Treatment of Youth Sexual
Offenders: Past, Present, and Future
Michael H. Miner, Ph.D.
Program in Human Sexuality
Department of Family Medicine and Community Health
Goals for this Presentation
• Describe the history of youthful sexual
offender treatment
• Describe current trends in treatment of
youthful sexual offenders
• Ideas of where to go from here
Driving Factors
• Data from retrospective studies of adult
offenders.
• Perceived increase in juvenile crime.
• Feminist perspective
In the beginning …..
• Clinicians moved from working with adult
sexual offenders to working with adolescents
(e.g., Judith Becker, Rob Longo)
• Move from “Boys will be boys” to
identification of behaviors that were abusive,
damaging, and inappropriate.
• Clinical practice proceeded research.
National Task Force on Juvenile
Sexual Offending (1993)
• Addressed a number of areas including
– Community Protection
– System Response
– Legal Response
•
•
•
•
Mandatory Reporting
Prosecution
Role and Responsibility of Defense Counsel
Court Process
– Assessment
– Treatment
Assumptions
• Sexually abusive youth require a specialized,
offense-specific treatment approach.
• Offense-specific treatment should be structured
• Treatment of sexual abusive youth requires
nontraditional techniques and may run counter to
original professional training
• Adequate treatment takes 12-24 months
• Family involvement may have a primary and
significant impact on treatment process and
management of aftercare plans.
• Labeling of sexually abusive behaviors is
necessary to prevent minimization and denial.
Issues to be addressed
(Task Force Report, 1993)
1.
2.
Acceptance of responsibility
Identification of pattern or
cycle
3. Interruption of cycle and
control of behavior
4. Resolution of victimization
5. Development of victim
awareness/empathy
6. Development of sense of
mastery and control
7. Understanding role of sexual
arousal, reduction of deviant
sexual arousal, definition of
non-abusive sexual fantasy
8. Development of positive sexual
identity
9. Understanding consequences
of offending behavior
10. Identification of family issues or
dysfunction
11. Identification of cognitive
distortions.
12. Identification and expression of
feelings
13. Development of pro-social
relationship skills
14. Development of realistic levels of
trust in adults
15. Management of
addictive/compulsive qualities
16. Remediation of developmental
delays, development of competent
psychological health skills
17. Indications of substance
abuse/gang involvement
18. Reconciliation of cross cultural
issues
19. Manage psychiatric disorders
20. Remediation of skills deficits
21. Develop relapse prevention plan
22. Restitution/reparation to victims
Treatment models: Adolescent and
Adult Programs: 1996 Survey
Treatment Models
Adolescent
Adult
(n-532)
(n=521)
Cognitive Behavioral/Relapse
Prevention
73.3
73.1
Relapse Prevention
8.1
9.2
Cognitive Behavioral
5.1
6.1
Psychotherapeutic
3.6
4.0
Family Systems
2.8
2.3
Developmental contextual
2.4
1.7
And the research said …
Weinrott, 1996 Center for Study and Prevention of
Violence, Univ. of Colorado
• Only one controlled evaluation of treatment
• All other studies were single group follow-up
• Two clear conclusions:
– Most boys who sexually abuse younger children
do not reoffend sexually
– Fair likelihood that JSOs will subsequently come
to the attention of police for non sex-offenses.
Anti-social vs. Sexual Deviant
(Butler & Seto, 2002)
Two types of adolescent sexual offenders.
1. A type that is persistently antisocial with a history
of conduct problems resembling other juvenile
delinquents.
40-50% of adolescent sex offenders could be classified as conduct
disordered (France & Hudson, 1993; Oliver, Nagayma-Hall & Neuhaus,
1993).
2. A type that does not demonstrate these antisocial
traits or conduct problems and appear more
similar to non-offenders with the exception of
more deviant sexual interests.
Age of Victim
• Offenders with child victims differ systematically
from those with peer/adult victims (Hendriks &
Bijleveld, 2004; Hunter, et al., 2000; Hunter et al.,
2003)
• Offenders with peer/adult victims more likely to
have conduct disorder and other delinquent
behaviors than offenders with child victims (Seto &
Lalumière, 2005).
• Stronger support for dividing ASOs into child vs.
peer offenders than single vs. group offenders
(Kjellgren, et al, 2006)
The Deadly Assumption
• Juvenile sexual offenders are a special class
of delinquent.
• Implications
– JSOs have more in common with adult sex
offenders than they do with other juvenile
delinquents.
– JSOs are more dangerous than other delinquent
youth.
– Cannot expect the “aging out” of criminal
behavior found in most delinquent populations.
Butler & Seto (2002)
Sample: 32 sex offenders, 48 criminally versatile
offenders, 34 nonaggressive offenders
Design: Cross-sectional comparison
Findings:
– Sex offenders similar to non-sex offenders on most
measures
– Sex only offenders had fewer conduct problems, better
current adjustment, more prosocial attitudes, and lower
risk for future delinquency
– Those with sex and other offenses resembled criminally
versatile offenders.
Van Wijk et al. (2005)
Sample: 986 boys ages from the middle and oldest samples of
Pittsburgh youth study (ages 10 – 25)
Design: Compared sex offenders (n=39); Index violence (n=139);
Reported violence (n=291); Moderate offenders (n=215); Minor
delinquency/nonoffender (n=302)
Findings:
– Prevalence: 0.04 for sex offenses; 0.14 for index violence; 0.44
for violence
– Sex offenders differed from violent non-sex offenders on only
two of variables tested.
• Sex offenders had more housing problems
• Sex offenders were older at screening
– Trends for sex offenders to differ from violent non-sex offenders
on:
• Higher academic achievement
• More running away
• Had younger mothers with less education
– Combined group of sex and violent offenders differed from
nonviolent offenders on most of the variables tested.
Miner et al. (2010)
Sample: 278 boys ages 13 – 28 recruited from treatment programs,
juvenile probations and juvenile detention facilities.
Design: Compared sex offenders with child victims (n=107); sex
offenders with peer/adult victims (n=49); non-sex delinquents
(n=122)
Findings:
– Logistic regression indicated sex offenders with child victims
when compared to non-sex delinquents showed less cynicism,
more anxiety with women, more hypersexuality, and more sexual
preoccupation.
– Sex offenders with peer/adult victims not substantially different
from non-sex delinquents.
– Sex offenders with child victims differed from those with
peer/adult victims in a similar manner as they differed from nonsex delinquents.
Conclusions
• In general, juvenile sexual offenders do not differ
from non-sex delinquents
• However:
– Sex offenders with child victims differ from both sex
offenders with pubescent victims and non-sex
delinquents on variables related to social skills, social
isolation, and sex drive.
– Some evidence of more family instability in sex offenders.
– Sex offenders with no history of delinquency may show
fewer problems and more prosocial attitudes and
achievements than other delinquents.
Treatment models: Adolescent and Adult
Community Programs – U.S.: 2009 Survey
Treatment Models
Adolescent
Adult
(n=268)
(n=324)
Cognitive Behavioral
63.8
65.1
Relapse Prevention
9.7
14.8
Family Systems
2.8
2.3
Risk-needs-responsivity
3.0
3.1
Multisystemic
6.0
3.1
Good Lives
3.7
5.2
Treatment Targets: Adolescent and Adult
Community Programs – U.S.: 2009 Survey
Targets
Adolescent
(n=268)
Adult
(n=324)
Arousal control
57.5
68.5
Emotional regulation
65.8
65.7
Family support networks
94.0
77.2
Intimacy/relationship skills
86.8
91.2
Offense responsibility
88.2
91.8
Offense supportive attitudes
51.8
54.4
Problem solving
86.0
79.9
Self-monitoring
54.0
56.2
Social skills training
94.1
87.5
Victim awareness and empathy
92.6
92.7
Treatment modality: Adolescent and Adult
Community Programs – U.S.: 2009 Survey
Treatment Models
Adolescent
Adult
(n=271)
(n=326)
Group
69.4
88.0
Individual
94.8
84.6
Family or couples
84.6
65.3
Conclusions
• Theoretic orientations similar for adult and
adolescent sex offender programs
• Targets similar for adult and adolescent sex
offender programs
• Less reliance on group therapy and more use of
family therapy in adolescent programs.
• Data similar across residential and community and
U.S. and Canadian programs.
Need for paradigm shift
• In general, youths who have committed sex crimes are
unlikely to go on to commit sex crimes as adults
• Accumulated data support the heterogeneity of youth who
commit sex crimes
• Accumulated data do not support the assumption that youth
who commit sex crimes are systematically different from
youth who commit non-sex crimes.
• When different, appears to be in areas of social isolation,
social skills, lack of misanthropic views
• Not clear how youth who commit sex crimes are
similar/different from youth with psychological problems
other than delinquency.
IATSO Standards of Care
(Miner et al., 2006)
1.
2.
3.
4.
Juveniles are best understood
within the context of their families
and social environments
Assessment and treatment of
juveniles should be based on a
developmental perspective, should
be sensitive to developmental
change, and should be an ongoing process.
Assessment and treatment should
include a focus on the youth’s
strengths.
The development of sexual
interest and orientation is dynamic.
The sexual interests of youth can
change over the course of
adolescence and this is the period
when sexual orientation immerges.
5.
6.
7.
8.
9.
Youth who have committed sexual
offenses are a diverse population.
They should not be treated with a
“one size fits all” approach.
Treatment should be broad-based
and comprehensive.
Labels can be more iatrogenic in
children and adolescents than in
adults. The juvenile and his/her
family/primary care-giving system
should be treated with respect and
dignity.
Sexual offender registries and
community notification, should not
be applied to juveniles.
Effective interventions result from
research guided by specialized
clinical experience, and not from
popular beliefs, or unusual cases in
the media.
And the research says ….
• Meta-analysis (Reitzel & Carbonell, 2006) found a
significant effect for treatment, but just one
additional random allocation study since Weinrott
(1996).
– Searched studies conducted from 1990-2001
– Only 9 studies (4 published) met inclusion criteria
• The only intervention that has been rigorously
tested in sexual offending youth is Multi-Systemic
Therapy (Borduin et al., 1990; Borduin & Schaeffer;
2001; Borduin et al., 2009).
Future Directions
New Assumptions
• Youth who commit sex crimes are not a special
class of delinquent.
• Most will not go on to commit sex crimes as adults.
• To understand a youth’s behavior, you have to
place it within the social and environmental context
in which he/she resides.
• When there are differences between youth who
commit sex crimes and those who commit other
crimes, they are in the areas of social involvement
and interpersonal relationships.
Future treatment interventions
• Move away from offense-specific focus
• Include a broad-based approach that focuses
on the youth’s strengths and needs, and on
the supports and barriers in his/her
environment.
• Foster social involvement rather than limit
social involvement.
• Focus on providing opportunities for growth
more than limiting opportunities to offend.
Moving forward
• Further develop empirical base.
• More rigorous treatment efficacy trials
– Currently MST most promising intervention
because it focuses broadly, but also because it is
the only intervention subjected to rigorous study.
Contact Information
• Program in Human Sexuality
1300 So. Second Street, Suite 180
Minneapolis, MN. 55454
• [email protected]
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