ADOLESCENT SEX OFFENDERS

ADOLESCENT SEX OFFENDERS A PRACTITIONER S PORTFOLIO Forensic Psychology Practice Ltd The Willows Clinic 98 Sheffield Road Boldmere Sutton Coldfield B73 5HW 0121 377 6276 FPP Ltd 2006 1 Adolescent Sex Offenders

Contents: Introduction.. 3 Characteristics of adolescent sex offenders. 4 Pathways to offending..... 8 Assessment of adolescent sex offenders..10 Recidivism.. 13 Risk assessment tools..15 Treatment.18 Supervision.. 22 Conclusions.. 24 References 25 Useful links and contacts. 30 FPP Ltd 2006 2 Adolescent Sex Offenders

Introduction Sex offences committed by adolescents are a serious problem. Nearly 16% of the arrests for forcible rape and 17% of the arrests for all other sex offences in 1995 involved youth under the age of 18 (Righthand & Welch, 2001). Approximately onethird of sexual offences against children are committed by teenagers and those offences against children under 12 years of age are typically committed by boys aged between 12 to 15 years (Davis & Leitenberg, 1987; Snyder & Sickmund, 1999). In the United States in 1995, 16,100 adolescents were arrested for sexual offences (excluding rape and prostitution) and approximately 18 adolescents per 100,000 were arrested for forcible rape (Sickmund, Snyder, & Poe-Yamagata, 1997). The costs imposed by adolescent sex offending are considerable, not only those inflicted on crime victims and society as a whole, but also those imposed on offenders and their families. Therefore, appropriate interventions, treatment and management strategies are required, taking into account their developmental needs as well as their offending behaviours. As with other delinquent behaviours, early intervention can be critical. Unfortunately, many programs used to treat adolescents who have committed sex offences appear to apply interventions derived from our knowledge of adult sex offenders without adequate attention to the unique developmental needs of youth (Righthand et al, 2001). This portfolio aims to inform those working with adolescent sex offenders about the characteristics of adolescent sex offenders and pathways to offending, how to carry out risk assessments using a variety of tools and how to identify treatment needs. It is designed as a reference document providing background information fundamental to this subject area. It also provides a framework to facilitate assessment and decisionmaking in respect of future risks, treatment and management strategies. Further advice may be sought from FPP practitioners if needed. FPP Ltd 2006 3 Adolescent Sex Offenders

Characteristics of Adolescent Sex Offenders Adolescents who have committed sex offences are a heterogeneous mix; they differ according to victim and offence characteristics and a wide range of other variables, including types of offending behaviours, histories of child maltreatment, sexual knowledge and experiences, academic and cognitive functioning, and mental health issues (Knight & Prentky, 1993; Weinrott, 1996). These variables are described in further detail below. Sexual Offence Behaviours and Victim Characteristics: Offence behaviours and victim characteristics differ across a range of factors: non-contact offences to penetrative acts age and sex of the victim the relationship between victim and offender degree of coercion and violence used group or solo offender Child Maltreatment Histories Research suggests that adolescent sexual offenders are more likely to repeat the behaviours they had experienced as victims and the characteristics of victims were more likely to be reflective of their own victim experiences (Veneziano, Veneziano & LeGrand, 2000). Those first sexually abused before the age of 5 years were twice as likely to offend against someone below the age of 5 years. Furthermore, those abused by males were twice as likely to offend against males, and those subjected to anal intercourse were 15 times more likely to subject their victims to this. Fondling was seven times more likely if they had been fondled and they were twice as likely to engage in fellatio if they had been subjected to this as a child. The childhood experience of sexual abuse has often been associated with adolescent sex offending (Fehrenbach, Smith, Monastersky & Deishner, 1986; Kahn & Chambers, 1991; Kobayashi, Sales, Becker, Figueredo & Kaplan, 1995). Childhood experiences of being physically abused, being neglected, and witnessing family violence has also been associated with sexual violence in adolescent offenders (Kobayashi et al., 1995; Ryan, Miyoshi, Metzner, Krugman & Fryer, 1996). The FPP Ltd 2006 4 Adolescent Sex Offenders

abusive experiences of adolescent sex offenders, however, has not consistently been found to differ significantly from those of other adolescent offenders (Spaccarelli, Bowden, Coatsworth & Kim, 1997) and not all adolescent sex offenders have a prior history of victimisation, thus this is not the sole contributing factor to adolescent sexual offending. Indeed, research suggests that the role of child maltreatment in the aetiology of sex offending is quite complex (Prentky, Harris, Frizzell & Righthand, 2000). Social and Interpersonal Skills and Relationships Family factors: Factors such as family instability, disorganization, and violence have been found to be prevalent among adolescents who engage in sexually abusive behaviour (Bagley & Shewchuk-Dann, 1991; Miner, Siekert & Ackland, 1997; Morenz & Becker, 1995). Various studies (e.g., Kahn et al., 1991; Fehrenbach et al., 1986; Smith & Israel, 1987) suggest many adolescent sex offenders have experienced physical and/or emotional separations from one or both of their parents. Child sex offenders are less likely to have secure adult attachment styles, experience more emotional loneliness and have a more external locus of control than violent offenders, non-violent offenders, and non-offending comparison groups (Marsa, O Reilly, Carr, Murphy, O Sullivan, Cotter & Hevey, 2004). Social skills and relationships:. Research has consistently found adolescents with sexual behaviour problems have significant deficits in social competence (Becker, 1990; Knight and Prentky, 1993). Inadequate social skills, poor peer relationships, and social isolation are among the difficulties identified in these adolescents (Fehrenbach et al., 1986; Katz, 1990; Miner & Crimmins, 1995). Furthermore, studies have consistently shown that adolescent sex offenders have poorer empathy and perspective taking skills than non-violent and non-offending comparison groups (Lindsey, Carlozzi & Eells, 2001; Burke, 2001). Sexual Knowledge and Experiences Sexual histories and beliefs: Research suggests adolescent sex offenders generally have had previous consenting sexual experiences (Ryan et al., 1996). Prior experiences with sexual dysfunction, most commonly impotence or premature ejaculation, have also been reported in adolescent sex offenders. A study of 1,600 juvenile sex offenders from 30 States (Ryan et al., 1996) found that FPP Ltd 2006 5 Adolescent Sex Offenders

only about one-third of the juveniles perceived sex as a way to demonstrate love or caring for another person; others perceived sex as a way to feel power and control (23.5%), to dissipate anger (9.4%), or to hurt, degrade, or punish (8.4%). Deviant sexual arousal. Studies of adult sex offenders have shown that deviant sexual arousal is strongly associated with sexually coercive behaviour (Boer et al., 1997; Craig et al, 2005; Hanson & Morton-Bourgon, 2004; Hanson & Thornton, 2000). Studies with adolescent sex offenders are limited and this is an area which requires more research. However, a minority of sexually abusive youth manifest established deviant sexual arousal and interest patterns, which are recurrent and intense and relate directly to the nature of the sexual behaviour problem; e.g. sexual arousal to young children (Hunter, 1999). Deviant sexual arousal is more clearly established as a motivator of adult sexual offending, particularly as it relates to paedophilia, though a small subset of adolescents who offend against children may represent cases of early onset paedophilia. Research has demonstrated the highest levels of deviant sexual arousal are found in adolescents who exclusively target young male children, specifically when penetration is involved (Hunter & Becker, 1994), though in general, the sexual arousal patterns of sexually abusive youth appear more changeable and relate less directly to their patterns of offending behaviours than in adult sex offenders. Pornography & sexual deviance:. This is another area which requires further investigation. A study by Wieckowski, Hartsoe, Mayer and Shortz (1998) found that exposure to pornographic material at a young age was common in a sample of 30 male adolescents who had committed sex offences. Another study, summarised by Becker and Hunter (1997), found that 42% of juvenile sex offenders, compared with 29% of juvenile violent offenders (whose offences were nonsexual) and status offenders, had been exposed to hardcore, sexually explicit magazines. Zolondek, Abel, Northey and Jordan (2001) found that more than 30% of 485 adolescent sex offenders reported the use of pornography, whereas 10 to 30% admitted involvement in exhibitionism, fetishism, frottage, voyeurism, obscene phone-calls and phone sex.. Academic and Cognitive Functioning Research that focuses on the intellectual and cognitive functioning of adolescents who have committed sex offences is limited. Based on their review of the literature, FPP Ltd 2006 6 Adolescent Sex Offenders

Ferrara and McDonald (1996) concluded that between one-quarter and one-third of adolescent sex offenders have some form of neurological impairment, whereas Awad and Saunders (1991) suggested the rate of learning disability and academic dysfunction was between 30 and 60% for these adolescents. This is an important factor to be assessed because adolescent sex offenders with intellectual and/or neurological deficits will have different treatment needs. Research suggests that adolescent sex offenders with cognitive deficits are more likely to offend against peers and strangers than those adolescents whose cognitive functioning falls within the normal range. Mental Health Issues Symptoms and disorders: Conduct disorder diagnoses and antisocial traits frequently have been observed in populations of adolescents who have sexually offended (Kavoussi, Kaplan, & Becker, 1988; Miner et al., 1997). Impulse control problems and lifestyle impulsivity are also prevalent in this population (Smith, Monastersky & Deishner, 1987; Epps, 1991; Vizard, Monck & Misch, 1995). Studies also have found higher rates of depression in adolescents who have sexually offended and that up to 80% have some diagnosable psychiatric disorder (Kavoussi et al., 1988). Substance abuse: Studies vary widely on the importance of substance abuse as a factor in sex offending among adolescents. Lightfoot and Barbaree (1993) reported rates at which adolescent sex offenders were found to be under the influence of drugs or alcohol at the time they committed their offences ranged from 3.4 to 72%. Although substance abuse has been identified as a problem for many adolescents who have sexually offended (Kahn et al., 1991; Miner et al., 1997), the role of substance abuse in sex offending remains unclear. Lightfoot et al. (1993) pointed out that assessments of adolescent sex offenders should differentiate substance abuse problems from "normative" experimentation that is part of the developmental process. It appears evidence is insufficient to identify substance abuse as a causative factor in the development of sexually abusive behaviour, although substance abuse has a disinhibiting potential and therefore, if present, may require intervention. Sibling Incest Although this type of offending appears to be quite prevalent, it is often underreported and ignored. Research suggests sibling offenders have more serious offending FPP Ltd 2006 7 Adolescent Sex Offenders

histories, were less likely to receive court-ordered treatment, and differed from the non-sibling offenders on several measures (including family factors such as presence of dysfunction and physical abuse). Female Adolescent Sex Offenders The prevalence of female adolescent sex offenders may be underestimated due to a social reluctance to accept that girls are capable of committing such offences. However, girls who do behave in a sexually aggressive manner are more likely to be victims of sexual abuse, and multiple types of abuse than males (Ray & English, 1995) and are more likely to receive therapeutic treatment for their experiences than are male adolescent sex offenders with a history of victimisation. Development of Deviant Sexual Interests and Pathways to Juvenile Sexual Offending Adolescence is a stage of development where individuals undergo numerous changes, including hormonal, biological, emotional and cognitive as well as changes in their social relationships and sexual activity (Smith, Guthrie, & Oakley, 2005). Developmental origins of sexual arousal typically involve elementary principles of operant conditioning. Fantasy images of graphic nudity, sexuality, and sadomasochistic erotica, partly fed from teen magazines and television shows and partly from adult pornography, pair with masturbation. Repeated pairings of deviant imagery and fantasy with sexual excitation result in gratifying effects of thinking about deviant sexual acts. Other motivation factors for deviant sexual interests may include: naïve exploration; revenge; the exercise of power, control, and authority; erotic arousal; Other factors have also been shown to be associated with deviant sexual arousal in adolescents, including: observing adult aggression in domestically violent homes, FPP Ltd 2006 8 Adolescent Sex Offenders

poor-quality childhood relationships with parents, lack of positive emotional connections within the family There are also a range of theories describing the pathways to offending (Rich, 2003). A brief summary is offered here: Physiological Theories: the cause of sexual aggression is biological. Physiological functions of sex. Behavioural Theories: behaviour and thought are products of the environment in which children grow up. Sexual aggression is a learned behaviour in which sexual arousal and aggression are linked stimuli. Cognitive Theories: consider irrational and learning impaired thinking shaping thoughts and attitudes to be the source of emotional distress. This concentrates on the patterns of thinking where distorted attitudes allow the individual to act out sexually further supporting and perpetuate the behaviour. Social Learning Theories: Learning via role models in the environment. As children grow the source of the model changes and continue to be influenced and shaped by socially learned processes. Witnessing domestic violence / exposure to family violence tend to engage in externalizing behaviors (the acting-out of psychological conflict or tension), including acts of interpersonal aggression. Developmental Theories: Individuals pass through distinct stages of physical, cognitive, and emotional development that set the stage for psychological and personality development, self-image etc. Sexual aggression is the composite outcome of damaged and incomplete development of a learning environment that has failed to meet the pro-social and positive personality development need of the individual. Attachment Theories: The mother-child relationship serves as a basis for intrapsychic and interactional experiences and for the experience of social interactions and dependencies. The ability to form affectionate ties and bonds serves as a basis of all FPP Ltd 2006 9 Adolescent Sex Offenders

later relationships. Sexual aggression and assault result from impaired attachments and a resulting lack of affectionate bonds or empathy. Trauma Theories: Traumatic events disrupt normative and expected emotional and personality development. Sexual aggression is considered to be trauma reactive and is sometimes viewed as a recapitulation of trauma. Sexually abusive adolescents take a different pathway than do other adolescents who are similar in every respect leading to the suggestion of Factor X that marks the adolescent sex offender. However, there are multiple Factor X s (including history of personal victimization; witness to family dysfunction; mental health issues; attachment difficulties; limited empathy; underdeveloped social skills; and regressed moral development) and no single common pathway. Assessment of Adolescent Sex Offenders What is risk assessment? Decisions pertaining to a sexual offender s dangerousness can be conceptualised in a number of different ways, but the central concern is usually risk of re-offending. However, risk in this sense is not the same as dangerousness (i.e. the severity of behaviour). A major difficulty in assessing risk in sexual offenders is the low base rate (rarity) of recidivism. Predicting relatively rare (low base rate) events such as sexual offences, increases possibility of making false positive errors (i.e. predicting that an offender will re-offend, when in fact they do not). The validity of a test or assessment depends on its sensitivity and specificity. Methods of Assessing Risk There are various methods of assessing risk, categorised as with clinical judgement (which includes unstructured and structured professional judgement) and actuarial (which uses tests and risk instruments). Structured clinical judgement has no fixed rules for tallying risk scores and no link between a total score and a specific probability of a re-offence. The assessment of risk remains a clinical judgement and is seen to be intuitive, though the structured clinical FPP Ltd 2006 10 Adolescent Sex Offenders

judgement has higher accuracy than the unstructured assessment. Structured clinical judgement is based on scientific evidence to support the risk factors being evaluated. Furthermore, the empirically guided approach is more systematic and should lead to better agreement among professionals (Boer et al., 1997). Unlike unstructured clinical judgments, actuarial assessments are based on an objective scoring system for a fixed number of risk factors. The risk factors included in most actuarial systems have been identified through an examination of follow-up research with large samples of individuals. In actuarial scales the resultant total score corresponds to a probabilistic estimate of risk over a fixed time period (e.g., 30% likelihood of being charged for a sexual re-offence over a 5-year period). Actuarial risk measures are up to six times better at predicting risk than clinical methods or mere gut feeling. However, there are a number of limitations associated with the use of actuarial scales. The lower the base rate of the event being predicted, the more inaccurate the tool will be (see Craig et al, 2004). Risk Factors Broadly speaking there are two types of risk factors - static and dynamic factors. Static factors are historical (non-changeable) factors, useful for evaluating long-term risk (e.g., previous convictions etc). Dynamic factors are linked to likelihood of offending but are subject to change. Dynamic factors can be stable - changeable but enduring factors (sexual attitudes, distortions, victim empathy, interpersonal functioning) or acute - rapidly changing factors (substance abuse, isolation, negative emotional states) the presence of which increase risk. When predicting future events, the shorter the time frame, the greater the accuracy. One piece of information can change the outcome of a risk assessment, thus it needs to be thorough, using information from a range of sources. Risk assessment should be considered as an ongoing process due to the dynamic factors that can wax and wane over time. Remember: garbage in = garbage out. Predicting risk of sexual offending: Accurate assessments of risk should be grounded in current knowledge and use structured / objective methods, which are considered the most accurate. It is important to recognise how difficult the task is and try to balance the static and dynamic risk FPP Ltd 2006 11 Adolescent Sex Offenders

factors. Assessment should also look to include facilitators and inhibitors of risk (some of these may be situationally determined and time dependent). In carrying out risk assessments, the person, their personality, the situation and context in which they are in, their mental state, victim factors, presence of controls and disinhibitors, level of support, history and behaviour and the costs and chance of re-offending should be considered. Clinical Assessment In view of the heterogeneous nature of adolescents who have sexually offended, comprehensive assessments of individuals are needed to facilitate treatment and intervention strategies. These include assessment of each adolescent's needs (psychological, social, cognitive, and medical), family relationships, risk factors, and risk management possibilities. Gathering Multiple Sources of Information. Assessments are the most reliable and comprehensive if information is gathered from a number of sources: Interview of offender Psychometric assessments of offender Phallometric tests of offender Victim statements Interview of parent of JSO School records Mental health records Court records Psychological tests can be used to assess intellectual and neurological, personality functioning and psychopathology, behavioural, and sexual deviance. Assessing deviant sexual arousal can be undertaken using phallometric tests. However, there are potential ethical concerns about this type of assessment with adolescents, thus other psychophysiological or psychometric tests may be used: Abel Assessment for Interest in Paraphilias (Abel Screening, Inc., 1996). FPP Ltd 2006 12 Adolescent Sex Offenders

Multiphasic Sex Inventory Juvenile (MSI-J, Nichols & Molinder, 2001) Multidimensional Assessment of Sex and Aggression (MASA; Knight, Prentky & Cerce, 1994) Substance abuse assessment can be carried out using psychometric testing Substance Abuse Subtle Screening Inventory Adolescent (SASSI-A2 Miller & Lazowski,1999), or as part of a structured interview, to assess the impact of any substance misuse on their offending behaviour. Recidivism: Rates and Associated Factors The sexual reconviction rate for adolescent sex offenders range from 5% to 14% and are substantially lower than reconviction rates for non-sexual offences (16-54%) (Worling & Curwen, 2001; Nisbet, Wilson & Smallbone, 2004; Waite, Keller, McGarvey, Wieckowski, Pinkerton & Brown, 2005). Adolescents who offend against young children tend to have slightly lower sexual recidivism rates than adolescents who sexually offend against other teens. However, there are higher rates of sexual recidivism among more disturbed, violent, and chronic adolescent offenders (Rubinstein, Yeager, Goodstein, & Lewis, 1993). Research suggests adolescents rate of sexual recidivism is lower than that of adult sex offenders. A follow-up of 46 adolescent sex offenders over a mean period of 5 years suggested that the base rates for sexual and general recidivism were 20% and 65%, respectively (Langstrom & Grann, 2000). Nisbet et al. (2004) studied the reconviction data of 292 adolescent sex offenders obtained over a 7 year period and found that 25% of them were reconvicted of sexual offences as adolescents; 9% had allegations of sexual offences made against them as adults; 5% were convicted of sexual offences as adults and 61.3% were reconvicted for nonsexual offences as adults. In the most recent 10 year follow-up study of 261 male adolescent sex offenders from two different treatment groups found that the re-arrest rate for violence was 28-39%; the re-arrest rates for property offences were 13-20%; for sexual offences, they were less than 5% and the recidivism rate for all offence types was 47-70% (Waite et al, FPP Ltd 2006 13 Adolescent Sex Offenders

2005). The average time before recidivism was 5 years and general recidivism was predicted by high impulsivity and anti-social behaviour. Methodological variations in research studies clearly influence recidivism rates and vary depending upon the definition of recidivism (self-report re-offend/ re-arrest/ reconviction) as well as the length of the follow-up period. Factors associated with recidivism: Predictors of sexual recidivism differ to those associated with adult sexual offenders. Characteristics that have been empirically associated with sexual recidivism are: Deviant arousal, i.e. to children, male victims (Weinrott, 1998; Langstrom & Grann, 2000; Worling & Curwen, 2001; Miner, 2002) Prior sex offence(s) (Weinrott, 1998; Worling et al, 2001; Nisbet et al, 2004) cognitive distortions, such as blaming the victim (Kahn et al, 1991; Schram, Milloy & Rowe, 1991; Weinrott, 1998) Use of threat or force and psychopathy (Weinrott, 1998) More than two victims in the index offence (Worling et al, 2001, Langstrom et al., 2000) Poor social skills (Langstrom & Grann, 2000; Worling & Curwen, 2001). Early onset of sexually abusive behaviour (Langstrom & Grann, 2000; Miner, 2002) Impulsivity (Miner, 2002; Waite et al, 2005) Short treatment stays (Miner, 2002) However, Nisbet et al (2004), found that those adolescent sex offenders who were rearrested/convicted for sexual offences as adults were older when first charged as an adolescent and were more likely to have adult victims as adolescents, contrary to previous findings. Although denial of the index sexual offence was once a popular predictor of sexual re-offending, the data published to date are not supportive of this assumption (Worling, 2002, as cited in Worling 2004). Furthermore, deviant sexual arousal (sexual excitation in response to deviant stimuli such as prepubescent children, aggression, or violence), is considered to represent a central risk for recidivism among adult and adolescent sexual offenders, and available FPP Ltd 2006 14 Adolescent Sex Offenders

actuarial assessment procedures for adults, as well as clinical assessment tools for adolescents, include deviant sexual arousal as a risk factor (Boer et al, 1997; Hanson & Bussiere, 1996; Worling & Curwen, 2001). Studies have found that adolescent sex offenders have higher recidivism rates for nonsexual offences (Worling & Curwen, 2001; Nisbet et al., 2004). Non-sexual recidivism is related to factors commonly predictive of general delinquency, such as a history of previous offences, low self-esteem, antisocial personality and use of weapons and death threats (Worling et al, 2001; Langstrom et al., 2000). Sexual Offence Recidivism Risk Assessment Tools Estimate of Risk of Adolescent Sex Offence Recidivism (ERASOR; Worling & Curwen, 2001). The ERASOR was designed to assist evaluators to estimate the risk of a sexual reoffence for individuals aged 12 18. The final risk estimate derived from using the ERASOR is short-term (i.e., at most 1 year) and should not be used to address questions related to long-term risk. This is based on the fact that (i) 12- to 18-year-olds are still rapidly developing with respect to many areas of functioning such as sexual, social, familial, and cognitive, (ii) the recidivism data in the published literature are typically based on mean follow-up periods of under 3 years, and (iii) 16 of the 25 risk factors in the ERASOR are dynamic and, therefore, must be reassessed following marked change or the passage of time. The 25 risk factors included in the ERASOR (Version 2.0; Worling & Curwen, 2001) fall into five categories: (1) Sexual Interests, Attitudes, and Behaviours, (2) Historical Sexual Assaults, (3) Psychosocial Functioning, (4) Family/Environmental Functioning, (5) Treatment. The factors are coded as present, possibly or partially present, no present or unknown. The overall risk estimate is a clinical judgment that is guided by both the number and FPP Ltd 2006 15 Adolescent Sex Offenders

combination of risk factors that are present for each adolescent. Preliminary psychometric data (inter-rater agreement, item-total correlation, internal consistency, discriminant validity) have been found to be largely supportive of the reliability and item composition, though further research is needed on the predictive accuracy of the ERASOR before it can be considered an actuarial measure (Worling, 2004). Juvenile Sex Offender Assessment Protocol (J-SOAP-II, Prentky & Righthand, 2003) The J-SOAP-II is a checklist to aid in the systematic review of risk factors identified for sexual and criminal offending. It can be used with boys aged 12 to 18 years and is designed as a measure of impulsive, aggressive, conduct-disordered behaviour as well as risk for sexual recidivism. There are many items in the J-SOAP-II related to the risk of general juvenile delinquency. The J-SOAP-II provides ratings of sexual reoffence risk using 28 items across four scales two static scales (Sexual Drive/Preoccupation and Impulsive, Antisocial Behaviour) and two dynamic scales (Clinical/Treatment and Community Stability/Adjustment). Each risk factor is scored 0, 1 or 2 (absent, partially present, present). Though it yields a total score, research is ongoing to develop this into an actuarial measure, as there are no cut-off scores yet to categorise the level of risk. Child and Adolescent Needs and Strengths-Sexual Development (CANS-SD, as cited in Hunter 2002). The CANS-SD is a comprehensive juvenile sex offender-specific needs assessment instrument. It provides ratings of the youth s functioning in each of the following domains: - Functional Status - Caregiver Capacity - Risk Behaviours - Strengths - Mental Health Needs - Characteristics of Sexual Behaviour. - Care Intensity and Organization The CANS-SD emphasizes the identification of both strengths and weaknesses in the functioning of the youth and in his familial and environmental support systems. It is intended to provide guidance to childcare workers, probation and parole officers, and clinicians in identifying salient case management issues and intervention needs. FPP Ltd 2006 16 Adolescent Sex Offenders

Juvenile Risk Assessment Tool (J-RAT:V2, Stetson School, 2003) The J-RAT is another assessment tool to assist the prediction of risk for re-offending of juvenile sex offenders. It assesses 118 static (historical) and dynamic (changeable) factors, ranging across 12 Risk Domains. Each factor is coded as high, medium or low risk: Responsibility Co-morbidity/other treatment Relationships Substance abuse Cognitive ability/skills Anti-social behaviour Social skills Pattern of sexual offending Past trauma Family factors Personal characteristics Environmental conditions Interim Modified Risk Assessment Tool version 2 (IM-RAT: V2, Stetson School, 2001) The IM-RAT is a modified version of J-RAT, used as an on-going measure of assessment during treatment the treatment phase. It measures more dynamic factors than the J-RAT and in all, assesses 105 factors in 14 Risk Domains: Responsibility Conduct Relationships Psychosocial stressors Social skills Interactions and contact Cognitive skills Ongoing sexual behaviour Impact of past trauma Prior sexual offending Personal characteristics Family factors Co-morbidity Progress in SO treatment There are also versions of the J-RAT and IM-RAT available for cognitively impaired adolescent sex offenders. Further advice can be sought from FPP regarding psychological tests and assessments for adolescent sexual offenders. FPP Ltd 2006 17 Adolescent Sex Offenders

Treatment of Adolescent Sex Offenders The number of treatment programs for sexually abusive youth in the United States has increased dramatically from only 20 in 1983 to more than 800 by 1993 (Freeman- Longo, Bird, Stevensen,& Fiske, 1995). Initially, treatment programs for adolescents were based on those developed for adult sex offenders, but due the differences identified between these two populations, treatment programs specific to adolescents have since been developed. Adolescent sex offenders are considered to be more responsive to treatment than adult sex offenders and do not appear to continue reoffending into adulthood, especially when provided with appropriate treatment (ATSA, 2000). As described by Ryan (1999), offence-specific interventions focus on the pattern of fantasy, planning, victim selection, grooming, access and opportunity, sexual arousal and reinforcement, distortions and rationalisations, decision making, secrecy, and denial. However, programs designed to focus exclusively on sex-offending behaviours are of limited value and a more holistic approach is recommended (Goocher, 1994). Holistic preventative interventions focus on defusing affective triggers, increasing developmental competence and self-efficacy, countering hopelessness and distrust, and increasing psychological safety in relationships (Ryan, 1999). The struggle is to combine the specific and the holistic into comprehensive models that can differentially diagnose and treat offenders while respecting the unique developmental and contextual realities of each individual. Furthermore, research (Henggeler, 1989) suggests that adolescent sexual offenders are embedded in multiple systems relating to family problems, peer relationships, and academic difficulties in school. Multisystemic Therapy (MST) is an ecologically based treatment model that addresses multiple determinants of serious antisocial behaviour in youth. Not every sexually abusive youth will need the same treatment, and not every youth will respond to treatment in the same way. The challenge is to become able to differentiate the treatment needs, measure the response to treatment periodically and revise the treatment plans as required (National Adolescent Perpetrator Network, NAPN, 1993). Treatment should be provided in the least restrictive environment FPP Ltd 2006 18 Adolescent Sex Offenders

necessary for community protection. Treatment efforts also should involve the least intrusive methods that can be expected to accomplish treatment objectives. Treatment efficacy: A follow-up study of 148 adolescent sexual offenders over 2-10 years showed different recidivism rates between the treated and un-treated groups (Worling & Curwen, 2000). Of the 58 adolescent sex offenders who received offence focussed treatment, 5.2% re-offended sexually, 18.9% violently and 20.7% general offending. Of the 90 non-treated adolescents, 17.8% re-offended sexually, 32.2% violently and 50% general offending, thus indicating the potential efficacy of offender treatment programmes. Treatment goals included increasing offender accountability; assisting offenders to understand and interrupt the thoughts, feelings, and behaviours that maintain sexual offending; reducing deviant sexual arousal, if present; improving family relationships; enhancing victim empathy; improving social skills; developing healthy attitudes towards sex and relationships; and reducing the offenders personal trauma, if present (Worling & Curwen, 2000). In controlled studies with serious juvenile offenders, MST has demonstrated long term reductions in criminal activity, violent offences, drug-related arrests, and incarceration (Borduin, 1999; Borduin, Cone, Mann, Henggeler, Fucci, Blaske & Williams, 1995). The MST group had recidivism rates of 12.5% for sexual offences and 25% for nonsexual offences, in contrast to the 75% and 50% recidivist rates for the group who had received individual counselling that focussed on personal, family, and academic issues, although the follow up period was relatively short (37 months) and the sample sizes were small (Borduin, Henggeler, Blaske & Stein, 1990). Schaeffer and Borduin (2005) examined the long-term criminal activity of the 176 youths who had participated in either MST or individual offence focussed therapy in the Borduin et al. (1995) study. Arrest and incarceration data were obtained on average 13.7 years later when participants were on average 28.8 years old. Results show MST participants had significantly lower recidivism rates at follow-up than did their counterparts who participated in individual offence focussed therapy (50% vs. 81%, respectively). However, while these results are encouraging, independent researchers not involved in MST approaches have yet to demonstrate treatment efficacy empirically. FPP Ltd 2006 19 Adolescent Sex Offenders

Continuum of Care Models During their treatment, adolescents may require different levels of supervision and treatment intensity. Bengis (1997) also stressed that to be most effective, the components of the continuum should have consistent treatment philosophies and approaches and should provide stability in treatment providers as the adolescent moves along the continuum. Treatment Approaches (Righthand et al., 2001) Overview. Primary goals in the treatment of adolescents who have sexually offended have been defined variously as community safety (NAPN, 1993), helping juveniles gain control over their abusive behaviours and increase their pro-social interactions (Cellini, 1995), and preventing further victimisation, halting development of additional psychosexual problems, and helping adolescents develop age-appropriate relationships (Becker and Hunter, 1997). To accomplish these goals, highly structured interventions are recommended (Morenz et al., 1995). Treatment approaches include individual, group, and family interventions. Recommended treatment content areas typically include sex education, correction of cognitive distortions (cognitive restructuring), empathy training, clarification of values concerning abusive versus non-abusive sexual behaviour, anger management, strategies to enhance impulse control and facilitate good judgment, social skills training, reduction of deviant arousal, and relapse prevention (Becker et al., 1997; Hunter and Figueredo, 1999; NAPN, 1993). Addressing deviant arousal. Most programs that address deviant arousal do so through covert sensitization, a treatment approach that teaches adolescents to interrupt thoughts associated with sex offending by thinking of negative consequences associated with abusive behaviour (Becker & Kaplan, 1993; Freeman-Longo, Bird, Stevensen & Fiske, 1994). Other techniques include various forms of behavioural conditioning and are much more invasive and aversive. Such techniques raise concerns regarding practicality, effectiveness, and/or ethics. Vicarious sensitization (VS) is a relatively new technique that involves exposing juveniles to audio-taped crime scenarios designed to stimulate arousal and then immediately showing a video that portrays the negative consequences of sexually abusive behaviour. Preliminary research findings suggest VS may be an effective approach for reducing deviant FPP Ltd 2006 20 Adolescent Sex Offenders

arousal in adolescents who are sexually aroused by prepubescent children (Weinrott, Riggan & Frothingham, 1997). Involving families. Rasmussen (1999) argued that adequate family support can help reduce recidivism and that treatment programs that involve families are likely to be more effective than others that do not. As Gray and Pithers (1993) observed, however, families vary in terms of their motivation and ability to effectively facilitate their child's treatment. Treatment also varies from community to residential based programmes, dependent upon the offenders risk and needs. In many cases of adolescent sex offenders, the victim is also member of their family (Miranda & Corcoran, 2000), thus rehabilitating the offender back home and reunification of the family is a necessary component of the treatment and management process. Victim clarification is the first step to family reunification, which often involves face-to-face sessions between the victim and the offender. However, due to the likely harm caused to the victim, this requires careful planning and sensitive handling and is extended to include immediate family members. It has been suggested that before such as session occurs, the victim should have already been engaging in therapy (Rich, 2003). Gray and Pithers (1993) applied relapse prevention to the treatment and supervision of adolescents with sexual behaviour problems. This technique requires that adolescents learn to identify factors associated with an increased risk of sex offending and use strategies to avoid high-risk situations or effectively manage them when they occur. Attrition from sex-offence-specific treatment. High rates of treatment attrition are extremely important. A study of adolescent sex offenders (Hunter & Figueredo, 1999) and several studies of adult offenders (e.g., Hanson & Buissière, 1998) suggest that failing to complete treatment is associated with higher rates of recidivism for both sex offences and other types of offences. Treatment of adolescents with cognitive or developmental disabilities. Behaviourally oriented interventions may be more effective than cognitive based programmes for adolescent sex offenders with cognitive impairments. Anyone engaging in treatment with adolescent sex offenders should be appropriately qualified and experienced in working with this complex population. FPP Ltd 2006 21 Adolescent Sex Offenders

Community Safety and Supervision Issues There is general agreement adolescent sex offenders should be processed through the juvenile justice system as it can provide documentation for future use and provide broader sentencing options. Adolescent sex offenders should be subjected to the normal juvenile probation supervision requirements. Most adolescent sex offenders pose a manageable level of risk to the community. They can be safely maintained in the community under supervision by probation officers and be treated in outpatient treatment programmes. However, a minority pose a danger to the community and require residential or custodial placement to ensure community safety. It is important to identify higher risk youth in order to make the most effective placement decisions. There is currently no scientifically validated system or test to determine exactly which adolescent sex offenders pose a high risk for recidivism. Mental health professionals and treatment staff typically overestimate the possibility of recidivism in evaluations, labelling far more teenagers as high risk than is actually accurate. In predicting risk to the community, it is usually appropriate to assume that an adolescent sex offender is relatively low risk unless there is significant evidence to suggest otherwise. Low risk does not imply the absence of risk, and low-risk offenders still need supervision and treatment. The following factors are important to consider in evaluating risk: A history of multiple sexual offences, especially if any occurs after adequate treatment. A history of repeated non-sexual juvenile offences Clear and persistent sexual interest in children Failure to comply with an adolescent sexual offender treatment program Self-evident risk signs such as out-of-control behaviour, statements of intent to re-offend, etc. Family resistance regarding supervision and compliance, (e.g., the youth needs to be supervised by appropriate adults in the home and community and the adults need to make certain the youth complies with probation and treatment requirements). FPP Ltd 2006 22 Adolescent Sex Offenders

Decisions about whether an adolescent sex offender should remain in the same home with the victim of his or her offence should be made carefully on a case-bycase basis. The decision may involve input from a variety of professionals within and outside of the juvenile justice system (e.g., child protection workers, therapists, etc.). For the adolescent sex offender who commits sexual offences against young children, additional supervision requirements should be considered. The following suggested rules should be adapted for the specific adolescent s family: No baby-sitting under any circumstances. No access to young children or potential victims without direct supervision by a responsible adult who is aware of the problem. No authority or supervisory role over young children (e.g., in school, church or job activities). No possession or use of sexually explicit, "x-rated," or pornographic material These rules do not preclude most ordinary daily activities, such as going to school, church, stores, or restaurants with family, or involvement in age-appropriate and appropriately supervised peer. FPP Ltd 2006 23 Adolescent Sex Offenders

Conclusions Adolescents who have committed sex offences are a heterogeneous group who, like all adolescents, have developmental needs, but who also have special needs and present special risks related to their abusive behaviours. There are various structured clinical judgement assessment tools and psychometric measures that have been designed specifically for use with adolescents who have exhibited sexually abusive behaviour. However, further empirical validation is needed because this area of research is still in its infancy. Sexual recidivism rates for adolescent sexual offenders are lower than those for adult sexual offenders. Furthermore, recidivism rates are lower for sexual offences than they are for violent or general offences types. Interventions that are tailored to the individual adolescent appear to be more effective in reducing recidivism other interventions. Risk management strategies likely to be most effective are those that address the needs underlying an adolescents behaviour and make the most of the adolescents existing strengths and positive supports. Interventions should target factors that are empirically associated with the risk of sex offending specifically (e.g., deviant arousal and limited social competence) and factors associated with delinquent offending in general (e.g., delinquent peers and antisocial attitudes). It should be remembered that the goal when working with adolescents who have committed sex offences is to help them stop their abusive behaviours. To label them "adolescent sex offenders" at a time when they are developing their identity may have deleterious effects. There is no evidence pertaining to these adolescents that suggests once a sex offender, always a sex offender, given the relatively low recidivism rates. Instead, it is important to remember that they are children and adolescents first they are young people who have committed offences and who deserve care and attention (Righthand et al., 2001). FPP Ltd 2006 24 Adolescent Sex Offenders

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Useful Links: Association for the Treatment of Sexual Abusers (ATSA) http://www.atsa.com National Center on Sexual Behaviour of Youth (U.S.A) http://www.ncsby.org/index.htm Park Street Programme Residential Treatment for Adolescent Sex Offenders (U.S.A) http://www.howardcenter.org/baird/baird%20programs/baird77park.htm A Project of the Office of Justice Programs, U.S. Department of Justice http://www.csom.org The Home Office For statistics and publications on youth crime: http://www.homeoffice.gov.uk/ National Society for the Prevention of Cruelty to Children (NSPCC) Information site for practitioners, research and trainers: http://www.nspcc.org.uk/inform/home/informhomepage_ifega26884.html The National Organisation for the Treatment of Abusers (NOTA) http://www.nota.co.uk/ Youth Offending Teams UK. Contact details can be found at: http://www.youth-justice-board.gov.uk/youthjusticeboard/youthoffendingteams/ Residential Units specialised in adolescent sex offenders: Aycliffe Secure Services Aycliffe Young People's Centre, Copelaw, Newton Aycliffe, County Durham. DL5 6JB Tel: 01325 375600, Fax: 01325 375735(daytime), 01325 307942 (out of hours) Male and female Beechfield Secure Unit Effingham Road, Copthorne, West Sussex, RH10 3HZ Tel: 01342 712309, Fax: 01342 717332 Male and female Clayfields House Secure Unit 18-20 Moorbridge Lane, Stapleford, Nottingham. NG9 8GU Tel:0115 9170010, Fax: 0115 9170011 Male and female http://www.clayfieldshouse.org.uk/ FPP Ltd 2006 30 Adolescent Sex Offenders

East Moor Secure Children's Home East Moor Lane, Adel, Leeds, West Yorkshire LS16 8EB Tel:0113 2610031, Fax: 0113 2672218 Male only Gladstone House Secure Children's Home Dyson Hall Campus, Higher Lane, Fazakerly, Liverpool. L9 7HB Tel:0151 2331455, Mob:07734327196, Fax:0151 2331464 Hillside Secure Centre Burnside, Neath, SA11 1UL South Wales. Tel:01639 641648, Fax:01639 620236 Male and female Lansdowne Unit Hawks Road, Hailsham, East Sussex. BN27 4HY Tel:01323 843771, Fax:01323 849235 Orchard Lodge William Booth Road, Anerley, London. SE20 8BG Tel: 0208 4029696, Fax:0208 4029697 All male www.orchardlodge.org.uk Red Bank Community Home Winwick Road, Newton-le-Willows, Merseyside. WA12 8EA Tel:01925 224621, Fax:01925 220710, Referrals: 01925 224621 All male St John's Secure Unit St John's Road, Tiffield, Towcester, Northants. NN12 8AA Tel:01604 858113, Fax:01604 859758 Male and female www.sjsecurecare.org.uk Watling House Secure Children's Home Watling Street, Gailey, Staffordshire. ST19 5PR Tel:01902 798220, Fax:01902 798224 Male and female Lowther Adolescent Unit, St. Andrews Hospital Billing Road, Northampton. NN1 5DG Tel: 01604 616000, Fax: 01604 614364, Referrals: 01604 614242 Male and female www.stah.org FPP Ltd 2006 31 Adolescent Sex Offenders