Juveniles commit a significant number of the sexual assaults against
children and women in this country. The onset of sexual offending behavior
in these youth can be linked to numerous factors reflected in their experiences,
exposure, and/or developmental deficits. Emerging research suggests that,
as in the case of adult sex offenders, a meaningful distinction can be
made between youth who target peers or adults and those who offend against
children. However, juveniles who sexually offend are distinct from their
adult counterparts. Youth who commit sexual offenses are not necessarily
"little adults;" many will not continue to offend sexually. This is a formative
area of research; while there is an ever-increasing body of knowledge regarding
the etiologies of dysfunction and aggression, there remains a tremendous
need for additional data to understand the etiology of juveniles sexual
The purpose of this brief is to discuss the current state of research
on sexually abusive youth, legislative trends, and promising approaches
to the treatment and supervision of these youth.
Sexual aggression perpetrated by young people has been a growing concern
in the United States over the past decade. Currently, it is estimated that
juveniles account for up to one-fifth of all rapes and almost one-half
of all cases of child molestation committed each year (Barbaree et al,
1993, Becker et al, 1993, Sickmund et al, 1997). Adolescents age 13 to
17 account for the vast majority of cases of rape and child molestation
perpetrated by minors (Davis and Leitenberg,1987). The majority of incidents
of juvenile sexual aggression involve male perpetrators (Sickmund et al,
1997). However, a number of clinical studies also point to prepubescent
youths and females engaging in sexually abusive behaviors. Although racial
and socioeconomic differences may be over represented in certain settings
(e.g., juvenile justice), juveniles referred for treatment in a variety
of environments reflect the same racial, religious, and socioeconomic distribution
as the general population of the United States (Ryan et al, 1996).
The influence of abusive experiences is considered multi-faceted and
includes effects related to both Post-Traumatic Stress Disorder and modeling
(Freeman-Longo, 1986, Gil and Johnson, 1992). Symptoms of Post-Traumatic
Stress Disorder have been observed in a number of youths with sexual behavior
disorders, especially children ages 13 and younger and females. These symptoms
include recurrent and intrusive recollections of past traumatic events
and increased levels of irritability and anger. Youths who have directly
experienced or witnessed sexual abuse may imitate the behavior of the aggressive
role model(s) in their interactions with others.
The presence of child maltreatment—whether neglect, physical abuse,
sexual abuse, or other forms of victimization—may eventually prove to be
a significant predictor of sexual offending behavior.
Assessment of the Youth’s Home
Assessments of the juvenile’s appropriateness for community-based programming
should include a thorough review of his or her living arrangements, as
well as a determination as to whether his or her parents are capable of
supervising the youth. Proper assessment requires evaluation of whether
the living environment affords the level of structure and supervision necessary
for the youth while providing for the safety of others in the home and
the community. Special consideration must be given to the needs and concerns
of individuals living in the home who may have been victimized by the youth
(e.g., younger siblings). It is essential that other children are protected
from potential harm, both physical and psychological. It is often necessary
to place a juvenile who sexually offends against family members temporarily
outside of the home. These youth should not be returned home until sufficient
clinical progress is attained, and issues of safety and psychological comfort
of family members are resolved. For an adjudicated youth, this decision
is typically made by the presiding judge with input from the parole/probation
officer and social services worker, the youth’s treatment provider, the
provider of services to family victim(s), and the youth’s family.
Clinical programming for sexually abusive youth typically includes a
combination of individual, group, and family therapies. In addition, many
programs offer supportive educational groups to families of these youth.
Juveniles who display more extensive psychiatric or behavioral problems,
such as substance abuse, may require additional treatment, including drug
and alcohol rehabilitation and psychiatric care. All therapies provided
to sexually abusive youth should be carefully coordinated within the treatment
agency and with external agencies providing case management and oversight.
Treatment programs need to be individually tailored through a thorough
assessment of the youth, family, and environment.
Providers have established the following as essential components of
the treatment process:
Gaining control of behavior.
Teaching the impulse control and coping skills needed to successfully manage
sexual and aggressive impulses.
Teaching assertiveness skills and conflict resolution skills to manage
anger and resolve interpersonal disputes.
Enhancing social skills to promote greater self-confidence and social competency.
Programming designed to enhance empathy and promote a greater appreciation
for the negative impact of sexual abuse on victims and their families.
Provisions for relapse prevention. This includes teaching youths to understand
the cycle of thoughts, feelings, and events that are antecedent to the
sexual acting-out, identify environmental circumstances and thinking patterns
that should be avoided because of increased risk of reoffending, and identify
and practice coping and self-control skills necessary for successful behavior
Establishing positive self-esteem and pride in one’s cultural heritage.
Teaching and clarifying values related to respect for self and others,
and a commitment to stop interpersonal violence. The most effective programs
promote a sense of healthy identity, mutual respect in male-female relationships,
and a respect for cultural diversity.
Providing sex education to give an understanding of healthy sexual behavior
and to correct distorted or erroneous beliefs about sexual behavior.
The planning and implementation of treatment services ideally reflect the
collaborative involvement of the youth, family, and all agencies involved
in the youth’s care as well as those agencies serving victims of these
youth. Often, this is accomplished by forming an advisory board to oversee
the operation of the program and serve as a mediator between the program
and the community. These boards typically consist of representatives from
public institutions serving youths and families, including the local juvenile
court, the department of social services, the prosecutor’s office, the
public defender’s office, victim advocacy services, and parents of youthful
perpetrators. The advisory board helps to ensure that the treatment program
is serving the needs of its clients while meeting community safety standards.
Controversial Areas of Practice
The following areas of practice have generated controversy, and therefore
pose special ethical and legal risks for practitioners assessing and treating
sexually abusive youth (Hunter and Lexier, 1998).
Treatment of juveniles who sexually offend is usually court ordered
or mandatorily provided in correctional settings. Historically, juvenile
courts have prescribed mental health care for youths with an emphasis on
rehabilitation. In contrast, adult courts have typically ordered involuntary
treatment on the grounds that the youth represents an imminent danger to
Given the shift of juvenile courts to a more adult-like criminal justice
model, and the increasing frequency with which juveniles are being adjudicated
and tried as adults, the issue of involuntary treatment may need to be
reexamined. Judicial decisions are no longer made with a consistent emphasis
on rehabilitation rather than punishment as a means of ensuring public
safety. However, many sexually abusive youth may not meet the legal criteria
for involuntary treatment based upon imminence of danger criteria.
A number of sexually abusive youth are referred for evaluation prior
to the initiation or completion of the adjudication process. Often, these
referrals are made by the court, or another public agency, in an attempt
to determine the most appropriate disposition for alleged sexual abusers.
Pre-adjudication assessments raise a number of ethical and legal issues.
Youths facing prosecution are placed in the position of being asked to
reveal information that may be used against them in court. Evaluations
present another set of problems associated with the validity of available
assessment instrumentation to determine innocence or guilt. There is no
scientific basis for assuming that any currently available psychometric
or psychophysiological measure of personality or sexual interest is valid
for that purpose (Murphy and Peters, 1992).
The courts frequently give clinicians the responsibility of determining
the youth’s risk of recidivism. These assessments are used to make dispositional
decisions and, as a result of legislative mandates, have potential relevance
in determining which juveniles should be placed on state registries, as
well as whether information about certain sexually abusive youth should
be released to the public.
Unfortunately, risk assessment, especially risk of violence, remains
an inexact science (Borum, 1996, Monahan and Steadman, 1996). Although
a number of risk assessment instruments are emerging as promising in the
assessment of risk of adult sex offenders, to date none of these have been
validated on a juvenile population. At this time, clinicians working with
sexually abusive youth rely on experience, existing research on delinquency
and pro-social functioning of youth, and retrospective and actuarial information
on adults who reoffend in making their evaluations of the risk posed by
A recent study has presented encouraging findings on an actuarial scale
for assessing risk among adolescent sexual abusers (Prentky et al, in press).
In this study, the Juvenile Sex Offender Assessment Protocol (J-SOAP) was
used to assess risk on 96 youth receiving treatment in an institutional
setting. Results from a 12-month follow-up period suggest that the instrument
is reliable, internally consistent and appears to possess concurrent and
predictive validity. The J-SOAP is currently being used in a variety of
locations and continues to be the subject of empirical scrutiny.
Phallometry is a diagnostic method to assess sexual arousal by measuring
blood flow (tumescence) to the penis during the presentation of potentially
erotic stimuli in the laboratory. The plethysmograph is a tool commonly
used in phallometric assessment. Use of the plethysmograph with juveniles
is an issue of some controversy (National Task Force on Juvenile Sexual
Offending, 1993). Research suggests that issues of client age and denial
compromise the validity of plethysmographic assessment of juveniles. Younger
clients appear to produce less reliable patterns of responding, and those
who deny their offenses tend to produce suppressed, and therefore non-interpretable,
patterns of arousal (Becker et al, 1992, Kaemingk et al, 1995). Most practitioners
agree that phallometric assessment should not be used on youth under the
age of 14. Phallometric assessments of sexual arousal patterns are most
appropriate for older adolescent males who report deviant sexual interest,
and/or those juveniles with more extensive histories of sexual offending.
Under these circumstances, such assessments may be useful for identifying
youths with emergent paraphilic (sexual deviation) disorders as well as
helping youth to become more aware of patterns and strengthen non-problematic
The purpose of a polygraph examination is to verify a perpetrator’s
completeness regarding offense history and compliance with therapeutic
directives and terms of supervision (Edson, 1991, Emerick and Dutton, 1993).
The polygraph is used more often with adult offenders than with juveniles.
To date, there is little research on the polygraph’s reliability and validity
in the evaluation of sexually abusive youth. Research suggests that results
potentially can be affected by a number of influences, including the client’s
physical and emotional status, the client’s age and intelligence, and the
examiner’s level of training and competency (Blasingame, 1998). Most practitioners
using the polygraph indicate that the age threshold for use with juveniles
is approximately 14 years old.
Polygraph Legislation in Texas
In Texas, law requires use of the polygraph on certain
sexually abusive youth. In 1997, legislation was enacted that prescribed
release conditions, including counseling and treatment for adolescents
convicted of certain sex offenses. Under this law, youth can be required,
as a condition of release from the Texas Youth Commission, to attend psychological
counseling sessions and to submit to polygraph examinations in order to
evaluate treatment progress (Texas Human Resources Code, Title 3, Ch. 61,
Sub. A, Sec. 61.0813).
Arousal Conditioning and Psychopharmacologic Therapies
Therapeutic techniques designed to change patterns of sexual arousal
remain controversial. Studies examining the effectiveness of techniques
such as arousal conditioning and drug therapies are inconsistent (Hunter
and Goodwin, 1992). Concerns about the appropriateness of techniques exposing
juveniles to physically or emotionally painful stimuli or involving masturbation
render arousal conditioning questionable (National Task Force on Juvenile
Sexual Offending, 1993). While several reports about the use of drug therapy
have appeared over the past few years, little information exists about
the safety and effectiveness of these drugs when used on juveniles. In
particular, anti-androgens and hormonal agents have typically not been
used with individuals under the age of 18 because of their potential suppression
of growth, and the other yet unknown long term risk that they may present.
Selective Serotonin Reuptake Inhibitors (SSRIs) are helpful in reducing
the frequency and/or intensity of sexual arousal and thoughts. SSRIs are
a class of antidepressant drugs known to cause a decrease in sexual arousal.
Further research is examining the effectiveness of such drugs in reducing
deviant sexual behavior.
Legal and Clinical Concerns
Subjecting juveniles to stricter penalties for sex offenses poses special
legal and clinical concerns. Legal issues can arise in the courtroom when
determining if these youth have the capacity to understand their cases,
to properly consult their attorneys, or to make sound decisions regarding
their defense (Grisso, 1997). Clinical concerns arise when clinicians place
demands on their clients to divulge information that may incur additional
restrictions or legal sanctions. Proper warning regarding the limits of
confidentiality is necessary and may include referral to parents or attorneys
prior to encouraging such disclosures. In many jurisdictions, clinicians
develop policies with district attorneys to clarify the consequences of
new disclosures in the course of treatment (National Task Force on Juvenile
Sexual Offending, 1993). Without these precautions, the reporting of such
information may interfere with the development of the therapist/client
relationship, an essential component of the treatment process, and increase
clinician vulnerability to civil suit (Hunter and Lexier, 1998). As with
adult offenders, these policies must address harm done to victims identified
through new disclosures and ways to offer assistance to these victims.
Areas for Future Research
Continued research is needed in each of the previously described areas.
Research on etiology is especially important to the development of prevention
programming for high-risk youths. Presently, the National Center for Child
Abuse and Neglect is funding two demonstration projects to evaluate treatment
outcomes for pre-pubescent children with sexual behavior problems. Studies
on effective supervision strategies for sexually abusive youth are clearly
needed. Treatment outcome studies that examine both individual and program
characteristics associated with positive treatment outcomes are also needed.
Research should focus on early identification of youths demonstrating patterns
of escalating aggression and violence. The U.S. Department of Justice,
Office of Juvenile Justice and Delinquency Prevention’s currently funded
research on the creation of a typology of juvenile sexual offending behavior
will help mental health and criminal justice professionals better understand
the major subtypes of sexually abusive youth and the most effective intervention
strategies for these groups.
Recommendations for Practice
The following suggestions may be used as guidelines for the ethical
and effective treatment of juveniles who abuse (Hunter and Lexier, 1998).
Clinical Assessments: When possible, clinicians should
conduct evaluations after adjudication and before sentencing. Clinical
assessments should help determine required level of care, identification
of treatment goals and objectives, and estimated risk of reoffending. Clinical
assessment should not be directed at determination of innocence or guilt.
Clinicians’ Roles: Clinicians should carefully explain
their role, as well as the limits of professional confidentiality, to juvenile
clients and their family prior to conducting a clinical interview or administering
assessment tests. Furthermore, it is strongly recommended that consent
forms, releases, and/or waivers addressing these issues be signed by clients
and their families. It is also prudent to review the above issues with
clients’ defense attorneys and/or guardian ad litems representing the youths.
Consent Forms: Clinicians should consider developing additional
consent forms to cover the use of more controversial assessment or treatment
procedures (e.g. phallometric assessment, aversive conditioning, and "off-label"
use of medications). These consent forms should be specific to the procedure
and clearly identify any potential risks associated with it. Clients should
understand that these procedures are voluntary and that they are free to
Phallometric and Polygraph Assessments: Phallometric and
polygraph assessments should be administered judiciously. Phallometric
assessment is best limited to males 14 years of age or older with extensive
histories of sexual offending, and/or those who self-report deviant sexual
arousal and interest patterns. This procedure should only be used with
the full, informed consent of the youth, their parent(s) or guardian, and
preferably the referral agency. Furthermore, it should only be used with
those who admit to their offenses and should generally be conducted with
auditory stimuli specifically designed for sexually abusive youth.
Risk Assessment: Clinicians should exercise caution in
rendering judgments of risk that individual juveniles represent for further
sexual offending. This is especially true when these judgments will figure
prominently in legal dispositions. Such assessments should state that they
reflect the best available predictive information on these issues, but
that empirical support for risk models is tentative at present.
Treatment Plans: Clinicians should demonstrate sensitivity
to developmental issues in assessing juveniles with sexual behavior problems
and formulating intervention plans. Treatment plans should be comprehensive,
reflecting a holistic understanding of youths, family systems, and sociocultural
environment in which they live.
Supervision Strategies: Sexually abusive youth have always
been in the community, and have been increasingly identified and supervised
by probation for many years. Only recently has the field moved toward the
development of specialized strategies to manage this unique population.
To be sure, this is an emerging area and one where much is yet to be learned.
However, many of the approaches commonly used with adult sex offenders
(e.g., the use of specialized supervision staff, sex offender specific
treatment providers, and the polygraph) are being adopted by juvenile supervision
agencies around the country. Models of a team approach to sex offender
management—teaming supervision agency staff with therapists, school personnel,
victim advocates and others to work closely with the offender, his/her
family, and victim(s)—are emerging as among the most promising approaches
to sex offender supervision.
Adolescents account for a significant percentage of the sexual assaults
against children and women in our society. The onset of sexual behavior
problems in juveniles appears to be linked to a number of factors, including
child maltreatment and exposure to violence. Emerging research suggests
that, as in the case of adult sex offenders, a meaningful distinction can
be made between juveniles who target peers or adults and those who offend
against children. The former group appears generally to be more antisocial
and violent, although considerable variation exists within each population.
Although available research does not suggest that the majority of sexually
abusive youth are destined to become adult sex offenders, legal and mental
health intervention can have significant impacts on deterring further sexual
offending. Currently, the most effective intervention consists of a combination
of legal sanctions and specialized clinical programming.
The National Adolescent Perpetration Network, contact: Gail Ryan, M.A.,
Kempe Children's Center, 1825
Marion Street, Denver, CO 80218, phone (303) 864-5252, fax (303) 864-5179,
The Association for the Treatment of Sexual Abusers (ATSA),
Connie Isaac, Executive Director, 10700 S.W. Beaverton-Hillsdale Hwy.,
Suite 26, Beaverton, OR 97005-3035, phone (503) 643-1023, fax (503) 643-5084,
Jefferson County, Colorado; contact: Leah Wicks, Supervisor, Juvenile
Sex Offender Program, First Judicial District Probation Department, 100
Jefferson County Parkway, Suite 2070, Golden, CO 80401.
The Center for Sex Offender Management would like to thank Dr. John
Hunter for principal authorship of this article. CSOM would also like to
thank Gail Ryan and Lloyd Sinclair for their comments and contributions
to this document. Edited by Madeline M. Carter and Scott Matson, Center
for Sex Offender Management.
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Center for Sex Offender Management
8403 Colesville Road, Suite 720
Silver Spring, MD 20910
Phone: (301) 589-9383
Fax: (301) 589-3505
Established in June 1997, CSOM’s goal is to enhance
public safety by preventing further victimization through improving the
management of adult and juvenile sex offenders who are in the community.
A collaborative effort of the Office of Justice Programs, the National
Institute of Corrections, and the State Justice Institute, CSOM is administered
by the Center for Effective Public Policy and the American Probation and
This project was supported by Grant No. 97-WT-VX-K007,
awarded by the Office of Justice Programs, U.S. Department of Justice.
Points of view in this document are those of the author and do not necessarily
represent the official position or policies of the U.S. Department of Justice.
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