March 30, 2014 Evaluation of the Adolescent Sex Offender Michael Adler, Ed.D., Licensed Psychologist 1 American Society for Adolescent Psychiatry 2 March 30, 2014 Background Clinical Director Chesapeake Treatment Center/New Directions Program Program Director Glass Health Programs/Hickey School Mental Health and Services Hickey School 3 March 30, 2014 Holland’s Self Directed Search Department of Juvenile Services Intake Probation Aftercare Services 4 March 30, 2014 Background information commonly available Social History Investigations, Educational History Formal charges, Juvenile Court Offense, formal charges, informal charges, type of offense, disposition, records, placement and treatment histories including, facility incident reports, reports to CPS Police reports, victim statements, medical screenings Previously completed psychiatric, psychological evaluations, cognitive and personality test results Records of previous treatment, treatment response, hospitalizations, medications 5 March 30, 2014 Sample Test Battery Clinical Interview Reynolds Adolescent Depression Scale-2nd edition Thematic Apperception Test Trauma Symptom Checklist for Children BASC2 Behavior Assessment System for Children Adolescent version 2nd edition-Self Report-ages 12-21 Adolescent Cognition Scale(Revised)Abel, Becker and Kaplan Adolescent Sexual History Inventory JSOAP II (Juvenile Sex Offender Assessment Protocol) ERASOR2 (The Estimate of Risk of Adolescent Sexual Offense Recitivism) 6 March 30, 2014 Test Battery Continued Phase Sexual Attitudes Questionnaire Bumby Cognitive Distortions Scale 7 March 30, 2014 8 BASC-Adaptive Scales Interpersonal Relations Relations with Parents Self Esteem Self-Reliance Personal Adjustment Flat Line Profile Faking Good/Faking Bad March 30, 2014 9 Critical Items This area presents items that may be of particular interest when responses include True, Sometimes, Often, or Almost always. Item Response 3. Nothing goes my way. True 24. I never seem to get anything right. True 33. Nobody ever listens to me. True 38. I just don't care anymore. False 73. Other kids hate to be with me. Often 81. I feel like my life is getting worse and worse. Often 98. No one understands me. Often 111. I feel sad. Sometimes 122. I hear voices in my head that no one else can hear. Sometimes March 30, 2014 10 Validity Index Item Summary Items contributing to Validity Indexes (except Response Pattern) with Caution or Extreme Caution ratings are presented below. F INDEX Item Response 1. I like who I am. False 13. My classmates don't like me. True 21. Nothing is fun anymore. True 43. Other children don't like to be with me. True 68. Nothing about me is right. True 86. People act as if they don't hear me. Almost always March 30, 2014 11 March 30, 2014 RADS 2 Test Results Score Summary Table Scale Raw Score T-Score Dysphoric Mood Anhedonia/Negative Affect Negative Self Evaluation Somatic Complaints Depression Total 16 22 51 62 (significant) %Rank 60 81 21 66 (significant) 92 13 72 44 59 32 80 12 RADS-Critical Items Loneliness Social withdrawal Self-injurious Self-reproach Self-deprecation Helplessness March 30, 2014 13 March 30, 2014 JSOAP-Sexual Drive Preoccupation Scale (items 1-8) Prior legally charged sex offenses Number of sexual abuse victims Male child victim Duration of sexual offense Degree of planning in sexual offenses Sexualized aggression Sexual drive and preoccupation Sexual victimization history 14 March 30, 2014 Impulsive Antisocial Behavior Scale(items 9-16) Care giver consistency, Pervasive anger School behavior problems History of conduct disorder Juvenile antisocial behavior Charged/arrested before age 16 Multiple types of offenses Physical assault and exposure to family violence 15 March 30, 2014 Intervention Scale (items 17-23) Accepting responsibility for offense(s) Internal motivation for change Understands risk factors Empathy Remorse and guilt Cognitive distortions Quality of peer relationships 16 March 30, 2014 Community (Items 24-28) Stability/Adjustment Scale Management of sexual urges and desire Management of anger Stability of current living situation Stability in school Evidence of support systems 17 March 30, 2014 Sample JSOAP II report On the JSOAP II Protocol, Juvenile Sex Offender Assessment Protocol on the static scales which are historical and based on an individual’s history or pattern of past sexually offending behaviors James had a score of 1 out of a possible 16 in the sexual drive/preoccupation scale. This placed James at low risk to sexually reoffend. 18 March 30, 2014 Sample JSOAP II Report On the scale of Impulsive Antisocial Behavioral Scale items 9-16 James had a score of 10 out of a possible 16 points which places him at moderate to high(62.5%) risk to sexually reoffend. On this scale items associated with problems with pervasive anger, school behavioral problems and being arrested prior to age 16 were problems areas for him related to his risk to reoffend. 19 March 30, 2014 Sample JSOAP II Report Individuals with high scale 2 Impulsive Antisocial Behavioral Scale scores are 3 times more likely to sexually reoffend compared to low scale 2 individuals. James’s overall score of11 out of a possible 32 points (34%)on items 1-16 on the Static/Historical Scale places him as moderate risk to reoffend sexually. 20 March 30, 2014 Sample JSOAP II Report The dynamic scales include the items 17 through 28 on this protocol and can change over time based on the individual’s adjustment to treatment interventions and treatment progress. On the dynamic scales (Intervention Scale) 17-23 James had a score of 8 out of a possible 14 points making him at moderate to high (57%) risk sexually offend. 21 March 30, 2014 Sample JSOAP II Report On the Community Stability Scales, items 2428 James had a score of 2 out of 10 suggesting that he is at low risk to reoffend. Items addressed on this scale included management of sexual urges, management of anger, stability of current living situation, stability in school and evidence of support systems. 22 March 30, 2014 Sample JSOAP II Report James was also at low to almost moderate risk to sexually reoffend on all of the Dynamic Scales items, 17-28 on this protocol having a score of10 out of a possible 24 points. James’s overall JSOAP score of 21 out of a possible 56 (41%) places him at moderate risk to sexually offend. 23 March 30, 2014 Sample JSOAP II Report The major areas of concern on this protocol were James’s school stability problems, management of his anger, quality of peer relationships, accepting responsibility for his offense and understanding of the risk factors. 24 March 30, 2014 ERASOR-Estimate of Risk of Adolescent Offense Recitivism Sexual Interests or attitudes 1. Deviant sexual interests(younger children, violence or both 2.Obsessive sexual interest and preoccupations with sexual thoughts 3. Attitudes of supportive offending 4. Unwillingness to alter deviant sexual interests/attitudes 25 Erasor Historical Sexual Assaults Psychosocial Functioning Family Environment Functioning Treatment March 30, 2014 26 March 30, 2014 Trauma Symptom Checklist for Children (TSCC) Validity Scales Underresponse Hyperesponse 27 TSCC-Clinical Scales Anxiety Depression Anger Posttraumatic Stress Dissociation Sexual Concerns March 30, 2014 28 March 30, 2014 TSCC-Sexual Concerns Subscales Sexual Preoccupation-(SC-P) Sexual Distress-(SC-D) Elevations on Sexual Concerns Subscales associated with being prematurely sexually traumatized-sexual abuse, exposure to pornography, witnessing sexual behavior, or sexual assault by a peer 29 March 30, 2014 TSCC Elevations on SC-P suggest preoccupation associated with childhood sexual abuse Elevations on SC-D suggest distress or conflict associated with sexual matters or experiences-high scores on this scale suggest sexual fears or ego-dystonic sexual feelings and behaviors. This scale highly correlated with Anxiety Scale 30 March 30, 2014 TSSC-Dissociation Subscale Derealization Mind going blank Emotional numbing Pretending to be somebody else Daydreaming Memory problems Dissociative avoidance More severe identity disturbance and fugue states not included 31 March 30, 2014 TSCC-Dissociative Subscale Overt Dissociation (DIS-O)- high scores in DIS-O-symptoms include emotional detachment and reduce response to external environment Fantasy (DIS-F)- involves fantasy or role playing rather more than classic dissociation-Daydreaming included in Fantasy-high scores here suggest being over involved in fantasy to exclusion of real world 32 March 30, 2014 TSCC-PTSD Subscale This subscale should be looked at with Anxiety and Dissociation subscales Intrusive thoughts, sensations of past memories of painful events, nighmares, fears of men or women and cognitive avoidance of negative memories and events. Scale includes more intrusive symptoms than avoidance and hyperarousal 33 March 30, 2014 TSCC Items-(Never, Sometimes, Lots of times, All the time) Can’t stop thinking about sex Having sex feelings in my body Touching my private parts too much Feeling scared of men or women Washing myself-feeling dirty on the inside Wishing bad things never happened Going away in my mind trying not to think Scary ideas or pictures pop into my head 34 March 30, 2014 TSCC-Critical Items Wanting to hurt myself (20) Wanting to hurt other people(21) Feeling scared of men/woman (25) Not trusting people as they want sex(34) Getting into fights(36) Feeling someone might kill me(50) Wanting to kill myself(52) 35 Taking a Sexual History Age of first girlfriend and age of adolescent sex offender Age of first kiss and both consenting partners Longest relationship History of physical abuse History of sexual abuse Age onset of sexual intercourse with consenting partner March 30, 2014 36 March 30, 2014 Sexual History Anatomical knowledge of sexual intercourse History of sexual intercourse Use and types of birth control protection Awareness of condoms, STD’s, birth control pills and abstinence Masturbation History and Frequency Exposure to sex education curriculums History of Pornography exposure 37 March 30, 2014 Sexual History Number of consenting intercourse partners and ages Frequency of use of birth control Ever masturbated to excess or to the point of pain or discomfort Increased exposure to pornography, internet, cell phones, filming of sex offenses, sexting, movies, videos, cable tv 38 March 30, 2014 Sexual History Exhibitionism, fetishism, masochism, sadism, or voyeuristic behaviors, crossdressing Sexual orientation Forced or coerced to observe others engaging in sexual behaviors History of sexual contacts with males and females 39 March 30, 2014 Adolescent Sex Offender Characteristics Grabs attention of society “NIMB” Institutional Status-”Low” peers and staff Fuels low self esteem Social isolation more important than social competence skills LD designation/awareness of deficits Early exposure to pornography Overly sexualized exposure experiences 40 March 30, 2014 Thematic Apperception Test Themes Authority figures/parental expectations surrounding achievement Depression/Self injurious Thought Disturbance/Reality Testing Resolution Relationship with objective personality measures and behavioral presentation 41 March 30, 2014 Federal Bureau of Prisons Level of Pathology Initial mental health evaluations Substance use Possession of child or other pronographic materials/increased underserved population Community Reintegration 42 March 30, 2014 Paraphilic Disorder DSM-5 A paraphilia that is currently causing distress or impairment to the individual and a pariphilia whose satisfaction has entailed personal harm, or risk of harm to others. A paraphilia is a necessary but not a sufficient condition for having a paraphilic disorder and a paraphilia by itself may not require or justify clinical intervention. 43 March 30, 2014 Paraphilic Disorders DSM-5 Voyuerisitc Disorder Exhibitionistic Disorder Frotteruistic Disorder Sexual Masochism Disorder Sexual Sadism Disorder Pedophililc Disorder Fetishistic Disorder Transvestic Disorder Other Specified Paraphilic Disorder Unspecified Paraphilic Disorder 44 Abel, Becker and Kaplan-Revised Adolescent Cognition Scale March 30, 2014 45 March 30, 2014 Revised Adolescent Cognition Scale 46 March 30, 2014 DJS Statistical Report on Female Offenders –February 2012 Youth Placed in Out-of-Home Program by DJS during Calendar Year 2010* Abuse History Females Males History of Physical/ Sexual Abuse 45.8% 13.4% History of Neglect 27.1% 24.6% Source: MCASP Needs Assessment: Social History Items 8 and 9. *Approximately 9.4% of the cohort was missing MCASP data. History of Physical or Sexual Abuse (during lifetime) and History of Neglect (during lifetime) Nearly half (46%) of females placed in an out-of-home program in CY 2010 reported a history of physical or sexual abuse during their lifetime. This compares to 13% of males reporting the same abuse history. Percentages of females and males reporting a history of neglect were similar for juveniles placed in an out-of-home placement in CY 2010. Females had a slightly higher percentage (27%) than males (25%) 47 March 30, 2014 DJS Intake Data Annual Report 2010 Males-all counties-122 general sex offenses-200 felony sex offenses Females-all counties- 6 general sex offenses-15 felony sex offenses Intake levels-informal, legally insufficient, closed Formalized to SAO 48 March 30, 2014 Sex Offender Legal Terms Sexual predator: offender who has been convicted of a sexually violent offense and has been deemed by a court likely to do it again. Sexually violent offender: offender who has been convicted of a sexually violent offense. Sexually violent offense: 1st or 2nd degree rape or attempted rape; 1st, 2nd, or 3rd degree sexual offense. 1st degree rape: Vaginal intercourse by force or threat of force, along with an aggravating factor, like causing or putting in fear of serious physical injury or disfigurement, suffocating, kidnapping, etc. 2nd degree rape: Vaginal intercourse by force or threat of force, or with mentally disabled victim, or with victim under 14 and perpetrator 4 years older. 1st degree sexual offense: Sexual act by force or threat of force, along with an aggravating factor, like causing or putting in fear of serious physical injury or disfigurement, suffocating, kidnapping, etc. Sexual act is oral sex, anal sex, or penetration by an object, but does not include vaginal intercourse. 2nd degree sexual offense: Sexual act by force or threat of force, or with mentally disabled victim, or with victim under 14 and perpetrator 4 years older. Sexual act is oral sex, anal sex, or penetration by an object, but does not include vaginal intercourse. 49 March 30, 2014 Sex Offender 3rd degree sexual offense: Sexual contact without the consent of the victim, along with an aggravating factor, like causing or putting in fear of serious physical injury or disfigurement, suffocating, kidnapping, etc. Sexual contact is intentionally touching genitalia, the anus or other intimate area. It includes penetration by a part of the body except the penis or mouth. Also includes sexual contact with mentally disabled victim, victim under age 14 and perpetrator 4 years older, a sexual act with victim 14 or 15 and perpetrator 21, vaginal intercourse with victim 14 or 15 and perpetrator 21. 4th degree sexual offense: Not considered a sexually violent offense. Sexual contact without consent of victim, sexual act with victim 14 or 15 and perpetrator 4 years older; vaginal intercourse with victim 14 or 15 and perpetrator 4 years older. Sexual contact is intentionally touching genitalia, the anus or other intimate area. It includes penetration by a part of the body except the penis or mouth. Child Sexual Offender: An offender who has been convicted of any of the above offenses with a victim less than 15 years old, i.e., any sexually violent offense (1st or 2nd degree rape; 1st, 2nd, or 3rd degree sexual offense), or a 4th degree sexual offense. Also includes offenders convicted of sexual abuse of a minor who is a family member or living in the household. Offender: An offender who has been convicted of certain other offenses related to sexual offending, like kidnapping or false imprisonment of a minor, violations of the child pornography and prostitution laws, etc. 50 March 30, 2014 References Briere,J. Trauma Symptom Checklist for Children (1996). Professional Manual. Odessa, Fl. Psychological Assessment Resources. Briere, J., and Lanktree, C. B.(1995). The Trauma Symptom Checlist for Children (TSCC): Preliminary psychometic characteristics. Unpublished manuscript, Department of Psychiatry. University of Southern California School of Medicine. 51 Diagnostic March 30, 2014 and statistical manual of mental disorders. Fifth Edition (DSM-5). American Psychiatric Association, 2013. Pratt, H.D., Patel, D.R., Greydanus, D.E., Dannison, L., Walcott, D., Sloane, M.A., (2001). Adolescent Sexual Offenders: Issues for Pediatricians. International Pediatrics; 16 (2). Reynolds, C.R., Kamphaus, R.W., (2005) Behavior assessment system for children, 2nd edition, Pearson, Inc. 52 Reynolds, March 30, 2014 W. (1987). Reynolds Adolescent Depression Scale, 2nd edition. Psychological Assessment Resources, Odessa, Fl. Righthand, S., Prentky, R. A., Knight, R. A., Carpenter, E., Heckler, J.E., and Nangle, D. (Manuscript in preparation). Factor structure and validation of the Juvenile Sex Offender Assessment Protocol (JSOAP). 53 Seto, March 14, 2016 M.C., Lalumiere, M.L., What is so special about male adolescent sexual offening? : A review and test of explanation through meta-analysis. American Psychological Association: Psychological bulletin (2010). Vol.136.No4.526-575.