Sexual abuse is widely recognized as a significant problem in society, and the scope of the problem may be underestimated because juvenile sex offenders who are known to the system may represent only a small proportion of juveniles who have committed such offenses. Studies of adult sex offenders suggest another dimension of the problem: many of these offenders began their sexually abusive behavior in their youth.
The costs of sex offending are substantial for victims and society and for the young offenders and their families. To minimize these costs, timely and appropriate interventions are needed. A review of the professional literature suggests, however, that programs designed to meet the perceived needs of these young offenders frequently apply knowledge and interventions designed for adult offenders without considering developmental issues and needs unique to juveniles.
Characteristics of Juveniles Who Have Committed Sex Offenses
Juveniles who have committed sex offenses are a heterogeneous mix (Bourke and Donohue, 1996; Knight and Prentky, 1993). They differ according to victim and offense characteristics and a wide range of other variables, including types of offending behaviors, histories of child maltreatment, sexual knowledge and experiences, academic and cognitive functioning, and mental health issues (Knight and Prentky, 1993; Weinrott, 1996).
Offending Behaviors
Sexually abusive behaviors and sex offense characteristics. Sexually abusive behaviors range from noncontact offenses to penetrative acts. Offense characteristics include factors such as the age and sex of the victim, the relationship between victim and offender, and the degree of coercion and violence used.
Nonsexual criminal behavior. Juvenile sex offenders frequently engage in nonsexual criminal and antisocial behavior (Fehrenbach et al., 1986; Ryan et al., 1996). A national survey found that most of the 80 juveniles who disclosed sexually assaultive behavior had previously committed a nonsexual aggravated assault (Elliot, as cited in Weinrott, 1996).
Child Maltreatment Histories
The childhood experience of sexual abuse has been associated with juvenile sex offending (Fehrenbach et al., 1986; Kahn and Chambers, 1991; Kobayashi et al., 1995). Childhood experiences of being physically abused, being neglected, and witnessing family violence also have been independently associated with sexual violence in juvenile offenders (Kobayashi et al., 1995; Ryan et al., 1996). The abusive experiences of juvenile sex offenders, however, have not consistently been found to differ significantly from those of other juvenile offenders (Lewis, Shanok, and Pincus, as cited in Knight and Prentky, 1993; Spaccarelli et al., 1997). Research suggests that the role of child maltreatment in the etiology of sex offending is quite complex (Prentky et al., 2000).
Social and Interpersonal Skills and Relationships
Family factors. Factors such as family instability, disorganization, and violence have been found to be prevalent among juveniles who engage in sexually abusive behavior (Bagley and Shewchuk-Dann, 1991; Miner, Siekert, and Ackland, 1997; Morenz and Becker, 1995). Various studies (e.g., Kahn and Chambers, 1991; Fehrenbach et al., 1986; Smith and Israel, 1987) suggest that many juvenile sex offenders have experienced physical and/or emotional separations from one or both of their parents.
Social skills and relationships. Research repeatedly documents that juveniles with sexual behavior 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 juveniles (Fehrenbach et al., 1986; Katz, 1990; Miner and Crimmins, 1995).
Sexual Knowledge and Experiences
Sexual histories and beliefs. Research suggests that adolescent sex offenders generally have had previous consenting sexual experiences (Becker, Kaplan, Cunningham-Rathner, and Kavoussi, as cited in Knight and Prentky, 1993; Groth and Longo, as cited in Knight and Prentky, 1993; Ryan et al., 1996). Research also suggests that sometimes their previous experiences exceed those of juveniles who have not committed sex offenses (McCord, McCord, and Venden, as cited in Knight and Prentky, 1993). Prior experiences with sexual dysfunction, most commonly impotence or premature ejaculation, have also been reported in juvenile sex offenders (Longo, as cited in Knight and Prentky, 1993). A study of 1,600 juvenile sex offenders from 30 States (Ryan et al., 1996) found that 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 percent), to dissipate anger (9.4 percent), or to hurt, degrade, or punish (8.4 percent).
Deviant sexual arousal. Studies of male college students and adult sex offenders have shown that deviant sexual arousal is strongly associated with sexually coercive behavior (Barbaree and Marshall, as cited in Hunter and Becker, 1994; Earls and Quinsey, as cited in Hunter and Becker, 1994; Prentky and Knight, as cited in Knight and Prentky, 1993). Controlled studies of deviant sexual arousal in juvenile sex offenders are lacking. Two studies (Schram, Milloy, and Rowe, 1991; Kahn and Chambers, 1991) reported associations between sexual reoffending in juveniles and deviant sexual arousal, but both studies relied on clinical judgments rather than objective methods to identify deviant arousal.
Pornography. Investigations into the role of pornography in juvenile sex offending are limited in number. One study (Becker and Stein, as cited in Hunter and Becker, 1994) found that only 11 percent of the juvenile sex offenders studied said they did not use sexually explicit materials. Another study (Wieckowski et al., 1998) found that exposure to pornographic material at a young age was common in a sample of 30 male juveniles who had committed sex offenses. A comparative study (Ford and Linney, as cited in Becker and Hunter, 1997) found that 42 percent of juvenile sex offenders, compared with 29 percent of juvenile violent offenders (whose offenses were nonsexual) and status offenders, had been exposed to hardcore, sexually explicit magazines.
Academic and Cognitive Functioning
Academic performance. Studies typically report that as a group, juveniles who sexually offended experienced academic difficulties (Fehrenbach et al., 1986; Kahn and Chambers, 1991; Miner, Siekert, and Ackland, 1997; Pierce and Pierce, as cited in Bourke and Donohue, 1996). One study (O'Brien, as cited in Ferrara and McDonald, 1996), however, found that 32 percent of a sample of male juvenile sex offenders had above-average academic performance.
Intellectual and cognitive impairments. Research that focuses on the intellectual and cognitive functioning of juveniles who have committed sex offenses is limited. Existing studies, however, suggest that intellectual and cognitive impairments are factors that should be addressed (Awad, Saunders, and Levene, as cited in Knight and Prentky, 1993; McCurry et al., 1998). Based on their review of the literature, Ferrara and McDonald (1996) concluded that between one-quarter and one-third of juvenile sex offenders have some form of neurological impairment.
Cognitive distortions and attributions. Knight and Prentky (1993) pointed out that some factors observed in abused children (e.g., reduced empathy, inability to recognize appropriate emotions in others, and inability to take another person's perspective) may have relevance for juvenile sex offenders who have been maltreated. This observation is consistent with research indicating that cognitive distortions, such as blaming the victim, are associated with sexual reoffending in juveniles (Kahn and Chambers, 1991; Schram, Milloy, and Rowe, 1991).
Mental Health Issues
Symptoms and disorders. Conduct disorder diagnoses and antisocial traits frequently have been observed in populations of juveniles who have sexually offended (Kavoussi, Kaplan, and Becker, 1988; Miner, Siekert, and Ackland, 1997). Studies also have described other behavioral and personality characteristics in juveniles who have sexually offended, such as impulse control problems and lifestyle impulsivity (Prentky and Knight, as cited in Prentky et al., 2000; Smith, Monastersky, and Deisher, as cited in Prentky et al., 2000). Carpenter, Peed, and Eastman (1995) found that juvenile sex offenders whose victims were younger children had higher scores on the Schizoid, Avoidant, and Dependent scales of the Millon Clinical Multiaxial Inventory (MCMI) than those whose victims were their age peers. Studies also have found higher rates of depression in juveniles who have sexually offended than in the general juvenile population (Becker et al., as cited in Becker and Hunter, 1997; Kaplan, Hong, and Weinhold, as cited in Becker and Hunter, 1997). Few studies of adolescents and children with sexual behavior problems report major psychopathology in the subjects and their families (Becker, as cited in Ferrara and McDonald, 1996; Johnson, as cited in Ferrara and McDonald, 1996).
Substance abuse. Studies vary widely on the importance of substance abuse as a factor in sex offending among juveniles. Lightfoot and Barbaree (1993) reported that rates at which juvenile sex offenders were found to be under the influence of drugs or alcohol at the time they committed their offenses ranged from 3.4 percent to 72 percent. Although substance abuse has been identified as a problem for many juveniles who have sexually offended (Kahn and Chambers, 1991; Miner, Siekert, and Ackland, 1997), the role of substance abuse in sex offending remains unclear. Lightfoot and Barbaree pointed out that assessments of juvenile sex offenders should differentiate substance abuse problems from "normative" experimentation that is part of the developmental process. It appears that evidence is insufficient to identify substance abuse as a causative factor in the development of sexually abusive behavior, although substance abuse has a disinhibiting potential and, if present, may require intervention.
Types and Classifications of Male Adolescents Who Have Committed Sex Offenses
Although a variety of characteristics have been identified among juveniles who have sexually offended, few studies have attempted to classify these juveniles according to their similarities and differences. O'Brien and Bera (as cited in Weinrott, 1996) defined seven categories of juvenile sex offenders: naive experimenters, undersocialized child exploiters, sexual aggressives, sexual compulsives, disturbed impulsives, group influenced, and pseudosocialized. Graves (as cited in Weinrott, 1996) suggested three typologies: pedophilic, sexual assault, and undifferentiated. Prentky et al. (2000) used six categories: child molesters, rapists, sexually reactive children, fondlers, paraphilic offenders, and unclassifiable. Weinrott (1998a) suggested four general types: juvenile delinquents in general, those who have deviant arousal, those who are psychopathic offenders, and those who fit none of these categories and may only require limited intervention. More research that differentiates juvenile sex offenders according to their various behavior patterns, cognitive and emotional functioning, and other relevant factors is needed to determine and apply appropriate and effective treatment strategies.
Sibling Incest
Few reports have specifically addressed issues pertaining to sibling incest. Araji (1997) noted that although sibling incest appears to be quite prevalent, often it is underreported and ignored. O'Brien (1991) compared sibling sex offenders with juvenile sex offenders whose victims were either children outside the family, adults, peers, or a mix of categories and found that the sibling offenders had more serious offending histories, were less likely to receive court-ordered treatment, and differed from the nonsibling offenders on several measures (including family factors such as presence of dysfunction and physical abuse). A study of inner-city minority juveniles (Becker et al., 1986), however, found that 9 of 22 sibling offenders also evidenced nonsibling paraphilic behavior. Bonner and Chaffin (1998) asserted that most interventions designed to address sibling sexual behavior assume a victim-perpetrator model but that such a model may not always be appropriate.
Girls Who Have Committed Sex Offenses
Incidence. Research on girls who have committed sex offenses has been relatively rare, and existing studies have been limited by small sample sizes and other factors. In their review of the literature, Lane and Lobanov-Rostovsky (1997) found that females represented 5–8 percent of juvenile sex offenders in three statewide incidence studies conducted in the 1980's. More recent studies, however, found a higher incidence of sex offending by young girls (English and Ray, as cited in Araji, 1997; Johnson, as cited in Lane and Lobanov-Rostovsky, 1997; Gray et al., 1997). The incidence of sex offending may be underestimated for female juveniles even more than for males, perhaps because of a societal reluctance (and even a reluctance among professionals) to acknowledge that girls are capable of committing such offenses (Travin, Cullen, and Protter, 1990).
Characteristics of female offenders and their offenses. Ray and English (1995) compared girls and boys in a sample of juveniles who were described as sexually aggressive. They found the girls tended to be younger than the boys and were less likely to have perpetrated acts of rape. The girls were more likely to be victims of sexual abuse, and more girls than boys had experienced multiple types of abuse. Fehrenbach and Monastersky (as cited in Bumby and Bumby, 1997) found that, in their sample, most adolescent girls who sexually victimized young children did so while engaged in a childcare situation. Studies of girls in inpatient settings (Bumby and Bumby, 1997; Hunter et al., as cited in Bumby and Bumby, 1997), although limited by small sample size, suggest that factors such as depression, suicidal ideation, anxiety, poor self-concept, and childhood sexual victimization are relevant for girls who commit sex offenses. In perhaps the largest study to date, Mathews, Hunter, and Vuz (1997) compared 67 girls and 70 boys who had histories of sex offending and found meaningful similarities and differences: the girls' offending behaviors were similar to the boys' in terms of types of offenses committed, and both tended to victimize young children of the opposite gender; but girls typically had more severe victimization experiences themselves.
Young Children Who Have Committed Sex Offenses
Incidence. In the 1980's, after the problem of adolescent sex offending gained attention, similar behaviors in preadolescent and younger children also were recognized. Recent surveys suggest an increase in the rate of preadolescent children who evidence sexually abusive behaviors. This apparent increase may reflect a greater awareness of the problem. In an extensive review of the literature pertaining to children who have been sexually aggressive, Araji (1997) stressed that research in this area is in its infancy and noted that many findings are simply clinical observations.
Individual characteristics. Available studies (Araji, 1997) have reported sexual aggression in children as young as 3 and 4; the most common age of onset appears to be between 6 and 9. Girls were represented in much greater numbers among these children than among adolescents who have abused, and these girls often engaged in behaviors that were just as aggressive as the boys' actions. Victims of preadolescents tended to be very young (averaging between ages 4 and 7), most often were female, and typically were siblings, friends, or acquaintances. Preadolescents who have sexually abused have been found to have high rates of sexual victimization experiences (Johnson, as cited in Araji, 1997; Friedrich and Luecke, as cited in Araji, 1997; Araji, Jache, Tyrrell, and Field, as cited in Araji, 1997; Araji, Jache, Pfeiffer, and Smith, as cited in Araji, 1997; Bonner, Walker, and Berliner, as cited in Araji, 1997; Pithers et al., 1998b) and significantly higher rates of abuse and neglect victimization experiences than those found among their adolescent counterparts (English and Ray, as cited in Araji, 1997). These preadolescents have also been found to have frequent academic and learning difficulties and impaired peer relationships (Friedrich and Luecke, as cited in Araji, 1997; Pithers and Gray, as cited in Araji, 1997).
Family characteristics. Studies described by Araji (1997) also found that families of preadolescents who have sexually abused tended to be dysfunctional. Araji concluded, "The evidence . . . points to family interactions as a primary source of the problem" (p. 87). The importance of family factors is supported by research conducted by Pithers et al. (1998a) concerning the caregivers of 72 children with sexual behavior problems. The families of these children tended to be characterized by high levels of poverty, single parenting, sexual abuse, domestic violence, and parenting stress.
Comparative studies of preadolescents and adolescents who have committed sex offenses. English and Ray (as cited in Araji, 1997) studied 271 juveniles who sexually offended by comparing the preadolescents with the adolescents. Although the researchers found many similarities between the groups (e.g., previous aggressive behavior, psychiatric problems, and levels of intellectual functioning), there were significant differences in the nature of their offenses and in their attitudes about the offenses. The adolescents had higher rates of depressive symptoms and suicidal gestures, perhaps (as Araji suggested) reflecting developmental differences between the groups. Both groups had a moderate to moderately high number of risk factors associated with repeat offending; risk factors included various characteristics of the juveniles, their families and environments, and their victims. The preadolescent children's families, however, evidenced significantly more problems, and the younger children also had significantly higher levels of social isolation and current life stresses.
Types and classifications. Young children who have sexual behavior problems are a heterogeneous group. Descriptions of these children typically differentiate normative sexual behavior from a continuum of progressively excessive and abusive sexual behaviors (Araji, 1997; Johnson, 1991). For example, Johnson (1991) classified these children into four groups: normal sexual exploration, sexually reactive, extensive mutual sexual behaviors, and child perpetrators. Araji (1997) conceptualized a subgroup of children—"sexually aggressive children"—who are comparable to children in Johnson's child perpetrators group and are at the extreme end of a childhood sexual behavior continuum. In a study of 127 children ages 6–12 who had evidenced sexual behavior problems, Pithers et al. (1998b) identified five subtypes: sexually aggressive, nonsymptomatic, highly traumatized, abusive reactive, and rule breaker. (The Pithers et al. study appears to be the first attempt to develop empirically derived and clinically relevant classifications of these children.) Longitudinal studies following these children over time are lacking; therefore, it is not known whether childhood sexual behavior problems continue or, more accurately, which children persist in their sexual misconduct in adolescence and adulthood.
Juveniles With Developmental Disabilities and Mental Retardation Who Have Committed Sex Offenses
In one of the few studies focusing on adolescent sex offenders with mental retardation, Gilby, Wolf, and Goldberg (1989) found that the frequency of sexual behavior problems among these juveniles did not differ significantly from the frequency among juveniles with normal (defined by the authors as borderline or higher) intellectual functioning. The researchers did, however, document some differences in the sexual behavior patterns of the two groups: for example, the juveniles with mental retardation had a higher rate of sexual assaults against peers and were less likely to know their victims. Although this study is informative, additional research is needed to determine whether the findings can be generalized to other juveniles with mental retardation who have committed sex offenses.
Juveniles Who Have Committed Sex Offenses Versus Other Types of Offenses
Although research is limited, available studies suggest that juveniles who commit sex offenses and juveniles who commit other types of offenses share many characteristics (e.g., Miner and Crimmins, 1995). Most recently, a study of chronic delinquents (Spaccarelli et al., 1997) found no differences on any of the measured variables between 50 sex offenders and 106 juveniles arrested for violent but nonsexual offenses.
Clinical Assessment
In view of the heterogeneous nature of juveniles who have sexually offended, comprehensive assessments of individuals are needed to facilitate treatment and intervention strategies. These include assessment of each juvenile's needs (psychological, social, cognitive, and medical), family relationships, risk factors, and risk management possibilities.
Gathering multiple sources of information. Parents or guardians of juveniles should be involved in the assessment and in the treatment process (Morenz and Becker, 1995). Their informed consent should be obtained, and they should be clearly informed of the limits of confidentiality (Becker and Hunter, 1997). Comprehensive assessments should include clinical interviews with the juveniles and family members, a psychological assessment, and, in certain cases (according to some), phallometric assessment (Bonner et al., 1998; Morenz and Becker, 1995; Becker and Kaplan, 1993). Evaluators should review victim statements, juvenile court records, mental health reports, and school records as part of their assessment (Becker and Hunter, 1997).
Using psychological tests. Psychological tests have been described as adding a "critical dimension" to comprehensive evaluations of juveniles who have sexually offended (Kraemer, Spielman, and Salisbury, 1995). Bourke and Donohue (1996) observed that studies consistently reveal the heterogeneity of these juveniles and cited a wide range of coexisting psychological disorders to emphasize the importance of using comprehensive, standardized methods of assessment. Kraemer, Spielman, and Salisbury (1995) described four primary domains that require assessment: intellectual and neurological, personality functioning and psychopathology, behavioral, and sexual deviance.
Assessing deviant sexual arousal. To adequately assess individuals who appear to evidence deviant arousal, Weinrott (1998a) stressed the importance of using direct measurement of an individual's sexual arousal, through phallometric assessment. Others, however, have discussed potential ethical concerns related to using phallometric assessment with juveniles (Bourke and Donohue, 1996; Cellini, 1995). Weinrott (1998a) suggested ways of addressing these issues. Another psychophysiological assessment measure used with juveniles who have sexually offended is the Abel Assessment for Interest in Paraphilias (Abel Screening, Inc., 1996). The Abel Assessment is significantly less invasive than phallometric assessment, and research conducted by the test developers has shown good results. However, an independent study of the Abel Assessment's reliability and validity raised questions about the use of this assessment approach with juveniles at this time (Smith and Fischer, 1999). The Abel Assessment is relatively new, and additional independent, published research is needed.
Substance abuse assessment. Assessment of a juvenile who has committed a sex offense needs to determine whether the juvenile has a substance abuse problem and, if so, whether it is a risk factor for that juvenile's sex offending. Researchers and clinicians have emphasized the importance of using valid and reliable assessment tools to screen for substance abuse problems (Becker and Hunter, 1997; Lightfoot and Barbaree, 1993).
Polygraph tests. Although controversial, the use of polygraph tests in treatment programs for juveniles who have been sexually abusive is increasing (National Adolescent Perpetrator Network [NAPN], 1993). The polygraph is used to facilitate more complete disclosures of sexually abusive behaviors and to monitor compliance with treatment. The National Task Force on Juvenile Sexual Offending has emphasized that polygraphs must be administered on a voluntary basis and with informed consent (NAPN, 1993). Research regarding the reliability and validity of the polygraph for assessing juveniles who have committed sex offenses is very limited (Hunter and Lexier, 1998), and some researchers have seriously questioned its validity (Cross and Saxe, as cited in Bonner et al., 1998; Saxe, Dougherty, and Cross, as cited in Bonner et al., 1998).
Risk Assessment
Few empirical studies have investigated sexual reoffense rates among juveniles or risk factors associated with recidivism. Two retrospective studies that investigated the frequency of offenses prior to the referral offense found relatively high offense rates (Awad and Saunders, 1991; Fehrenbach et al., 1986).
Rates of recidivism. The results of research investigating recidivism after juveniles were referred for sex offenses typically reveal relatively low rates of sexual recidivism (8 to 14 percent) (Kahn and Chambers, 1991; Miner, Siekert, and Ackland, 1997; Rasmussen, 1999; Schram, Milloy, and Rowe, 1991; Sipe, Jensen, and Everett, 1998; Smith and Monastersky, 1986). The studies also find higher rates of nonsexual recidivism (16 to 54 percent). Methodological variations clearly influence recidivism rates (Prentky et al., 1997). Nevertheless, in an extensive review of studies investigating recidivism rates among juvenile sex offenders, Weinrott (1996, p. 67) noted: "What virtually all of the studies show, contrary to popular opinion, is that relatively few [juvenile sex offenders] are charged with a subsequent sex crime."
Factors associated with recidivism. Various studies have described characteristics identified in juveniles who have sexually offended. However, Weinrott (1998b) reported that very few characteristics have actually been empirically associated with sexual recidivism. He noted that these characteristics include the following: psychopathy, deviant arousal, cognitive distortions, truancy, a prior (known) sex offense, blaming the victim, and use of threat/force. Weinrott also reported that, contrary to common belief, factors such as social skills deficits, lack of empathy, or denial of offense or sexual intent either have not been empirically associated with sexual recidivism or have simply not been investigated. (This is not to say that interventions designed to address such factors, such as efforts to reduce social skills deficits or educate offenders about victim impact, are not effective in reducing sexual recidivism, only that there is no empirical evidence indicating they are effective.)
Prediction of recidivism. Chaffin and Bonner (1998) pointed out that there are no true experimental studies comparing untreated and treated juvenile sex offenders and no prospective studies evaluating risk factors or the natural course of sexual offending. Studies suggest that treatment providers may tend to overpredict sexual recidivism rather than risk the dire consequences associated with failing to predict recidivism that comes to pass. Factors limiting the accuracy of recidivism predictions include the relative infrequency and hidden nature of sex offending, too-short followup periods, and insufficient or inadequate information relevant for decisionmaking. To enhance predictive accuracy, professionals should balance historical and actuarial information with clinical and situational information (Smith and Monastersky, 1986; Webster et al., 1997). Prentky et al. (2000) have developed and conducted initial testing of an actuarial risk assessment schedule designed to evaluate the risk of reoffending among juvenile sex offenders. As Epps (1994) noted, potential problems in using risk assessment tools to predict juvenile sex offenders' likelihood of reoffending include difficulties in gathering reliable and valid information upon which to base such instruments.
The National Task Force on Juvenile Sexual Offending articulated a set of assumptions intended to reflect the current thinking relevant to a comprehensive systems response to juveniles who have sexually offended (NAPN, 1993). These assumptions are summarized below:
- Following a full assessment of the juvenile's risk factors and needs, individualized and developmentally sensitive interventions are required.
- Individualized treatment plans should be designed and periodically reassessed and revised. Plans should specify treatment needs, treatment objectives, and required interventions.
- Treatment should be provided in the least restrictive environment necessary for community protection. Treatment efforts also should involve the least intrusive methods that can be expected to accomplish treatment objectives.
- Written progress reports should be issued to the agency that has mandated treatment and should be discussed with the juvenile and parents. Progress "must be based on specific measurable objectives, observable changes, and demonstrated ability to apply changes in current situations" (NAPN, 1993, p. 53).
- Although adequate outcome data are lacking, NAPN (1993) suggests that satisfactory treatment will require a minimum of 12 to 24 months.
Some individual States also have worked to develop appropriate protocols and standards for effective interventions with juveniles who have committed sex offenses. Treatment programs for these juveniles have proliferated during the past decade, increasing from approximately 20 in 1982 (NAPN, 1988) to more than 680 in 1994 (Freeman-Longo et al., 1994).
Continuum of Care Models
To adequately address both the needs of individual juveniles who have committed sex offenses and the needs of the community, a continuum of care is recommended (Bengis, 1997; NAPN, 1993). Offering a range of interventions and placement options makes it possible to provide cost-effective interventions while placing paramount importance on community safety. Suggested components of such a continuum have been described in the Oregon Report on Juvenile Sex Offenders (Avalon Associates, 1986) and also by Bengis (1997) and the Utah Task Force of the Utah Network on Juveniles Offending Sexually (1996). Bengis pointed out that at different points during their treatment, juveniles may require different levels of supervision and treatment intensity. Bengis 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 juvenile moves along the continuum.
Treatment Approaches
Overview. Primary goals in the treatment of juveniles who have sexually offended have been defined variously as community safety (NAPN, 1993), helping juveniles gain control over their abusive behaviors and increase their prosocial interactions (Cellini, 1995), and preventing further victimization, halting development of additional psychosexual problems, and helping juveniles develop age-appropriate relationships (Becker and Hunter, 1997). To accomplish these goals, highly structured interventions are recommended (Morenz and Becker, 1995). Treatment approaches include individual, group, and family interventions. Although group therapy often is described as the treatment of choice and cotherapy teams also are recommended (NAPN, 1993), empirical evidence of the superiority of these approaches is lacking. Advantages and disadvantages of these approaches have been described elsewhere (e.g., Marshall and Barbaree, 1990; Henggeler, Melton, and Smith, 1992). The first step in treatment typically involves helping the juvenile accept responsibility for his or her behavior (Becker and Hunter, 1997). Recommended treatment content areas typically include sex education, correction of cognitive distortions (cognitive restructuring), empathy training, clarification of values concerning abusive versus nonabusive sexual behavior, anger management, strategies to enhance impulse control and facilitate good judgment, social skills training, reduction of deviant arousal, and relapse prevention (Becker and Hunter, 1997; Hunter and Figueredo, 1999; NAPN, 1993). Many other relevant interventions also have been documented. Leaders in the treatment field have argued that programs designed to focus exclusively on sex-offending behaviors are of limited value and have recommended a more holistic approach (Goocher, 1994).
Addressing deviant arousal. Most programs that address deviant arousal do so through covert sensitization, a treatment approach that teaches juveniles to interrupt thoughts associated with sex offending by thinking of negative consequences associated with abusive behavior (Becker and Kaplan, 1993; Freeman-Longo et al., 1994). Other techniques include various forms of behavioral 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 audiotaped crime scenarios designed to stimulate arousal and then immediately showing a video that portrays the negative consequences of sexually abusive behavior. Preliminary research findings suggest VS may be an effective approach for reducing deviant arousal in juveniles who are sexually aroused by prepubescent children (Weinrott, Riggan, and 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. Gray and Pithers described strategies that can engage the cooperation of family members and reported approaches that parents found useful.
Using a relapse prevention model. Gray and Pithers (1993) applied relapse prevention to the treatment and supervision of children and adolescents with sexual behavior problems. This technique requires that juveniles 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. When relapse prevention is applied to children, greater emphasis is placed on external supervision to prevent further victimization. Empirical studies investigating the effectiveness of this approach are lacking.
Summary. Some of the interventions described above appear appropriate for some juveniles who have committed sex offenses, but others do not. Furthermore, many of the target areas described are relevant not only for sex offenders but also for juveniles who commit other types of offenses. In view of the many studies identifying general delinquency and antisocial attitudes and behavior among juveniles who exhibit sexual behavior problems, Weinrott (1998a) suggested that relevant empirically based treatment interventions for juvenile delinquents be used with those who have committed sex offenses.
Research on Treatment Efficacy
Specialized treatment for juveniles who have committed sex offenses. Programs specifically designed for juveniles who have sexually offended have proliferated, but evaluation of these specialized approaches has been limited. For example, most programs have learning about the "sexual assault cycle" at their core, but despite the fact that the sexual assault cycle has been in use in sex offender treatment for nearly 20 years, the model has not been empirically validated (Weinrott, 1996). Chaffin and Bonner (1998) cautioned against the "conviction" that those working in the field have found the right approach and summarized the beliefs about sex-offense-specific interventions that may be included in such "dogma." Chaffin and Bonner (1998) and Weinrott (1996) have observed that it currently is not possible to say whether one type of treatment is better than another, with the possible exception that delinquency-focused multisystemic treatment appears to be more effective than individual counseling with juveniles who have committed sex offenses. A study by Lab, Shields, and Schondel (1993) appears to raise questions about the efficacy of specialized treatment for juveniles who have committed sex offenses. A study by Kimball and Guarino-Ghezzi (1996), however, found that juvenile sex offenders placed in sex-offense-specific treatment demonstrated more positive attitudes and greater skill acquisition than those in nonspecific treatment. (Juveniles in sex-offense-specific treatment, however, received more intensive and varied interventions than those in non-offense-specific treatment.)
Treatment for juveniles who are delinquent. Research has been conducted to assess the effectiveness of interventions with juveniles who commit various types of offenses, not just sex offenses. Because general delinquency and antisocial attitudes and behavior are frequently found in juveniles who have committed sex offenses, these treatment approaches may be relevant and effective with these juveniles. Izzo and Ross (1990) conducted a meta-analysis of rehabilitation programs designed for all juvenile delinquents, not just those who have committed sex offenses. Their findings suggest that programs based on cognitive therapy were twice as effective as those using other approaches. More recently, Lipsey and Wilson (1998) conducted a meta-analysis of 200 experimental or quasi-experimental studies to assess the effectiveness of treatment interventions used with juvenile offenders. They found that among noninstitutionalized juveniles, treatments that focused on interpersonal skills and used behavioral programs consistently yielded positive effects. Other interventions that have been validated with chronic delinquents, such as multisystemic therapy and multidimensional treatment foster care, also are promising approaches for juveniles who have committed sex offenses (Borduin et al., 1990; Chamberlain and Reid, 1998; Swenson et al., 1998).
Attrition from sex-offense-specific treatment. Several studies of sex offender treatment programs have demonstrated high rates of treatment dropouts (Becker, 1990; Hunter and Figueredo, 1999; Kraemer, Salisbury, and Spielman, 1998; Rasmussen, 1999; Schram, Milloy, and Rowe, 1991). High rates of treatment attrition are extremely important. A study of juvenile sex offenders (Hunter and Figueredo, 1999) and several studies of adult offenders (e.g., Hanson and Buissière, 1998) suggest that failing to complete treatment is associated with higher rates of recidivism for both sex offenses and other types of offenses.
Treatment Setting
Segregating versus integrating juveniles who have committed sex offenses. Historically, treating juveniles who have committed sex offenses in a setting specifically designed for sex offenders has been considered "optimal" (Morenz and Becker, 1995). The literature, however, indicates that the effectiveness of this approach has not been proven. In fact, some studies suggest that other approaches may be more beneficial. Milloy (1994) indicated that no controlled studies have been published investigating the effect of segregating juvenile sex offenders from the general delinquent population. Whether juveniles who have been sexually abusive should be grouped with juveniles who have committed nonsexual offenses or with juveniles who have other behavioral problems is a complex issue. Arguments exist both for and against the use of segregated treatment units. In the meantime, the importance of individualized assessment and treatment planning cannot be overemphasized.
Facilitating safety in residential treatment settings. The issue of community safety exists regardless of whether a juvenile sex offender remains in the community or is placed in a segregated or unsegregated residential facility. NAPN (1993) provided specific recommendations to facilitate safety in residential treatment facilities.
Special Populations
Treatment of young and preadolescent children with sexual behavior problems. Gray and Pithers (1993) suggested that sexually abusive behaviors in children might be most effectively addressed by targeting risk factors that predispose a child to sexual behavior problems or that precipitate or perpetuate the problems. Araji (1997) described 10 treatment programs and practices for children with sexual behavior problems. All of the programs reviewed by Araji included cognitive-behavioral approaches; treatment modalities involved individual, group, pair, and family therapy (most providers appeared to prefer group therapies). Important factors when intervening with children who have been sexually abusive include addressing developmental issues and involving parents and other caregivers. As noted above, Pithers et al. (1998b) identified five subtypes of children with sexual behavior problems. Their investigations also revealed some differences in how children in various subtype classifications responded to different types of treatment.
Treatment of juveniles with cognitive or developmental disabilities. Special interventions may be necessary for juveniles with intellectual and cognitive impairments. For example, individuals with learning difficulties may not respond well to therapies (such as cognitive-behavioral approaches) that resemble their negative experiences in the classroom. A review of the literature (Stermac and Sheridan, 1993) found a dearth of research on treatment of adults and adolescents with developmental disabilities. Most studies have focused on adult offenders and have stressed behaviorally oriented interventions, and most interventions involving adolescents with developmental disabilities who have committed sex offenses have used approaches modified from adult treatment programs. Langevin, Marentette, and Rosati (1996) urged treatment professionals to reach out to these juveniles and suggested steps for doing so. Ferrara and McDonald (1996) provided a detailed discussion of treatment strategies and techniques that may be useful.
Training and Qualifications of Treatment Providers
Individuals providing treatment for juveniles with sexual behavior problems must be personally and professionally qualified (Association for the Treatment of Sexual Abusers, 1997a; NAPN, 1993). Personal qualifications include being emotionally healthy, having respect for oneself and others, using good listening skills, and having the ability to empathize. Professional qualifications include relevant education, training, and experience. Treatment providers should receive appropriate training before they begin their work and thereafter on a continuing basis. Working with juveniles who have sexual behavior problems is a challenging job. As NAPN (1993) observed, "Systems must be aware of potential emotional/psychological impacts on providers and take steps to protect against or counter negative effects" (p. 46).
Adequate program evaluation involves at least two primary approaches: (1) implementation research to ensure that the components necessary for effective treatment exist and are implemented and (2) outcome research to determine whether the interventions have been effective. Although the importance of program evaluation cannot be overemphasized, evaluations of sex offender treatment programs have been few, and those that have been conducted often have had inadequate designs (Camp and Thyer, 1993). Most outcome studies have used recidivism rates to assess treatment effectiveness, but several problems (generally low rates of recidivism, short followup periods, variability in outcome measures, and other methodological problems) limit the usefulness of this approach. Other approaches to assessing treatment effectiveness are required. Two studies have used self-report measures to evaluate treatment effectiveness (Hains et al., as cited in Camp and Thyer, 1993; Miner, Siekert, and Ackland, 1997). Laben, Dodd, and Sneed (1991) used goal attainment theory to develop measurable outcomes in an inpatient juvenile sex offender treatment program. This approach required treatment providers and clients to establish mutual goals through a process of bargaining, negotiating, identifying commonalties, and defining measurable outcomes.
The findings of this literature review indicate that juveniles who have committed sex offenses are a heterogeneous group who, like all juveniles, have developmental needs, but who also have special needs and present special risks related to their abusive behaviors. Existing studies suggest that a substantial proportion of these juveniles desist from committing sex offenses following the initial disclosed offense and intervention.
The literature clearly supports the importance of interventions that are tailored to the individual juvenile. Risk management strategies likely to be most effective are those that address the needs underlying a juvenile's behavior and make the most of the juvenile's existing strengths and positive supports. Although efficacy has not been established for many sex offender interventions considered standard and required, there are a wide range of interventions with more of an empirical basis, particularly within the juvenile delinquency field (such as multisystemic therapy), that may be effective. It also should be remembered that some juveniles may require minimal interventions once their sex offending has been disclosed. An additional—and important—caution is that treatment efforts should not be harmful.
Lastly, it should be remembered that although the goal when working with juveniles who have committed sex offenses is to help them stop their abusive behaviors, they are children and adolescents first. They are young people who have committed offenses and who deserve care and attention.