Section 4: Treatment
2 Hours

Lecture Topic TOPIC: TREATMENT

Pharmacological Interventions

You may be aware that there is a high prevalence of mental health disorders among youth in juvenile justice settings—and with juvenile sex offenders, co–occurring mental health difficulties are common as well.63 This means that we need to consider the implications of these critical issues on our work with sexually abusive youth.

Use SlideUse Slide #23: Psychiatric Disorders and Juvenile Sex Offenders
Use SlideUse Slide #24: Potential Pharmacological Interventions and Cautions

Selective Serotonin Reuptake Inhibitors (SSRI’s)

Perhaps most commonly used with juvenile sex offenders is the class of medications known as Selective Serotonin Reuptake Inhibitors (SSRIs), which are generally used to mitigate symptoms of depressive, anxiety-related, and obsessive–compulsive disorders.65  In addition to assisting with the reduction of obsessive or ruminating thoughts that contribute to depression and anxiety, these medications may also reduce other recurring thoughts or sexual preoccupations.

A common side effect of SSRIs is decreased sexual drive, which may be helpful for youth who have sexually compulsive behaviors. However, you should be aware that the Food and Drug Administration (FDA), which is responsible for approving and regulating the use of medications for specific purposes, has not sanctioned the use of SSRIs for sex offender treatment. Perhaps even more importantly, a recent health advisory was issued regarding the use of SSRIs with adolescents, because of the potential for increased self-harm and harm toward others among youth who have been prescribed SSRIs.

So, if these medications are to be considered with juvenile sex offenders—or adolescents in general—it is critical that a careful risk–benefit analysis is conducted by a qualified mental health professional.66 And if used, increased monitoring and precautions must be in place to ensure the safety of the youth and others.

Hormonal Agents

Another class of pharmacological intervention used with sex offenders—primarily with adults—is the group known as antiandrogens. These are hormonal agents that reduce the level of “male hormones” such as testosterone in the body and consequently lessen or eliminate sexual urges and desires. As such, some refer to their use as “chemical castration.”

However, there are considerable concerns about the use of hormonal agents with juvenile sex offenders, primarily because they have not been rigorously tested on adolescents.67 As a result, the short– and long–term side effects of these medications are not known. Nor is there an understanding of the impact of hormonal agents on adolescents’ growth and development. For these reasons, although there may be a small subset of serious and persistent juvenile sex offenders for whom antiandrogens may be beneficial even despite the current concerns, the use of hormonal agents is quite controversial with juvenile sex offenders.68

Polygraphy and Treatment

As we discussed during the assessment section of this training, the polygraph has become increasingly common as a means of facilitating sexual history disclosures among youth.

Use SlideUse Slide #25: Juvenile Programs Using the Polygraph Nationwide

In addition, as you can see in this slide, programs for sexually abusive youth also use the polygraph for monitoring compliance with treatment and supervision, and to further explore specific issues that may arise during the course of treatment.69 However, the use of the polygraph with juveniles remains an area of controversy.70

For example, some practitioners question the need for the complete and total disclosure of all details of a youth’s sexual history. Instead, it could be that having a broad understanding of a youth’s patterns and offenses may be sufficient for assisting the youth with making progress in treatment and developing effective plans to manage his or her behavior. Further, we may reach a point of diminishing returns when it comes to trying to uncover every single detail pertaining to a youth’s sexual history.

Other treatment providers, however, believe that the polygraph can be a helpful—if not vital—tool for treatment. This is because the polygraph may lead to additional disclosures about sexual deviance issues or sex offenses that had not been previously detected. Some believe that “complete” disclosure must occur if treatment is to be most meaningful and effective.

In addition, some treatment providers believe that the true measure of a youth’s commitment and progress in treatment can be revealed through his or her responses during a polygraph examination. As such, some programs require youth to submit to periodic polygraphs throughout the course of treatment to facilitate full disclosure, assess treatment progress, or explore treatment compliance—or some combination of these three uses. And in some juvenile sex offender treatment programs, youth may even be required to “pass” a polygraph in order to be considered for advancement to different levels of a program—or as a prerequisite for completing a treatment program.

Remember, however, as we noted previously, that there exist a number of concerns about the reliability and validity of the polygraph—particularly when used with juveniles.71 And despite its growing popularity, caution should be exercised with its use. Presently, there is no empirical evidence indicating that “passing” a polygraph examination is associated with positive treatment gains or reductions in recidivism rates with juvenile sex offenders or adult sex offenders, for that matter.

So, if the polygraph is going to be used in a treatment program, the results should never be used as the only criteria for making critical decisions such as treatment completion or release to the community.72 Rather, the disclosures or other information gleaned from a polygraph examination should be considered as only one piece of information that should be substantiated by other sources when possible. And when concerns are identified from a polygraph examination, it signals the need to assess a situation further before responding decisively.

Furthermore, if and when a polygraph examination is used as part of a treatment program, the resulting information should be shared with the other key stakeholders involved in juvenile sex offender management so that collaborative and fully informed decisions can be made.

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