Clinical Issues with Sexually
Abusive Youth:
Assessing Risk and Needs
Sean Hiscox, Ph.D.
Associates in Psychological Services, PA
Recent Data
• Juveniles commit 20% to 30% of reported rapes and
30% to 60% of child molestation (Hunter, 1999;
Weinrott, 1996).
• Juveniles account for approximately 20% of the
individuals charged for a sexual assault in the United
States and Canada (Barbaree, Hudson, & Seto, 1993;
Federal Bureau of Investigation, 1993; Statistics
Canada, 1997; Weinrott, 1996).
• In one meta-analysis with 1,025 juveniles, recidivism
rates were 5.8% for rapists, 2.1% for child molesters,
and 7.5% for an unspecified group (Alexander, 1999).
• Recidivism rates generally vary from 2% to 19%
depending on the study and length of follow up.
• Recent JRAS study with 231 juveniles found that 38
(16%) recidivated sexually and 119 recidivated
nonsexually (52%) (unpublished dissertation, Haran,
2006) .
Key Concepts
(Epperson et al. in Prescott, 2006)
• Risk
– Internal characteristics that make an individual more or less likely to
commit a sexual offense in the future
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Desire to engage in deviant sexual acts
Deviant sexual interests
Poor\good impulse control
Poor\good judgment
Presence\absence of psychopathology, such as an antisocial
orientation.
• Risk management
– External factors
– Interventions designed to reduce the danger to the public
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Treatment
Supervision
Setting
Drug testing
Legislation
• Relationship between risk and risk management
– The danger/threat to the community is the likelihood,
relative to risk, of an offender reoffending given the level
of risk management in place
– If there is no risk management or it is poorly applied, the
danger to the public is equal to the risk inherent in the
individual
– Risk assessments are most helpful when put in the broader
context of risk management
• Good risk assessments match the level of risk
management to the level of risk inherent in the
individual
• For a low risk offender, intensive supervision wastes
resources on an individual who’s threat to the public
is already so low that it cannot be reduced much
further
• May increase risk for low risk offenders when
exposed to higher risk peers
• Risk Reduction\Needs Assessment
– Risk is inherent in the individual but it is not Static
– We can facilitate change in the individual through treatment
and provide additional supervision
– Treatment targets
• Increasing impulse control
• Decreasing deviant sexual interest
• Decreasing distorted attitudes
• Increasing lifestyle stability and community adjustment
• Increasing social skills
• Needs assessment, also called assessment driven
treatment, is the opposite of a “one size fits all”
approach
• Majority of sexually abusive youth reoffend
nonsexually, so treatment should target those
nonsexual areas, if appropriate (e.g., lifestyle
instability)
• Segregating low risk offenders from high risk
offenders
Problems
• Methods for assessing risk are only beginning the validation
process
• Low base rates
• Risk assessment can cause harm\unintended consequences
• Young people are changing rapidly
• No profiles exist
• Risk assessments often neglect protective factors that mitigate risk
• Unaided clinical judgment has consistently been found as not much better
than chance
• Risk assessments by treatment providers become less effective the longer
the therapist is in contact with the person
• Evaluators should anticipate resistance. We’re asking them to disclose
embarrassing\shameful things.
– Resistance should be put in this context and not necessarily made a
“risk factor.”
(Prescott, 2006)
What we know (and what we don’t)
(Prescott, 2006)
• Diverse group of young people
• Sexually abusive youth (SAY) are more likely
to come in contact with the legal system again
for something OTHER than sex offending.
• Minority of SAY show deviant sexual arousal.
• Remorse, empathy, and denial are not well
established predictors of reoffense
– These issues, however, provide information about
the youth’s motivation and readiness for treatment
– Research has struggled with assessing these
variables, so part of the problem might be how
they are defined
• “Instant Offense” is not as predictive as once thought
– Instant offense involves the youth’s willingness to abuse on
one occasion. It doesn’t necessarily capture persistent
behavior, which is predictive.
• Penetration also is generally not predictive of sexual
reoffense.
– It has been found, however, to predict future violence.
Significant Risk Factors:
(Prescott, 2006)
Early onset
• Research often uses age 12 as cut off
Persistence
• continuing sexually abusive behavior after being
detected and sanctioned
– Established deviant sexual preference
– Stranger victims
– Psychopathy
• a callous disregard for the feelings and welfare of
others, and an egocentric, antisocial personality
Risk Factors
• Static:
– Historical factors not subject to change
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Number of prior sexual offenses
Characteristics of prior sexual offenses
Prior victim selection
Prior nonsexual antisocial behavior
Sexual history
Family history
Past psychiatric history
• Dynamic:
– Factors subject to change over time, either slowly (stable
dynamic factors, such as personality) or rapidly (acute
dynamic factors, such as substance abuse)
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Motivation
Acceptance of responsibility
Level of victim empathy
Quality of peer relationships
Level of sexual self regulation
Level of general self regulation
Current substance abuse
Current symptoms of mental illness
Risk Assessment Methods
• Unstructured clinical
– Based on review of records and unstructured clinical
interview;
– No explicit prediction formula;
– Rough, inexact prediction, sometimes without articulation
of rationale;
– Advantage of convenience;
– May be inaccurate;
– May have relatively low level of agreement between
independent evaluators who examine the same individual
(i.e., low level of interrater reliability).
• Structured clinical
– Use of standardized list of risk criteria;
– Criteria not necessarily empirically supported;
– Criteria may be derived solely from the developer’s
experience and opinions;
– Unclear which criteria are best predictors of sex offending;
– Advantage of increased interrater agreement;
– Examples include informal risk checklists used in various
correctional institutions or by parole and probation
authorities.
• Empirically guided
– Use of standardized list of risk criteria and specific
formula or method for combining these criteria;
– Reliance on research literature
– Although the individual criteria have support in the
empirical literature, the instrument as a whole does
not have tested predictive validity;
– Examples include JSOAP, ERASOR.
• Clinically adjusted actuarial
– Use of actuarial scale to provide foundation for
prediction;
– Adjustment of prediction based on clinical factors;
– Advantage of firm foundation in actuarial scale
with flexibility of clinical adjustment;
– Potential disadvantage if reasons for clinical
adjustment are not well founded or not clearly
articulated.
• Actuarial
– Prediction based entirely on scale that has been validated
with a predictive validity study (i.e., a study linking present
scale scores with varying levels of future recidivism);
– Advantage of strong empirical foundation with explicit
recidivism levels for different scores on scale;
– Disadvantages of inflexibility, heavy reliance on static,
historical risk factors such as age of offender, prior
criminal history, sex offense history, characteristics of
victims), and inability to take into account variables beyond
limited set used in scale.
Pre-Adjudication Evaluations
• Assessment occurs throughout the legal process and beyond.
• Requested by multiple referral sources; prosecutor, defense attorney,
judge, and DYFS.
• Often requests for evaluations are post adjudication, but pre-disposition to
help the judge make sentencing decisions.
• Pre-Adjudication assessments include special circumstances and are a
matter of debate
• What factual basis to evaluate risk? There are typically conflicting
accounts of what illegal sexual acts the defendant allegedly performed.
• Some believe that evaluation and treatment should begin only after the
court has reached a finding-of-fact. Others believe that, despite the factual
ambiguity, evaluation and treatment should begin as soon as possible.
• As long as the assessment does not address the ultimate issue—guilt or
innocence—you can assess a number of things, including risk.
• Conclusions should clearly state what factual assumptions are being used,
and both sets of factual assumptions need to be included in the analysis
(allegations, defendant’s account).
• There is no test or procedure that leads an evaluator to a guilt or innocence
finding other than the defendants’ own self-report or a finding by a
judge/jury.
Tools
• Varying stages of development
• Different sample characteristics
• Evaluators need to clearly state limitations
• Current state of science indicates that we
cannot yet rely on total scores
Juvenile Sexual Offense Recidivism
Assessment Tool-II (JSORRAT-II)
(Epperson et al. in Prescott, 2006)
• Actuarial scale intended for risk classification, although
currently it is considered a screening instrument
• Comprised of 12 items from seven ‘families’: 1) sex offending
history; 2) offense characteristics; 3) sexual offense treatment
history; 4) abuse history; 5) special education history; 6)
school discipline history; and 7) nonsexual offending behavior
• Sample consisted of 636 males, ages 12 through 17,
adjudicated for a sexual offense in Utah. Majority of sample,
76%, were white.
• 84 (13%) recidivated sexually, 126 (20%)
nonsexually
• charges were used as recidivism measure and follow
up was 13 to 14 years
• Two main factors; high persistent drive to engage in
deviant sexual behavior and an antisocial orientation
• Excellent predictor of sexual recidivism (ROC = .89)
and nonsexual recidivism ROC = .79) with the
development sample. Needs a cross validation study.
JSOAP-II
(Prentky & Righthand, 2003)
• Age range of 12 to 18 who have been adjudicated for sexual offenses, as
well as nonadjudicated youths with a history of sexually coercive behavior
• Small sample size (N=76), short follow up, and low base rate (3)
• 27 items, both static and dynamic variable, and assesses four factors:
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Sexual drive/preoccupation
Impulsive/antisocial behavior
Clinical/intervention
Community stability/adjustment (past 6 months)
Estimate of Risk of Adolescent Sex
Offender Recidivism (ERASOR)
(Worling & Curwen, 2001)
• The ERASOR is an empirically guided scale. 25 criteria grouped into five
broad domains supported as risk factors.
• 12 to 18 year-olds who have previously committed a sexual assault
• Five domains:
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Sexual interests, attitudes, and behavior
Historical sexual assaults
Psychosocial functioning
Family/environmental functioning
Treatment
• In a comprehensive manual, the authors provide a rationale and empirical
support for each of the 25 criteria. The manual itself is a useful, wellorganized review of the adolescent sexual offending risk assessment
literature.
Juvenile Risk Assessment Scale (JRAS)
(Haran, unpublished dissertation, 2006)
• Modified version of the RRAS; used to place juveniles in risk tiers in
accord with Megan’s Law
• Diverse sample; 45% African-American, 43% White 10% Hispanic, and
1% as other
• 14 items sub-divided into three broad areas: sex offense history, antisocial
behavior, environmental characteristics
• Predictive validity study (2006)
– 231 subjects
– 38 reoffended sexually (16%)
– 119 reoffended nonsexually (52%)
– 74 did not reoffend (32%)
• Two factors: antisocial, unstable lifestyle and sexual deviance
• JRAS tier was found “moderately” predictive of sexual
recidivism (ROC=.656)
• Antisocial factor “moderately” predicted nonsexual recidivism
(ROC=.699) and sexual recidivism (ROC=.669)
• Sexual deviance factor alone was not predictive
• STATIC-99 ROC’s: sexual recidivism = .71, violent = .69;
MnSOST-R = .73; RRASOR = .68
Structured Assessment of Violence Risk in
Youth (SAVRY)
(Borum, Forth & Bartel, 2002)
• Samples static and dynamic risk factors associated
with violent recidivism in juveniles, including sexual
violence
• Four domains:
– Historical risk factors (such as history of violence,
early initiation of violence, past
supervision/intervention failures, and poor school
achievement)
– Social/contextual risk factors (such as peer delinquency,
peer rejection, poor parental management, and lack of
personal/social support)
– Individual/Clinical risk factors (such as substance use
difficulties, anger management problems, psychopathic
characteristics, and low commitment to school)
– protective factors (such as prosocial involvement strong
social support, strong attachments and bonds (to positive
figures), and a strong commitment to school
– Two validity studies of the SAVRY, both of which support
its positive relationship with future serious delinquent acts
Take Home Points:
• Diversity of population
• Importance of not using a “one size fits all” approach
• Conservative approach when making conclusions
about risk
• Tying evaluations to a needs assessment
• Importance of environment, such as peers and home