I wanted to share a "Case Study" of a student who was enrolled at Oxbow Academy a short time ago. This student was 15 years old and was adopted at birth. He reached developmental milestones on an average basis. The student was diagnosed with ASD Level 1 in fourth grade, and an IEP was subsequently developed for the remainder of elementary school. There were occasional episodes of dysregulation and some sexually reactive behaviors with peers. Teachers and other professionals attributed this behavior to ASD and/or RAD. At 14 years old, the student was referred to an RTC that specializes in working with students struggling with ASD. The clinical data presented below comes from an email report written by the student’s therapist at Oxbow, directed to the referring professional. This communication is standard in an effort to ensure continuity of care and collaboration.
As you may know, students at Oxbow Academy participate in a process of documenting a detailed sexual disclosure as part of the evaluation. Only when the student says they are ready do we schedule the clinical validation of the disclosure. The therapist, parents, polygrapher, and student collaborate to determine the questions to be asked. This is done in a very transparent and open way. When the student arrives at the polygrapher’s office, the polygrapher explains the process, reviews the questions, and also checks if there is any additional information the student needs to disclose that hasn’t already been shared.
It is emphasized throughout this process that the goal is to help them “build a relationship with honesty,” thus allowing them to experience what it feels like to be trusted again. It is common for students to disclose additional information during this session.
You may wonder, “Why would a teen disclose more information at the last moment?”
The answer lies in the internal conflict that these students often experience. These students are not sexual deviants, perpetrators, or offenders (labels and language that originate in the adult legal system). They are simply teens who have been exposed to pornography, trauma, and life events that have sexualized them at a formative and vulnerable age. Many of the students at Oxbow report having first seen pornography around the age of four. How does a four-year-old integrate and make sense of what they are seeing at such a young age? At this point, it is not a moral issue, but one of early childhood development.
Each student has learned to manage the lies, secrets, and associated shame in a very individualized way, just as anyone would. Above all, they long for honest and trusting relationships with family and peers. Despite how difficult it may be to disclose their behaviors, they learn to understand that telling the truth is far better than enduring the pain of continuing a lie.
Again, the below excerpt was written by the boy’s therapist to the referring professional. It has been edited to maintain confidentiality.
“...as you already know, Xxxxxx passed his polygraph. Ironically, both parents are now really upset and scared for Xxxxxx. Passing the polygraph came at the price of new information he shared with the polygrapher, but not with me or his parents prior to the exam.
Xxxxxx has sexually engaged with a friend of the family's pet animals (5-7 times over the course of 2 years), ...Also, Xxxxxx did have sexual contact with a number of different students from [His previous placement].
[Mom] stated yesterday, ‘Thank God he is with you guys, no doubt he needs this treatment’.
...Xxxxxx is making significant shifts here at Oxbow. Parents can see that, and they believe he will do better with his testing now, compared to the state of mind he was in at [His previous placement].”
It is important to remember that the main question is not:
“Are things ‘bad enough’ that the student needs Oxbow Academy?”
The clinical best practice question needs to be:
“What is the most clinically sophisticated way to assist the teen in disclosing information, identifying the clinical relevance, and creating a treatment plan based on fact and not suspicion?”
If you have a client where you suspect there may be “more to the story,” here are a few questions you can share with the parents when considering further evaluation from Oxbow Academy:
- How clinically important is it for this information to be disclosed?
- How does this information affect his short-term and long-term treatment plan?
- What impact has keeping these secrets had on his progress in other treatment settings?
- Is there an economic benefit to uncovering this information early in the treatment process?
Families often share with us that they appreciate these difficult conversations, even though they can be painful. Quite often, they report that there have been stressful and embarrassing situations that they have navigated for many years. There is actually a sense of relief for the family once the evaluation process begins.
Scheduling an evaluation is the first step. Learn more here.
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