotional, physical, and
sexual), neglect (emotional and physical), and household dysfunc-
 ACE AND SEX OFFENSE PATTERNS 97

Table 1 on this brief instrument in hundreds of studies (Centers for Disease

Sample Demographics Control & Prevention, 2013a).
The second section of the survey collected information about
Demographic categories Percent (N ⫽ 740) offense characteristics, which were used to measure the constructs
Race of interest in this study (sexual deviance and sexual violence) and
White 68 can be seen in Table 4. No information that could potentially
Minority 32 identify offenders or victims was sought.
Gender
Male 93.5
Female 6.5 Variables
Age (years)
18–30 20 The primary purpose of the study was to explore the influence
31–40 22 of adverse childhood experiences on sexual deviance and sexual
41–50 30 violence, and two dependent variables were created for this pur-
51–60 19 pose. The Sexual Deviance Scale (possible score range ⫽ 0 – 4)
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Over 60 9
comprised four dichotomous (yes/no) items including male victim,
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Marital status
Never married 46
Married 16
Divorced/separated 35
Widowed 3 patterns; a higher score (endorsement of multiple categories) in-
Education
Not high school graduate 18
High school graduate or GED 62
College graduate or higher 20
Income
Under $20,000 41
$20,000–$29,999 18
$30,000–$49,999 20
$50,000⫹ 21
tion (domestic violence, unmarried parents, and the presence of a
substance-abusing, mentally ill, or incarcerated member of the
household). One’s total ACE score is the sum of the number of
items endorsed by that individual (range ⫽ 0 –10).
The ACE categories were originally developed by adapting
items from instruments that demonstrated validity and reliability in
earlier studies: the Conflict Tactics Scale (Straus, Gelles, & Smith,
1990), the Child Trauma Questionnaire (Bernstein et al., 1994),
and questions from a survey about sexual abuse (Wyatt, 1985).
The test–retest reliability of the ACE scale has been examined by
administering the survey twice to over 600 participants, and re-
searchers found that Kappa coefficients ranged from good to
excellent, indicating that retrospective reports of early abuse and
household dysfunction are normally stable over time (Dube, Wil-
liamson, Thompson, Felitti, & Anda, 2004). Though no validity
data are available on the ACE scale itself, a review of 40 studies
assessing the validity of retrospective reports found that underre-
porting of child maltreatment was common, but false positives
were rare, and researchers should not be dissuaded from using
well-defined self-report measures of childhood adversity (Hardt &
Rutter, 2004). Finkelhor et al. (2013) attempted to improve the
ACE scale by modifying some items and adding additional do-
mains (e.g., peer victimization, community violence, illnesses and
injuries, socioeconomic status), and then testing the new version
on a nationally representative sample. They concluded that the
adjustments led to more robust effects when measuring distress by
trauma scores, but that the child maltreatment items in the original
ACE scale remained important contributors to the cumulative
stress of early adversity (Finkelhor, Shattuck, Turner, & Hamby,
2013). Noteworthy is that the ACE scale has become a widely used
measure of childhood adversity and many researchers have relied
stranger victim, victim under 12, and multiple victims (Cronbach’s
alpha ⫽ .61). The scale was devised using known risk factors for
sex offense recidivism and indicators of paraphilic preference
dicated a higher degree of sexual deviance. The other variable, the
Sexual Violence Scale, was intended to capture the use of violence
in the commission of a sexual crime, as measured by endorsement
of “yes” to questions asking whether the offender had ever used
force, weapons, or caused injury during a sexual crime (range ⫽
0 –3; Cronbach’s alpha ⫽ .73). All of these variables were ob-
tained via self-report in the survey.
Independent variables included the 10 dichotomous ACE items
(yes/no; see Table 2) and the total ACE score, by which a higher
score reflects a wider scope of childhood maltreatment and expo-
sure to household dysfunction.
Analyses
Descriptive statistics are reported for each of the ACE items and
constructs of interest. Group comparisons (t tests and chi-square)
and bivariate correlations were used to examine relationships
between variables. Multivariate regression was used to examine
the influence of individual ACE factors in explaining sexual de-
viance and violent sexual offending.
Results
Table 2 displays the endorsements of ACE items and distribu-
tion of ACE scores for the current sample. It should be noted that
these results have been published elsewhere (Levenson, Willis, &
Prescott, 2014, 2015) but are included here for readers’ conve-
nience.
Participants answered a series of questions about victim char-
acteristics, taking into account their index offense, any prior ar-
rests, and any undetected offending, and endorsed whether they
had ever had a victim in any of the gender, age, or relationship
categories listed in Table 3. There were significant differences
between males and females in most of the categories. Importantly,
males were more likely to have stranger victims, more victims,
more sex crime arrests, and more general arrests. Males were more
likely to use force or weapons. Nearly three-quarters of the females
were specialist offenders (compared to half the males), for whom
sexual offenses constituted more than half of their total arrests.
t tests were used to test mean differences between groups in
ACE scores (see Table 4). Though males and minorities had
 98 LEVENSON AND GRADY

Table 2
ACE Item Endorsement and Score Distribution (Valid n ⫽ 689)

Total Male Female

Measure (n ⫽ 681) (n ⫽ 635) (n ⫽ 46)

ACE item endorsement

Childhood experience with Chi-square
... % responding ‘yes’ (male/female comparison)
Verbal abuse 52 53 38 3.982ⴱ
Physical abuse 42 42 34 1.209
Child sexual abuse 38 38 50 2.847
Emotional neglect 37 38 40 .150
Physical neglect 16 16 11 .942
Parents not married 54 54 47 1.003
DV in home 24 24 23 .010
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Substance abuse in home 46 47 40 .706

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Mental illness in home 26 26 21 .486

Incarcerated family member 23 23 17 .804

Distribution of ACE scores

Total ACE score % with ACE score Chi-square
0 15.7 16 20 ns
1 13.8 14 11 ns
2 12.8 13 15 ns
3 12.5 12 13 ns
4⫹ 45.3 45 41 ns
Mean ACE score (SD) 3.51 (2.71) 3.54 (2.7) 3.2 (2.6) t ⫽ .816
Note. ACE Scores ranged from 0 to 10. ns ⫽ not significant.
ⴱ
p ⬍ .05.

slightly higher ACE scores than females and Whites, these differ- exclude females was made because there is less consensus in the
ences were not significant. However, sex offenders with male, conceptualization of sexual deviance for female sex offenders, and
stranger, prepubescent, and multiple victims had significantly therefore the use of factors to devise this construct would be
higher ACE scores, as did those who had used force or weapons or speculative. Paraphilic sexual deviance indicators are much more
caused injury during a sex offense. Specialists whose sex offenses well-established in the research literature about male sex offend-
constituted more than half of their arrests were found to have ers. Missing data reduced the sample size in all models by case-
significantly lower ACE scores than generalist offenders. wise (listwise) deletion, however power analysis determined that
Bivariate correlations revealed that higher ACE scores were
significantly correlated with higher scores on the scales measuring
sexual deviance, r ⫽ .30, p ⬍ .01 and sexual violence, r ⫽ .28, p ⬍ Table 4
.001. Sexual deviance and sexual violence were significantly cor- Group Comparisons of Mean ACE Scores
related with each other, r ⫽ .41, p ⬍ .01. Groups
Multiple regression techniques were used to further examine the
influence of childhood adversity on sexual deviance and sexual Variable Mean ACE score Sig.
violence for male offenders only (see Table 5). The decision to Gender Male Female ns
3.5 3.2
Race Minority White ns
Table 3 3.7 3.5
Offense and Victim Characteristics by Gender of Offender Male victim Yes No .000
4.3 3.2
Male Female Stranger victim Yes No .000
Characteristic %/mean %/mean 4.1 3.2
Victim under 12 Yes No .000
Male victimⴱ 27% 42% 4.2 2.9
Stranger victimⴱⴱ 35% 11% Ever used force Yes No .000
Victim under 12 52% 40% 4.9 3.1
Ever used forceⴱⴱ 23% 4% Ever used weapon Yes No .000
Ever used weaponⴱ 9% 0% 5.3 3.4
Ever caused injury 10% 2% Ever caused injury Yes No .000
Total sex crime arrestsⴱ 1.47 1.09 5.4 3.3
Total nonsex arrestsⴱⴱ 2.99 1.87 Multiple victims Yes No .000
Multiple (2 or more) victimsⴱⴱⴱ 58% 30% 3.9 2.9
Specialistⴱⴱ 50% 73% Specialist (versus generalist) Yes No .000
3.1 4.1
Note. Chi-Square Significant differences between groups.
ⴱ
p ⬍ .05. ⴱⴱ p ⬍ .01. ⴱⴱⴱ p ⬍ .001. Note. ns ⫽ not significant.
 ACE AND SEX OFFENSE PATTERNS 99

Table 5 life. The regression models examining the influence of the ACE
ACE Items Predicting Sexual Deviance and Sexual Violence items were statistically significant, however the effect sizes were
(Male Offenders) not substantial and explained only a minority of the variance in the
outcomes of interest. This implies that there are other factors, not
ACE items Beta t Sig. contained in these models, which provide explanatory power about
Model 1: ACE items predicting sexual deviance the overall etiology of sexual deviance and sexual violence. It
Verbal abuse .072 1.363 .173 appears that adverse childhood experiences do contribute to these
Physical abuse ⫺.010 ⫺.187 .852 negative adult outcomes, but obviously they do so in combination
Child sexual abuse .257 6.092 .000 with other variables, not available in these analyses, that mediate
Emotional neglect .118 2.626 .009
Physical neglect ⫺.057 ⫺1.295 .196 risk and resilience. Consistent with developmental and attachment
Parents not married ⫺.095 ⫺2.341 .020 theories of criminality and sexual offending, the findings sup-
DV in home .057 1.288 .198 ported the hypothesis that higher ACE scores would be associated
Substance abuse in home .026 .606 .545 with indicators of sexual deviance and sexual violence.
Mental illness in home .099 2.329 .020
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The findings offer some insight into the different pathways

Incarceration family member .021 .526 .599
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Model 2: ACE items predicting sexual violence leading to sexually deviant and sexually violent behaviors. Predic-
Verbal abuse .022 .405 .686 tors of deviance included childhood sexual abuse, emotional ne-
Physical abuse .108 2.005 .045 glect, mental illness in the home, and unmarried parents. It is
Child sexual abuse .077 1.776 .076 known that children with single or unmarried parents are at higher
Emotional neglect .066 1.434 .152
Physical neglect ⫺.020 ⫺.454 .650 risk for CSA (Finkelhor & Baron, 1986) because of less attentive
Parents not married ⫺.009 ⫺.204 .839 supervision and exposure to multiple caretakers on whom an
DV in home .008 .177 .860 unmarried parent might rely for child care assistance. At the same
Substance Abuse in home .097 2.179 .030 time, an overwhelmed single parent might be physically absent
Mental illness in home .009 .202 .840
and/or emotionally unavailable, increasing the child’s vulnerability
Incarceration family member .126 3.073 .002
to a sexually abusive adult who grooms the child by providing
attention and nurturing. Sexually abused children may grow up to
use sex to compensate for feelings of invalidation or powerless-
to detect a medium effect size with 10 predictors, the reduced ness, they may replicate their own abuser’s behavior and distorted
sample size of 609 was more than sufficient (Faul, Erdfelder, thinking, or they may come to associate sexual arousal with
Lang, & Buchner, 2007). Preliminary analyses were conducted to adult-child sexual activity (Seto, 2008). Sexualized coping can
check for normality, outliers, and collinearity. Residuals were offer a way of soothing distress and/or meeting needs for intimacy,
observed in the probability plots and revealed no major deviations. affection, attention, and control (Bushman et al., 2001; Levenson
Standardized residuals were checked and few cases had values et al., 2014). The abused or neglected child, as an adult, may tend
above 3.0 or below ⫺3.0. The maximum Cook’s Distance was to seek out younger individuals whom he perceives as looking up
.015, indicating that outliers were not a significant problem. The to him and who will not hurt him. His victim choices are “safe”
variance inflation factors were all below 10, and tolerance was and therefore he feels less vulnerable.
well above .10, indicating that multicollinearity was not problem- On the other hand, predictors of violence included physical child
atic. abuse, substance abuse in the home, and having an incarcerated
ACE items were entered into the multiple regression model with family member. Sexual violence in adulthood might be shaped by
the sexual deviance scale score as the dependent variable. The earlier observations of aggression via harsh corporal punishment
model explained about 15.7% of the variance in the dependent or arbitrary discipline practices. The effects of physically abusive
variable, F(10, 609) ⫽ 11.150, p ⬍ .001.Within the model, child- parenting can be exacerbated when substance abuse interferes with
hood sexual abuse, emotional neglect, mental illness in the home, a parent’s anger management and further models poor self-
and parents not married were significant (p ⬍ .05) predictors of regulation (Dube et al., 2001). Having incarcerated family mem-
increased sexual deviance. The strongest contributors were child bers may reinforce criminal modeling, and may also generate
sexual abuse and emotional neglect. feelings of hopelessness and helplessness for children witnessing
ACE items were entered into a new multiple regression model with such conditions in their own homes. Disempowerment and a view
sexual violence as the dependent variable, explaining 9.7% of the of the world as unfair might lead to a distorted sense of entitle-
variance, F(10, 616) ⫽ 6.540, p ⬍ .001.Within the final model, ment, and violence can become a way to seize a sense of power
childhood physical abuse, substance abuse in the childhood home, and and control. As well, the chaotic familial dynamics characterized
an incarcerated family member were significant predictors of in- by aggression and addiction may offer few opportunities to ob-
creased sexual violence. Incarcerated family member was the stron- serve and establish healthy intimate attachments, paving the way
gest contributor, followed by physical abuse and substance abuse. for affective and behavioral dysregulation as well as maladaptive
coping (Ford, Chapman, Connor, & Cruise, 2012).
Deficits in interpersonal functioning and coping are commonly
Discussion
found among individuals with insecure attachments. Research
The results revealed that childhood adversity was associated shows that individuals without a secure attachment are more likely
with sexual deviance and sexual violence for male sex offenders, to struggle with affect regulation (Ford et al., 2012), have a mental
suggesting that the accumulation of early trauma can increase the health diagnosis (DeKlyen & Greenberg, 2008; Mikulincer &
likelihood of sexual and general self-regulation difficulties later in Shaver, 2012), and have higher rates of violence across the life
 100 LEVENSON AND GRADY
span (Crittenden, 1992). It is therefore possible that sexual vio-
lence and deviance, in many cases, can be traced back to insecure
attachments that were formed through adverse childhood experi-
ences (Grady, Levenson, & Bolder, 2016). The link between child
abuse and neglect and later offending behavior is well established
(Abbiati et al., 2014; Lee, Jackson, Pattison, & Ward, 2002;
Simons, Wurtele, & Durham, 2008).
Implications for Practice and Policy
Trauma-informed practitioners recognize the prevalence of
childhood adversity in the general population, expect the majority
of clients to have experienced early trauma, and understand the
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
biological, social, psychological, cognitive, and relational impact
This document is copyrighted by the American Psychological Association or one of its allied publishers.
of traumatic events on adult functioning and high-risk behavior
(Larkin et al., 2014; Levenson, 2014; D. S. Young, 2014). Clini-
cians assessing and treating sex offenders should be well-versed in
knowledge related to trauma and how it contributes to problematic
sexual behaviors. Though cognitive– behavioral interventions are
the conventional treatment of choice for sex offenders, such pro-
grams can be informed by the literature on attachment, develop-
mental psychopathology, and trauma-informed care.
Trauma-informed clinicians recognize that relational patterns in
adulthood often mimic those learned early in life. That sexual
deviance was significantly associated with sexual abuse, and that
sexual violence was associated with physical abuse, reinforces the
notion of isomorphism between early victimization and later per-
petration. Isomorphism as a psychological construct refers to a
symbolic representation that generates behavior and decision-
making based on anticipated events and relations in the environ-
ment (Gallistel, 2001). In other words, expectations associated
with past encounters are triggered when similar environmental
conditions exist in the present, and thus adult perpetration patterns
may replicate victimization experiences. Helping sex offender
clients understand the impact of traumatic childhood experiences
on their adult functioning might lead to improved therapeutic
outcomes that diminish future risk (Abbiati et al., 2014; Levenson,
2014) and provide reparative opportunities for anxious and inse-
cure attachment styles (Grady, Swett, & Shields, 2016).
The therapeutic alliance itself can have a profound positive
impact on outcomes for sex offenders through exposure to trauma-
informed corrective emotional experiences that model empathy
and effective relational skills (Connors, 2011; Marshall, Burton, &
Marshall, 2013; Marshall et al., 2003; Marshall et al., 2002).
Research indicates that through the curative nature of a trauma-
informed counseling relationship, clients’ attachment styles can
shift and become more secure (Mikulincer & Shaver, 2012). Re-
cent research specifically with sex offenders demonstrated that
they can and do become more securely attached with a strong
therapeutic bond, even in a CBT-based program (Grady et al.,
2016). Furthermore, as attachment becomes more secure, dynamic
risk factors associated with criminality are reduced (Grady et al.,
under review). Clinical practitioners can advance social justice
through the application of trauma-informed service delivery (Mas-
chi & Killian, 2011; Sheehan, 2012; D. S. Young, 2014).
Moreover, it is crucial that social policies be responsive to the
lasting and substantial impacts of early adversities and their role in
the development of criminal and abusive behaviors. Adverse child-
hood experiences are now viewed as a public health crisis (Anda
et al., 2010; Felitti, 2002; Larkin et al., 2014). There is a robust
body of research documenting the significant impact of childhood
adversity on risk for poly victimization as well as pervasive and
profound posttraumatic stress symptoms (Cloitre et al., 2009;
Finkelhor, Turner, Hamby, & Ormrod, 2011). Unfortunately, pri-
mary prevention of child maltreatment has been somewhat ne-
glected in favor of American social policies focused predomi-
nantly on offender punishment and child placement (Larkin et al.,
2014; Levenson & Socia, 2015). Youth growing up in disadvan-
taged communities and society as a whole would benefit from
prioritizing preventive interventions.
Household dysfunction and chronic maltreatment put children at
a higher risk for becoming addicted to substances and committing
crimes (DeHart et al., 2009; DeHart, Lynch, Belknap, Dass-
Brailsford, & Green, 2014; Harlow, 1999; Jennings et al., 2014;
Mersky et al., 2012; Topitzes, Mersky, & Reynolds, 2012; Widom
& Maxfield, 2001). Multiple public health and primary prevention
implications are clear: we need to provide victims of all forms of
child maltreatment with immediate and appropriate therapeutic
services, to intervene early with at-risk parents to help them
develop skills that foster attachments and healthy family function-
ing, and to alter the culture of the criminal justice system to utilize
a more trauma informed approach to incarceration and reentry
(Baglivio et al., 2014; Larkin et al., 2014; Mendelson & Letour-
neau, 2015; Miller & Najavits, 2012). To halt the cycle of inter-
personal violence in communities, it is critical that the mental
health, child protective, and criminal justice systems invest in
comprehensive prevention programs for high risk families and
treatment for child victims (Anda et al., 2010; Baglivio et al.,
2014; Miller & Najavits, 2012).
Limitations
There are several limitations to this study. First, all information was
provided by offender self-report, and the design of the study did not
allow for review of official documentation to verify responses. The
responses may reflect impression management bias, a desire to hide
embarrassing behaviors or experiences, or exaggeration of early
trauma experiences in a maneuver to gain sympathy or justify behav-
ior. On the other hand, it is plausible that some offenders do not
readily recognize early adversity as pertaining to themselves, perhaps
underreporting childhood trauma. Another limitation of self-report is
that we were unable to obtain DSM diagnoses made by a clinician to
determine whether a participant met criteria for a paraphilic disorder,
which might have provided an additional and important measure of
sexual deviance. Second, the participants were all in treatment pro-
grams and therefore the findings might not generalize to the full
population of sexual offenders. Third, the ACE scale as a measure of
early adversity is imperfect. Clearly there is an array of traumatic
experiences beyond child maltreatment and family dysfunction that
shape adult behavior. Moreover, the ACE scale measures only intra-
familial experiences and its dichotomous nature does not allow for
unmeasured heterogeneity in the frequency, duration, or severity of
childhood traumas. This study does not account for extrafamilial or
environmental factors such as community violence, poverty, discrim-
ination, microaggression, death, illness, natural disasters, or bullying.
The ACE scale is not intended to be an exhaustive measure of trauma,
nor does it fully capture the scope of variables that contribute to
 ACE AND SEX OFFENSE PATTERNS
sexually abusive behavior. Finally, given the retrospective and cross-
sectional research design, causality cannot be inferred.
Conclusions
Adverse childhood experiences were associated with sexual
deviance and sexual violence. Clinicians should recognize the
prevalence of early trauma in the lives of clients and consider the
role of childhood adversity to inform treatment planning for both
offenders and victims. Because self-regulatory deficits are often a
consequence of ACEs and should be viewed as dynamic risk
factors for reoffending, practitioners should integrate trauma-
informed forensic counseling methods that individualize and de-
liver services in a way that is relevant to risk, criminogenic needs,
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
and responsivity factors (Andrews & Bonta, 2010; Hanson, Bour-
gon, Helmus, & Hodgson, 2009; Levenson, 2014). Social policies
that prioritize primary prevention programs, child protection ser-
vices, and early interventions for at-risk families and maltreated
youth can disrupt the trajectory toward criminal and sexually
abusive behavior in adulthood. Trauma-informed practitioners
must address the micro, mezzo, and macro issues that perpetuate
the cycle of sexual violence in our communities.
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Received October 3, 2015
Revision received December 30, 2015
Accepted January 18, 2016 䡲