U.S. Department of Justice

Office of Justice Programs

Office of Juvenile Justice and Delinquency Prevention
Research and Program Development Division

develops knowledge on national trends in juvenile 

delinquency; supports a program for data collection 

and information sharing that incorporates elements 

of statistical and systems development; identifies the

pathways to delinquency and the best methods to

prevent, intervene in, and treat it; and analyzes practices and trends in the juvenile justice system.

Training and Technical Assistance Division provides

juvenile justice training and technical assistance to

Federal, State, and local governments; law enforcement, judiciary, and corrections personnel; and private

agencies, educational institutions, and community

organizations.

Special Emphasis Division provides discretionary

funds to public and private agencies, organizations,

and individuals to develop and support programs and

replicate tested approaches to delinquency prevention,

treatment, and control in such pertinent areas as 

mentoring, gangs, chronic juvenile offending, and 

community-based sanctions.

State and Tribal Assistance Division provides funds

for State, local, and tribal governments to help them

achieve the system improvement goals of the JJDP

Act, address underage drinking, conduct State challenge activities, implement prevention programs, and

support initiatives to hold juvenile offenders accountable. This Division also provides training and technical assistance, including support to jurisdictions that

are implementing OJJDP’s Comprehensive Strategy

for Serious, Violent, and Chronic Juvenile Offenders.

Information Dissemination and Planning Unit produces and distributes information resources on juvenile

justice research, statistics, and programs and coordinates the Office’s program planning and competitive

award activities. Information that meets the needs of

juvenile justice professionals and policymakers is provided through print and online publications, videotapes,

CD–ROM’s, electronic listservs, and the Office’s Web

site. As part of the program planning and award process,

IDPU identifies program priorities, publishes solicitations and application kits, and facilitates peer reviews

for discretionary funding awards.

Concentration of Federal Efforts Program promotes

interagency cooperation and coordination among Federal agencies with responsibilities in the area of juvenile justice. The Program primarily carries out this

responsibility through the Coordinating Council on

Juvenile Justice and Delinquency Prevention, an independent body within the executive branch that was

established by Congress through the JJDP Act.

Child Protection Division administers programs related to crimes against children and children’s exposure

to violence. The Division provides leadership and funding to promote effective policies and procedures to

address the problems of missing and exploited children,

abused or neglected children, and children exposed to

domestic or community violence. CPD program activities include supporting research; providing information,

training, and technical assistance on programs to prevent and respond to child victims, witnesses, and their

families; developing and demonstrating effective child

protection initiatives; and supporting the National

Center for Missing and Exploited Children.

Office of Juvenile Justice

and Delinquency Prevention

The Office of Juvenile Justice and Delinquency Prevention (OJJDP) was established by the President and Congress

through the Juvenile Justice and Delinquency Prevention (JJDP) Act of 1974, Public Law 93–415, as amended. Located

within the Office of Justice Programs of the U.S. Department of Justice, OJJDP’s goal is to provide national leadership in

addressing the issues of preventing and controlling juvenile delinquency and improving the juvenile justice system.

OJJDP sponsors a broad array of research, demonstration, and training initiatives to improve State and local juvenile programs and to benefit private youth-serving agencies. These initiatives are carried out by seven components within OJJDP,

described below.

The mission of OJJDP is to provide national leadership, coordination, and resources to prevent and respond to juvenile

offending and child victimization. OJJDP accomplishes its mission by supporting States, local communities, and tribal

jurisdictions in their efforts to develop and implement effective, multidisciplinary prevention and intervention programs 

and improve the capacity of the juvenile justice system to protect public safety, hold offenders accountable, and provide

treatment and rehabilitative services tailored to the needs of individual juveniles and their families.
i

Juveniles Who Have

Sexually Offended

A Review of the Professional Literature

Report

Office of Juvenile Justice and Delinquency Prevention

March 2001

Sue Righthand

Carlann Welch
ii

Preparation of this document was supported in part by a joint grant from the Maine Departments of

Corrections and Human Services and a Federal child abuse and neglect grant from the National Center

on Child Abuse, U.S. Department of Health and Human Services.

Points of view or opinions expressed in this document are those of the authors and do not necessarily

represent the official position or policies of OJJDP or the U.S. Department of Justice.

Cover photograph © 1995 Digital Stock.

The Office of Juvenile Justice and Delinquency Prevention is a component of the Office of Justice

Programs, which also includes the Bureau of Justice Assistance, the Bureau of Justice Statistics, the

National Institute of Justice, and the Office for Victims of Crime.

U.S. Department of Justice

Office of Justice Programs

Office of Juvenile Justice and Delinquency Prevention

810 Seventh Street NW.

Washington, DC 20531

John Ashcroft

Attorney General
iii

Foreword

Sex offenses committed by juveniles are a serious problem. Nearly 16 percent of the arrests for forcible rape

in 1995 and 17 percent of the arrests for all other sex offenses in 1995 involved youth under the age of 18.

Perhaps even more disturbing are the indications that one in two adult sex offenders began sexually abusive

behavior as a juvenile.

The costs imposed by juvenile 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.

As with other delinquent behaviors, early intervention can be critical. Unfortunately, many programs used to

treat juveniles who have committed sex offenses appear to apply interventions derived from our knowledge of

adult sex offenders without adequate attention to the unique developmental needs of youth.

The authors of Juveniles Who Have Sexually Offended have diligently mined the research literature to provide a

comprehensive and annotated account of the characteristics of juveniles who commit sex offenses and their

families, and the type of offenses they commit.

A broad array of clinical assessment tools, including psychological testing, are described, and a thorough

discussion of recidivism rates and issues is presented. The Report concludes with a review of treatment

approaches and settings and a look at program assessment.

Youth who have committed sex offenses both have developmental needs and pose unique risks related to their

abusive behaviors. The information provided by the review of the professional literature presented in this

Report should enable us to better address those needs and risks.
v

Acknowledgments

This Report was written by Sue Righthand, Ph.D., and Carlann Welch, Psy.D. The authors express their sincere thanks to Mary Ann Saar, Associate Commissioner for Juvenile Corrections, Maine Department of Corrections, and Sandra Hodge, Director of Child Welfare, Maine Department of Human Services, for their deep

commitment to children, for their astute understanding of facilitating individual and social change, and for

making this literature review possible.

The authors also extend their appreciation to Karen Stern, Program Manager, Office of Juvenile Justice and

Delinquency Prevention (OJJDP), and to OJJDP for recognizing the importance of disseminating the

information contained in this literature review. The authors also express thanks to Lynn Marble, Senior

Writer/Editor, Aspen Systems Corporation, for her superb editorial assistance.

This Report provides a convenient and up-to-date review of the literature and a discussion of the pragmatics of

professional work with juveniles who have committed sex offenses. The authors hope that the review will assist caseworkers, clinicians, legal professionals, and others who work with these juveniles. Although this work

often is difficult and challenging, combined efforts can make a difference.
vii

Table of Contents

Foreword ............................................................................................................................................................. iii

Acknowledgments ............................................................................................................................................ v

Executive Summary .......................................................................................................................................... xi

Introduction ........................................................................................................................................................ 1

Characteristics of Juveniles Who Have Committed Sex Offenses ................................................ 3

Offending Behaviors ...................................................................................................................................... 3

Sexually Abusive Behaviors and Sex Offense Characteristics ................................................................ 3

Nonsexual Criminal Behavior ................................................................................................................... 3

Child Maltreatment Histories ....................................................................................................................... 3

Social and Interpersonal Skills and Relationships ..................................................................................... 5

Family Factors ............................................................................................................................................ 5

Social Skills and Relationships .................................................................................................................. 6

Sexual Knowledge and Experiences ............................................................................................................. 7

Sexual Histories and Beliefs ...................................................................................................................... 7

Deviant Sexual Arousal ............................................................................................................................. 7

Pornography ............................................................................................................................................... 8

Academic and Cognitive Functioning .......................................................................................................... 8

Academic Performance .............................................................................................................................. 8

Intellectual and Cognitive Impairments .................................................................................................... 8

Cognitive Distortions and Attributions ................................................................................................... 10

Mental Health Issues .................................................................................................................................... 10

Symptoms and Disorders ......................................................................................................................... 10

Substance Abuse ...................................................................................................................................... 11

Types and Classifications ............................................................................................................................. 13

Types and Classifications of Male Adolescents Who Have Committed Sex Offenses ......................... 13

Sibling Incest ................................................................................................................................................. 14

Girls Who Have Committed Sex Offenses ................................................................................................ 16

Incidence ................................................................................................................................................... 16

Characteristics of Female Offenders and Their Offenses ...................................................................... 16
viii

Young Children Who Have Committed Sex Offenses ............................................................................. 19

Incidence ................................................................................................................................................... 19

Individual Characteristics ........................................................................................................................ 20

Family Characteristics.............................................................................................................................. 20

Comparative Studies of Preadolescents and Adolescents Who

Have Committed Sex Offenses................................................................................................................ 21

Types and Classifications ......................................................................................................................... 21

Juveniles With Developmental Disabilities and Mental Retardation Who

Have Committed Sex Offenses ................................................................................................................... 23

Juveniles Who Have Committed Sex Offenses Versus Other Types of Offenses ............................... 24

Assessment ....................................................................................................................................................... 27

Clinical Assessment ...................................................................................................................................... 27

Gathering Multiple Sources of Information ........................................................................................... 27

Using Psychological Tests ........................................................................................................................ 27

Assessing Deviant Sexual Arousal .......................................................................................................... 29

Using Other Assessment Strategies ........................................................................................................ 29

Risk Assessment ............................................................................................................................................ 30

Rates of Recidivism ................................................................................................................................. 30

Factors Associated With Recidivism ...................................................................................................... 32

Prediction of Recidivism ......................................................................................................................... 34

Treatment ........................................................................................................................................................... 37

Continuum of Care Models ......................................................................................................................... 37

Treatment Approaches ................................................................................................................................. 38

Overview................................................................................................................................................... 38

Addressing Deviant Arousal .................................................................................................................... 40

Involving Families .................................................................................................................................... 41

Using a Relapse Prevention Model ......................................................................................................... 41

Summary ................................................................................................................................................... 42

Research on Treatment Efficacy ................................................................................................................. 42

Specialized Treatment for Juveniles Who Have Committed Sex Offenses .......................................... 42

Treatment for Juveniles Who Are Delinquent ....................................................................................... 45

Attrition From Sex-Offense-Specific Treatment .................................................................................... 47

Treatment Setting ......................................................................................................................................... 48

Segregating Versus Integrating Juveniles Who Have Committed Sex Offenses ................................. 48

Facilitating Safety in Residential Treatment Settings............................................................................. 49
ix

Special Populations ...................................................................................................................................... 49

Treatment of Young and Preadolescent Children With Sexual Behavior Problems ............................ 49

Treatment of Juveniles With Cognitive or Developmental Disabilities ................................................ 52

Training and Qualifications of Treatment Providers ............................................................................... 53

Program Evaluation ......................................................................................................................................... 55

Conclusions ....................................................................................................................................................... 57

References ......................................................................................................................................................... 59
x

Table 1 Sex Offense Characteristics ........................................................................................................... 4

Table 2 Sexual and Nonsexual Recidivism by Juvenile Offenders ........................................................ 32

Table 3 Treatment To Reduce Offending Behaviors ............................................................................... 43

List of Tables
xi

Executive Summary

Introduction

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).
xii

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 aboveaverage academic performance.
xiii

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

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
xiv

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 LobanovRostovsky (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
xv

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.
xvi

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.

Assessment

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).
xvii

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
xviii

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.

Treatment

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.
xix

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.
xx

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.
xxi

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).

Program Evaluation

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
xxii

this approach. Other approaches to assessing treatment effectiveness are required. Two studies have used selfreport 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.

Conclusions

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.
1

Introduction

Sexual abuse is widely recognized as a significant

problem in society. Juveniles1 who commit sex offenses have victimized many people. Federal Bureau

of Investigation data (as cited in Sipe, Jensen, and

Everett, 1998) indicate that in 1995, 15.8 percent of

arrests for forcible rape and 17 percent of arrests for

all other sex offenses involved persons under 18

years old. Furthermore, Becker, CunninghamRouleau, and Kaplan (as cited in Prentky et al.,

2000) reported that 79 percent of their sample of

juvenile sex offenders had been arrested for a prior

sex offense. Similarly, Groth (as cited in Prentky et

al., 2000) found that nearly 75 percent of his sample

of juvenile sex offenders had committed a prior

sexual assault.

Studies of adult sex offenders (who were assured

that the information they provided would remain

confidential) also support the conclusion that sexual

abuse by juveniles is a serious problem. This research suggests that approximately half of these

individuals began their sexually abusive behavior

before adulthood (Abel, Mittelman, and Becker,

1985; Groth, Longo, and McFadin, 1982; Saylor, as

cited in Smith and Monastersky, 1986). Studies of

juveniles and adults who committed sex offenses as

juveniles indicate that juvenile sex offending includes a wide range of sexual misconduct. Offenses

included noncontact sexual behaviors (such as exhibitionism and voyeurism), child molestation, and

rape (Abel, Osborn, and Twigg, 1993; Righthand,

Hennings, and Wigley, 1989). Research has shown

that the sexual behavior problems exhibited by

these juveniles are “not simply isolated incidents

involving normally developing adolescents”

(Fehrenbach et al., 1986, p. 231).

The scope of the problem may be underestimated

because juvenile sex offenders who become known

to the system may represent only a small proportion

of juveniles who have committed such offenses.

Knight and Prentky (1993) found that only 37 percent of the adult sex offenders in their sample had

official records documenting juvenile sex offending

histories. In contrast, when these subjects completed

a computer-generated questionnaire and were assured that their responses would remain confidential, 55 percent acknowledged engaging in sexually

abusive behavior as juveniles.

The importance of early intervention with juveniles

who evidence sexual behavior problems cannot be

overstated. As noted by Abel, Osborn, and Twigg

(1993)—

If an individual begins to engage in such behaviors and is not subject to intervention and/

or negative consequences for such actions, he

will be reinforced by the innate positive reinforcers of the sexual act. These inherent positive reinforcers include, but are not limited to,

the pleasure of orgasm, the pleasure of stress

reduction, and the feeling of power the individual may feel over another person. (p. 15)

1 Historically, most studies have focused on males, although

some, particularly those that describe the characteristics of

juveniles who commit sex offenses, have also included females.

In this review, among the studies specifying that both males and

females were included (or publications citing such studies) are

the following: Becker and Hunter, 1997; Bourke and Donohue,

1996; Bumby and Bumby, 1997; English and Ray (as cited in

Araji, 1997); Fehrenbach et al., 1986; Fehrenbach and

Monastersky (as cited in Bumby and Bumby, 1997); Hunter,

Lexier, Goodwin, Browne, and Dennis (as cited in Bumby and

Bumby, 1997); Johnson (as cited in Lane and LobanovRostovsky, 1997); Kahn and Chambers, 1991; Gray et al., 1997;

Lane and Lobanov-Rostovsky, 1997; Mathews, Hunter, and

Vuz, 1997; McCurry et al., 1998; Morenz and Becker, 1995; Ray

and English, 1995; Righthand, Hennings, and Wigley, 1989;

Ryan et al., 1996; Smith and Israel, 1987; and Weinrott, 1996.
2

The costs of sex offending are substantial for victims

and society and for the young offenders and their

families. In addition to the human costs in terms of

emotional and physical anguish and suffering, staggering financial costs are incurred as a result of child

welfare and juvenile and criminal justice system

involvement, therapeutic intervention, and so forth

(Prentky and Burgess, 1990). To minimize these

costs, timely and appropriate interventions are

needed.

A review of the professional literature suggests that

developers of programs to meet the perceived needs

of these young offenders frequently have applied

knowledge and interventions designed for adult

offenders without considering the developmental

issues and needs unique to juveniles. Only recently

have a growing number of professionals pointed to

the empirical literature to emphasize that, especially

when it comes to juveniles, research has not supported the notion that “once a sex offender, always

a sex offender” (Association for the Treatment of

Sexual Abusers, 1997b; Becker, 1998). The longitudinal research necessary to conclusively support

such a hypothesis has not been conducted (Becker,

1998).

In addition, there are important distinctions that

differentiate juveniles from adult sex offenders (Association for the Treatment of Sexual Abusers,

1997b; Becker, 1998; Bonner, 1997). In fact, the

appropriateness and ethics of the term “juvenile sex

offender” have been called into question (Bonner,

1997). Language describing these young people as

children or teenagers who have been sexually abusive (rather than as juvenile sex offenders) holds

them accountable for their behavior yet does not

suggest that they are and always will be disreputable

sex offenders. Language that emphasizes the behavior rather than the person may help to avoid selffulfilling prophecies that can contribute to offending

behavior by promoting the belief that a person can

never be more than his or her past. When the past

includes sex offending, this can be a hopeless and

esteem-deflating perspective.

Because most papers and studies in the literature

have used the term “juvenile sex offenders,” this

term will be used, at times, in this review. Yet, it is

important to consider the impact of language and

begin to make appropriate changes.
3

Juveniles who have committed sex offenses are a

heterogeneous mix (Bourke and Donohue, 1996;

Knight and Prentky, 1993). They vary according to

victim and offense characteristics. They also differ

on 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).

In spite of the apparent heterogeneity of juveniles

who have sexually offended, findings from the few

existing studies that compared juveniles who committed sex offenses with those who committed other

types of offenses frequently have not revealed significant differences between samples (Becker and

Hunter, 1997). This finding may suggest that a substantial number of juvenile sex offenders may not

differ significantly from other juvenile offenders, although subgroups of juveniles who committed sex

offenses do differ from juveniles who committed other

offenses. Subgroups of juveniles who committed sex

offenses are discussed in more detail in the section on

Types and Classifications.

Offending Behaviors

Sexually Abusive Behaviors and

Sex Offense Characteristics

As noted above, sexually abusive behaviors range

from noncontact offenses to penetrative acts. In a

study of Maine juveniles identified as having committed sex offenses (Righthand, Hennings, and

Wigley, 1989), more than half of the abusive acts

involved oral-genital contact or attempted or actual

vaginal or anal penetration.

Offense characteristics include factors such as the

age and sex of the victim, the relationship between

the victim and the offender, and the degree of coercion and violence used. See table 1 for details of

offense characteristics.

Nonsexual Criminal Behavior

Juvenile sex offenders frequently engage in nonsexual criminal and antisocial behavior (Fehrenbach

et al., 1986; Ryan et al., 1996). Such behavior may,

in fact, be quite typical of juvenile sex offenders,

especially those who engage in forcible sexual assaults such as rape and attempted rape. In a national

survey, Elliott (as cited in Weinrott, 1996) found

that most of the 80 juveniles who disclosed sexually

assaultive behavior had previously committed a nonsexual aggravated assault, whereas relatively few (7

percent) had perpetrated exclusively sex offenses.

Nonsexual (violent and nonviolent) criminal behavior is correlated with repeated sexual violence by

adult sex offenders (Chaffin, 1994; Hanson and

Buissière, 1996) and may also be an important risk

factor for repeated sex offending by juveniles.

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). Rates of juvenile sex offenders who

have experienced sexual abuse as children reportedly range from 40 to 80 percent (Becker and

Hunter, 1997). Yet, such abusive experiences of

juvenile sex offenders 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). Furthermore, Smith and Monastersky (1986)

Characteristics of Juveniles Who Have

Committed Sex Offenses
4

found that among the juvenile sex offenders in their

sample, there was a relationship between childhood

experience of sexual abuse and higher rates of

nonsexual reoffending but lower rates of sexual

reoffending.

Not surprisingly, childhood experiences of being

physically abused, being neglected, and witnessing

family violence have been independently associated

with sexual violence in juvenile offenders (Kobayashi

et al., 1995; Ryan et al., 1996). Proportions of juvenile sex offenders who have experienced physical

abuse as children reportedly range from 25 to 50 percent (Becker and Hunter, 1997). A study comparing

juvenile sex offenders with juveniles who have committed nonsexual offenses suggests that sex offenders

may have higher rates of childhood physical abuse

(Ford and Linsey, as cited in Becker and Hunter,

1997). When juvenile sex offenders were compared

only with juveniles who have committed nonsexual

violent offenses, however, this result was not replicated (Knight and Prentky, 1993). This latter finding

suggests that a history of physical abuse is correlated

with some type of violent behavior but not necessarily

with sexually violent behavior.

The role of child maltreatment in the etiology of sex

offending appears quite complex (Prentky et al.,

2000). One recent study (Hunter and Figueredo, as

cited in Becker and Hunter, 1997) used several comparison and control groups to investigate factors

associated with sex offending, such as a history of

Victim Characteristics ◆ Female children are targeted most frequently.a,b,c,d,e,f,g,h

◆ Male victims represent up to 25 percent of some samples.e,h,i

Relationship Characteristics ◆ Victims are more often substantially younger than the offender,

 rather than peer age.a,b,c,d,e,f,g,h,i

◆ Victims are usually relatives or acquaintances; rarely are they

strangers.a,e,f,g,h,i

◆ Babysitting frequently provides the opportunity to offend.b,h

Use of Aggression ◆ Although juvenile sex offenders usually are less physically violent

than adult offenders, they may secure the victim’s compliance

via intimidation, threats of violence, physical force, or extreme

violence.a,j

◆ Approximately 40 percent of the juveniles from a sample of 91

displayed expressive aggression in their sex offense(s).d

◆ Juveniles who victimized peers or adults tended to use more force

than those who victimized younger children.k

Triggers ◆ Some of the “triggers” that have been described as related to sex

offending include anger, boredom, and family problems.g

Table 1: Sex Offense Characteristics

Notes: a Davis and Leitenberg, 1987; b Fehrenbach et al., 1986; c Hunter and Figueredo, 1999; d Miner, Siekert, and Ackland, 1997; e Rasmussen, 1999; f

Righthand, Hennings, and Wigley, 1989; g Ryan et al., 1996; h Smith and Monastersky, 1986; iWieckowski et al., 1998; j Knight and Prentky, 1993; k Becker, 1998.

Domain Characteristic
5

sexual victimization and family support. The study

found four variables predictive of sex offending:

younger age at the time of victimization, higher rates

of abusive incidents, longer period between abuse

and disclosure, and lower level of perceived family

support following the disclosure of the abuse.

Cooper, Murphy, and Haynes (as cited in Becker,

1998) compared juvenile sex offenders who had

been sexually or physically abused with those who

had not. They found that the abused juveniles began their sex offending 1.6 years earlier than the

nonabused group, had twice the number of victims,

were more likely to have both female and male

victims, and were less likely to limit their offending

to family members.

Other research on various offender groups suggests

that offenders with histories of maltreatment begin

offending at earlier ages than other offenders who

were not maltreated. For example, Knight and

Prentky (1993) found that rapists who began offending as juveniles had higher rates of emotional

neglect as children than other rapists who began

their assaults in adulthood. Child molesters who

began offending as juveniles also had higher rates of

physical abuse as children than did child molesters

who began offending in adulthood. Although these

samples did not differ significantly regarding the

experience of intrafamilial sex abuse, child molesters

who began offending as juveniles had higher rates of

sexual victimization experiences throughout their

childhood than did rapists who began their offending as adults. Rapists who began offending while

still juveniles, as contrasted with those who began

offending in adulthood, tended to come from families where sexually deviant or abusive behavior was

directed at other family members. Data pertaining to

an additional group of sex offenders, who had no

official record of juvenile sex offenses but who admitted to such behavior in a confidential, computergenerated interview, were similar. In this group,

offenders who began perpetrating as juveniles, contrasted with those who began as adults, had overall

higher rates of childhood sexual victimization, their

sexually abusive experiences began at younger ages,

and the sexual assaults they experienced as children

tended to be more severe (i.e., on a scale ranging

from fondling to intercourse).

Social and Interpersonal Skills

and Relationships

Family Factors

In addition to child maltreatment, 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). Studies

vary as to the percentages of these juveniles who are

from intact families. Some studies (Kahn and Chambers, 1991; Fehrenbach et al., 1986) have found that

less than one-third of the juvenile sex offenders in

their samples resided with both birth parents.

Graves et al. (as cited in Becker, 1998) used statistical procedures (meta-analysis) to analyze the findings of multiple studies that were conducted over 20

years and described characteristics of juvenile sex

offenders. The analysis resulted in identification of

three groups of juveniles: sexually assaultive juveniles, whose victims were the offenders’ peers or

older; pedophilic juveniles, whose victims were at

least 3 years younger than the offenders; and a

mixed group, described as including juveniles who

perpetrated more than one class of sex offense, including hands-off and hands-on offenses (Weinrott,

1996). The Graves et al. results (as cited in Becker,

1998) also indicated that juveniles who committed

sexual assaults against victims who were their

peers or older were more likely to come from

single-parent homes (78 percent) than those who

committed “pedophilic” offenses (44 percent) or

mixed offenses (37 percent). Those who committed

pedophilic offenses, however, frequently lived with

foster or blended families (53 percent).

Miner, Siekert, and Ackland’s (1997) study of incarcerated offenders revealed that only 16 percent of

the juveniles in their sample came from intact families. The low rate of intact families, however, may

reflect the nature of the sample (i.e., incarcerated

juveniles).

In contrast to these studies, Cellini (1995) reported

that approximately 70 percent of juvenile sex offenders lived in two-parent homes at the time their
6

abusive behavior was discovered. It was not clear,

however, whether the two parents in these homes

were both birth parents.

Together, these various studies suggest that many

juvenile sex offenders have experienced physical

and/or emotional separations from one or both of

their parents. The cause of this separation may be

family instability, parental separation or divorce, or

residential placement of the juvenile.

Research on family factors affecting juvenile sex

offenders has also examined family communication

styles and types of family involvement with the juvenile. Studies have found that supportive communication and comments that facilitate dialog are limited

in the families of juvenile sex offenders and violent

offenders, whereas negative communication, such as

aggressive statements and interruptions, are frequent (Blaske, Borduin, Henggeler, and Mann, as

cited in Morenz and Becker, 1995). Not surprisingly, adequate support and supervision may be

lacking in the families of these juveniles (Borduin,

Henggeler, Blaske, and Stein, as cited in Hunter and

Figueredo, 1999).

In a comparison study of juvenile sex offenders and

other juvenile offenders in two residential treatment

centers, sexually assaultive juveniles were described

as typically coming from intact, “hothouse” families

that frequently evidenced severe pathology, including child maltreatment (Bagley and ShewchukDann, 1991). Although the sexually aggressive

juveniles experienced less family instability (as defined by multiple male adult caregivers and/or desertions by their father figure), their parents evidenced

higher levels of marital stress. Furthermore, the

mothers and fathers of these juveniles had more

mental health problems that required intervention,

and the fathers evidenced slightly greater rates of

alcohol abuse. Parents of juveniles in the sexually

aggressive group also were more likely to be overly

ambitious for their children and excessively critical

of poor school grades.

Similarly, Miner, Siekert, and Ackland (1997) described the juvenile sex offenders in their sample as

coming from “chaotic” family environments. Nearly

60 percent of the biological fathers had substance

abuse histories, and 28 percent had criminal

histories. Biological mothers, when compared to fathers, were less likely to have substance abuse histories (28 percent) or criminal histories (17 percent).

The mothers, however, were more likely than the

fathers to have a history of psychiatric treatment (23

percent versus 13 percent, respectively). Furthermore, nearly one-fifth of the subjects’ siblings had

criminal histories, and 29 percent of biological siblings and 20 percent of stepsiblings had psychiatric

histories.

Smith and Israel (1987) found that some parents of

juveniles who sexually abused their siblings were

physically and/or emotionally inaccessible and distant. They also reported that some parents evidenced sexual pathology and exposed the juveniles

to their sexual behaviors. Similarly, Miner and

Crimmins (1995) found that sex-offending juveniles

appeared to be more disengaged from their families

than were other juveniles and, consequently, may

have been cut off from possible sources of emotional

support and less able to form positive attachments.

This latter possibility gains some support from the

finding of Kobayashi et al. (1995) that more positive

relationships between juveniles and their mothers

may be related to decreased levels of sexual aggression in juveniles. Weinrott (1996) reported there is

strong evidence that family instability and problems

in parent-child attachment in childhood are associated with more intrusive forms of juvenile sex offending.

Kimball and Guarino-Ghezzi (1996) found that the

juveniles in their sample identified as child molesters

reported significantly more ongoing conflict with a

parental figure than was reported by juveniles identified as rapists. Rapists were significantly more

likely than molesters to perceive their parents as not

supportive of treatment. Stevenson and Wimberley

(1990) opined, “The importance of family influences

in the life of the adolescent sex offender cannot be

underestimated as it is often the barometer of what

can or cannot happen in treatment” (p. 59).

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 some of the
7

difficulties identified in these juveniles (Fehrenbach

et al., 1986; Katz, 1990; Miner and Crimmins, 1995).

For example, Katz (1990) compared three groups—

adolescent “child molesters,” juvenile delinquents

who had not committed sex offenses, and a comparison group recruited from a local high school2—on

various measures of social competence. The juveniles who had committed child molestation offenses

were more socially maladjusted than either of the

other groups and evidenced more social anxiety

and fear of heterosexual interactions. Miner and

Crimmins (1995) found that juveniles who have

sexually offended had fewer peer attachments and

felt less positive attachment to their schools, compared with other delinquent juveniles and nondelinquent juveniles. In fact, they stated that this and

other research—

point to the primacy of isolation and poor social adjustment as distinguishing characteristics

of adolescent sex offenders, indicating that

interventions that maximize the ability to build

interpersonal attachments potentially affect the

propensity to engage in sexually abusive and

aggressive behaviors. (pp. 9–11)

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 experiences have exceeded the experiences of control 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 described by 90 independent

contributors 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, although some related research has been

reported.

In their sample of 197 juvenile sex offenders,

Schram, Milloy, and Rowe (1991) found that sexual

recidivists, defined as juveniles arrested for a new

offense, were significantly more likely than other

offenders to have deviant patterns of sexual arousal.

Similarly, Kahn and Chambers (1991) found a trend

associating deviant arousal and sexual reoffending,

but it was not statistically significant. Both studies,

however, relied on clinical judgments to determine

the existence of deviant arousal, rather than more

objective means such as phallometric assessment.

Knight and Prentky (1993) found that adult sex

offenders who began offending as juveniles did not

differ from those who began as adults in terms of

preoccupation with sexual fantasies, problems with

sexuality, or sexually deviant conduct. Knight and

Prentky concluded this finding suggests that the

importance of sexualization as an issue for juvenile

sex offenders, as for adult sex offenders, may vary

depending on the type of offender.

In their review of the role of deviant sexual arousal

in juvenile sex offending, Hunter and Becker (1994)

noted the limited research in this area and encouraged further investigations. They stressed that although deviant arousal may be more of a factor for

sex offenders who target children (particularly those

2 Some of the high school students in the comparison group may

have had contact with the juvenile or criminal justice systems,

but this number was assumed to be small.
8

who target boys), research suggests that juveniles

who engage in sexually abusive behavior are a

heterogeneous group. They also emphasized that the

sexual interest and arousal patterns of these juveniles are more changeable than those of adult sex

offenders and cautioned against applying to juveniles what is known about deviant arousal in adults.

Pornography

Investigations into the role of pornography in juvenile sex offending are limited in number. Becker and

Stein (as cited in Hunter and Becker, 1994) found

that only 11 percent of the juvenile sex offenders in

their study reported that they did not use sexually

explicit material. Approximately 74 percent reported

that pornography increased their sexual arousal, 3

percent indicated it decreased their arousal, and 23

percent said it had no effect. There were no statistically significant differences between the subjects in

terms of use of pornography and number of victims

or in terms of types of pornography used and number of victims.

In a sample of 30 juveniles who had committed sex

offenses, exposure to pornographic material at a

young age was common (Wieckowski et al., 1998).

The researchers reported that 29 of the 30 juveniles

had been exposed to X-rated magazines or videos;

the average age at exposure was about 7.5 years.

Similarly, 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. The juvenile sex offenders also had been exposed at younger ages, ranging

from 5 to 8. High rates of exposure to pornography

also have been found for girls who have committed

sex offenses (Mathews, Hunter, and Vuz, 1997).

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). For example, Kahn and Chambers found

that more than half of the juveniles in their study had

evidenced at least one of three kinds of difficulty at

school: disruptive behavior (53 percent), truancy

(nearly 30 percent), or a learning disability (39

percent). Only 57 percent of the sample used by

Fehrenbach et al. had achieved grade-appropriate

placement or better. Pierce and Pierce found that 49

percent of the juvenile sex offenders in their sample

had academic problems, 38 percent had been placed

in special classes, and 14 percent were diagnosed as

mentally retarded.

As part of an investigation of learning difficulties

as a potential factor in sex offender treatment,

Langevin, Marentette, and Rosati (1996) examined

the case files of 162 male adult sex offenders who

had participated in a treatment program and who

had relevant data available. Fifty percent of the

sample had repeated a grade. Although most of the

subjects (43 percent) had repeated just one grade,

14 percent had repeated two grades and 3.5 percent

had failed three or more grades. Seven others had

been placed in special education classes as children.

In all, 53 percent of the subjects apparently experienced learning difficulties during childhood.

Some juveniles who have sexually offended, however, do well in school. For example, O’Brien (as

cited in Ferrara and McDonald, 1996) found that

32 percent of the offenders in his sample were described as above average in their 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 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). For example, in a comparative study of juvenile sex offenders and delinquents

who had not committed sex offenses, the sex offenders had slightly lower IQ scores and more variability

within subtests of standardized tests (Atcheson and

Williams, as cited in Ferrara and McDonald, 1996).
9

In addition, more than one-quarter (25.2 percent) of

the juvenile sex offenders had IQ scores below 80,

whereas only 11.1 percent of the other delinquents

scored in this range. Additionally, Saunders et al. (as

cited in Ferrara and McDonald, 1996) found that

violent juvenile sex offenders tended to have lower

IQ scores than nonviolent sex offenders. Ferrara

and McDonald argued that such differences may be

attributed to higher rates of neurological impairments among violent offenders.

McCurry et al. (1998) noted that verbal deficits

among juveniles who had conduct disorders and

who scored within the average range on standardized tests were associated with higher rates of aggression and antisocial behavior. To investigate the

role of verbal deficits in adolescents and children

with inappropriate sexual behaviors, McCurry et al.

studied 200 juveniles with serious psychiatric disorders, 99 of whom also evidenced inappropriate

sexual behaviors such as hypersexuality (37 of the

juveniles), exposing (24), and victimizing (38).

Analyses revealed that, in general, subjects with

lower IQ scores evidenced significantly more inappropriate sexual behaviors than did those with

higher scores. This finding was especially true for

subjects who molested or raped. Furthermore, subjects who evidenced the most serious inappropriate

sexual behaviors had verbal IQ scores that were

significantly lower than their performance IQ

scores. The authors noted that deficits in verbal cognitive functioning, reflected by impulsivity and poor

judgment, may contribute to the increased rates of

serious inappropriate sexual behaviors among these

juveniles. The authors stressed that treatment providers should consider the effects of verbal deficits

when designing and applying interventions.

Lewis, Shanok, and Pincus (as cited in Ferrara and

McDonald, 1996) investigated possible neurological deficits in a group of juvenile sex offenders and

a comparison group of juveniles who had committed nonsexual but violently assaultive offenses.

Psychological tests were administered,3 and sleep

electroencephalographs (EEG’s) were performed

when possible. The groups did not differ on 

full-scale, verbal, or performance IQ scores. Sex

offenders evidenced greater difficulties on the

reading test than the comparison group (5.59

versus 3.95 years below grade level, respectively).

The results of the EEG’s revealed the most direct

evidence of neurological impairments among the

juveniles from both groups: 23.5 percent of the sex

offenders and 3.3 percent of the comparison group

evidenced grossly abnormal EEG’s or grand mal

seizures. The finding of neurological impairments

in both groups of juvenile offenders is consistent

with other research regarding juvenile delinquents

in general and violent juvenile offenders specifically (Ferrara and McDonald, 1996).

Academic functioning is not determined solely by

intellectual or neurological functioning (parental

level of education and support, truancy, and other

variables are important); nevertheless, learning disorders are related to below-average academic

achievement (Ferrara and McDonald, 1996). Furthermore, although the role of learning disabilities

has not been well investigated, one study (O’Brien,

as cited in Ferrara and McDonald, 1996) found that

of a sample of 170 male adolescents who sexually

offended, as many as 37 percent experienced learning disabilities.

The incidence of attention deficit disorders in juveniles with sexual behavior problems has not been

satisfactorily examined. Kavoussi, Kaplan, and Becker

(1988), however, found that of the 58 juveniles who

had been evaluated or treated in an outpatient juvenile

sex offender program, approximately 7 percent met

the full diagnostic criteria for attention deficit disorder

as specified in the Diagnostic and Statistical Manual of

Mental Health Disorders, 3rd Edition (DSM–III). Nearly

35 percent of the juveniles evidenced some symptoms

of an attention deficit disorder. Miner, Siekert, and

Ackland (1997) found that more than 60 percent of

the incarcerated juveniles in their study exhibited

hyperactive and restless behaviors, and approximately

75 percent were identified as having attention problems, a learning disability, or both.

Although studies investigating specific areas of cognitive deficits in juvenile sex offenders are lacking,

Ferrara and McDonald (1996) noted that research

on juvenile delinquents has demonstrated two areas

of impairment: difficulties with executive functions,

3 Tests included the Wechsler Intellectual Scale for Children,

Bender Gestalt, Woodcock Reading Mastery Tests, and Key

Math Diagnostic Arithmetic Test.
10

such as planning, abstraction, inhibition of inappropriate impulses, and cognitive flexibility; and difficulties with receptive and expressive language. Studies

as noted above suggest that at least some juveniles

who sexually offend do not differ significantly from

juveniles who commit other types of offenses and that

some juvenile sex offenders experience cognitive deficits similar to those identified in other groups of juvenile offenders. Based on their review of the literature,

Ferrara and McDonald concluded that between onequarter and one-third of juvenile sex offenders may

have some form of neurological impairment. They

noted, “Furthermore, it is likely that the neurologically impaired juvenile sex offender who goes undetected will not attain the [optimal] benefit from

treatment due to problems in concentration, comprehension, and memory” (p. 13).

In their study of the impact of learning difficulties in

adult sex offender treatment, Langevin, Marentette,

and Rosati (1996) observed that cognitive and neuropsychological testing revealed that the average

level of intellectual functioning of the sample was in

the average range. A closer examination, based on

normative data, revealed that more than expected

fell within the borderline range of intellectual functioning (i.e., IQ of 70–79), fewer than expected were

within the “bright normal” range (IQ of 110–119),

and more than expected fell within the very superior

range (i.e., IQ of 130–140). Neuropsychological

testing with the Halstead-Reitan Battery indicated

that 33 percent of the sample scored within the impaired range.

Cognitive Distortions and Attributions

Knight and Prentky (1993) pointed out that some

factors observed in abused children may have relevance for juvenile sex offenders who have been

maltreated. For example, they cited studies indicating that abused children evidence less empathy than

nonabused children, have trouble recognizing appropriate emotions in others, and have difficulty

taking another person’s perspective. This observation is consistent with research indicating that cognitive distortions, such as blaming the victim, were

associated with increased rates of sexual reoffending

among juveniles who committed sex offenses (Kahn

and Chambers, 1991; Schram, Milloy, and Rowe,

1991).

Mental Health Issues

Symptoms and Disorders

Conduct disorder diagnoses and antisocial behavior

frequently have been observed in populations of

juveniles who have sexually offended (Kavoussi,

Kaplan, and Becker, 1988; Miner, Siekert, and

Ackland, 1997). For example, Kavoussi, Kaplan,

and Becker found that the most common DSM–III

diagnosis in their sample of male juvenile sex offenders was a conduct disorder (48 percent). Most of the

juveniles were classified with the socialized, nonaggressive type. A much higher rate of conduct disorders was found among juveniles who had raped or

attempted to rape adult women (75 percent).

In addition to conduct disorder diagnoses and antisocial traits, studies have described other behavioral

and personality characteristics in juveniles who have

sexually offended. For example, impulse control

problems and lifestyle impulsivity have been associated with juvenile sex offending (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 adolescents who sexually offended against

younger children evidenced higher scores on the

Schizoid, Avoidant, and Dependent scales of the

Millon Clinical Multiaxial Inventory (MCMI) than

those who offended against age peers. These differences were statistically significant. Carpenter and

colleagues also found that the degree of narcissism

in the group of adolescents who offended against

peers was within the clinically significant range,

whereas the degree of narcissism in the group who

offended against younger children was not clinically

significant. The difference between the scores of the

two groups on the narcissism scale was not, however, statistically significant. In another study,

Schram, Milloy, and Rowe (1991) described slightly

more than half of the juveniles in their sample of

juvenile sex offenders as shy or immature.
11

Studies have indicated that juveniles who have sexually offended have higher rates of depressive symptoms than are found in the general juvenile population

(Becker, Kaplan, and Tenke, as cited in Becker and

Hunter, 1997; Kaplan, Hong, and Weinhold, as cited

in Becker and Hunter, 1997). Sexually aggressive

juveniles who had histories of childhood physical

abuse or sexual abuse had higher rates of depressive

symptoms, with as many as 29.2 percent of these

offenders appearing severely depressed (Becker, as

cited in Becker and Hunter, 1997). Becker and

Hunter stressed that this finding illustrates the importance of evaluating whether juvenile sex offenders are experiencing symptoms of depression,

especially if they have been victimized themselves.

Few studies of adolescents and children who evidence sexual behavior problems report major psychopathology in the subjects or their families

(Becker, as cited in Ferrara and McDonald, 1996;

Johnson, as cited in Ferrara and McDonald, 1996).

Sexually aggressive juveniles placed in residential

programs, however, evidence higher levels of “emotional disturbance,” compared with other juveniles

in these programs (Lewis et al., as cited in Ferrara

and McDonald, 1996). Bagley and SchewchukDann (1991) studied male juveniles in two residential treatment centers. They found that residents

with sexual behavior problems, as compared with an

age-matched control group of residents with no

record of sexual problems, demonstrated higher

levels of hyperactivity or restlessness; more depression and anxiety; more histories of fire setting, encopresis (defecation in inappropriate places), and

running away; more early-onset neurological conditions or illnesses; more learning disorders; and

health problems beginning at an earlier age. In contrast, juveniles from the control group were more

aggressive toward peers and siblings and were more

destructive of possessions and property.

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 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, and for some juveniles, substance abuse may not be related to sex

offending. Becker and Stein (as cited in Hunter and

Becker, 1994) found that although 62 percent of the

juvenile sex offenders in their study admitted to

alcohol use, only 11 percent reported that alcohol

use increased their sexual arousal. Statistical analyses indicated that the juveniles who reported increased arousal had more victims than those who

said alcohol had no effect on their arousal or who

said they did not drink. Illicit drug use was less commonly reported than alcohol use among these juveniles: 39 percent reported illicit drug use. Of these,

approximately 23 percent reported that it increased

their sexual arousal. There were no statistically significant differences between subjects in terms of

drug use and number of victims.

As Lightfoot and Barbaree (1993) pointed out, assessments should differentiate substance abuse

problems from “normative” experimentation that is

part of the developmental process. They noted that

classification schemes have been developed (George

and Skinner, as cited in Lightfoot and Barbaree,

1993) to differentiate between infrequent, experimental, recreational, and chronic users and between

different types of life problems associated with substance abuse among juvenile offenders (Lightfoot,

Lightfoot, and Hodgins, as cited in Lightfoot and

Barbaree, 1993). These authors stressed the importance of adequate assessments of substance abuse as

part of a comprehensive evaluation of sex offenders.

They pointed out that offenders who have evidence

of organic impairment, possibly as a result of their

substance abuse, are likely to require treatment similar to that required by offenders who are below average in intellectual functioning. Such treatment

approaches should be simple and concrete, provide

opportunities to rehearse new skills, and include

strategies to facilitate the development and use of

new skills in a variety of settings. The authors also

noted that even among adolescents who are infrequent substance abusers, issues such as poor impulse

control, problem-solving difficulties, and poor social

skills can be exacerbated by even small amounts of
12

substance and, consequently, may increase the risk

of sex offending. Lightfoot and Barbaree (1993)

further suggested that whereas less frequent users

may benefit from substance abuse treatment efforts

that are part of a comprehensive treatment program,

more chronic users may require more intensive substance abuse treatment efforts, possibly prior to

treatment related to sex offending.

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. For example,

Miner and Crimmins (1995) found that the

substance abuse histories of juvenile sex offenders

were very similar to those of other adolescents, including both nonoffenders and juveniles who committed violent but nonsexual offenses. Although the

three groups did not differ in their alcohol abuse, the

violent nonsexual offenders had the highest rates of

drug abuse. Yet, as Lightfoot and Barbaree (1993)

have suggested, assessments of juveniles who have

committed sex offenses would do better to determine

not simply whether substance abuse is present in a

juvenile’s life but whether it is a risk factor for

offending. If it is found to be a risk factor, the next

step is to evaluate what interventions are required to

reduce this risk.
13

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.

Weinrott (1996) noted that even though it is widely

accepted that juveniles who have abused young children differ from those who have sexually assaulted

peers, most studies of juvenile sex offenders combine these groups. Furthermore, in spite of alarming

statistics pertaining to the prevalence of juvenile

sex offending, sexual recidivism rates for juvenile

sex offenders typically are very low (Weinrott,

1996). The apparently low recidivism rate suggests that there may be a significant subgroup of

identified juvenile sex offenders who do not continue to commit sex offenses as adults (Knight and

Prentky, 1993). Such a finding would be consistent

with the literature on juvenile delinquents (Tolan

and Gorman-Smith, 1998). Yet, studies investigating

this probability are lacking. Research on juveniles

who commit sex offenses that differentiates these

juveniles 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.

Becker and Kaplan (as cited in Becker, 1998) proposed that an initial sex offense by a juvenile results

from a combination of individual factors such as a

lack of social skills, family factors such as familial

relationships, and social-environmental factors such

as social isolation. They suggested that three paths

are possible after the initial offense: a dead end

(no further crimes), a delinquency path, and a sex

interest path involving continued sex offending and,

frequently, the development of deviant sexual

arousal patterns. Becker (1998) pointed out that this

hypothesized model, like other classification models,

has not been empirically validated.

In 1986, O’Brien and Bera (as cited in Weinrott,

1996) grouped juvenile sex offenders into the following seven categories:

◆ Naive experimenters.

◆ Undersocialized child exploiters.

◆ Sexual aggressives.

◆ Sexual compulsives.

◆ Disturbed impulsives.

◆ Group influenced.

◆ Pseudosocialized.

Although this classification scheme has been described as having much “face validity” (Weinrott,

1996) and has been recommended to facilitate interventions and treatment (e.g., Avalon Associates,

1986), systematic investigations of its reliability and

validity are lacking. Some indirect support for the

O’Brien and Bera (as cited in Weinrott, 1996) classification scheme comes through the work of Knight

and Prentky (1993). These researchers reported that

four of the O’Brien and Bera types overlap with

factors supported by the empirical literature and by

their own research with adult offenders who committed sex offenses as juveniles.

Knight and Prentky (1993) compared adult sex offenders who had official records of juvenile sex offending with those who did not. They also compared

Types and Classifications
14

a third group of “hidden juvenile sex offenders”—

individuals who reported they had committed sex

offenses as juveniles but who did not have official

records of such offenses. Their findings indicated that

certain factors, such as low social competence and

high rates of antisocial behavior and impulsivity, differentiated sex offenders who began offending as

juveniles from those who did not. These factors also

are significant in differentiating types of adult sex

offenders. For example, of the nine rapist types,

three—low social competence/opportunistic, low

social competence/nonsadistic/sexual, and low social

competence/vindictive—have low social competence

as a defining characteristic. Combined, these findings

suggest that the sex offender classification schemes

validated by Knight and Prentky (1993) for adults

may also be useful for differentiating juvenile sex

offenders. The authors noted that social competence

also is an important factor in the child molester typology, along with factors such as degree of sexual preoccupation and amount of contact with children.

Graves (as cited in Weinrott, 1996) conducted a

meta-analysis of 140 samples involving 16,000

juvenile sex offenders. Results suggested three

typologies: pedophilic, sexual assault, and undifferentiated. Pedophilic juveniles tended to lack social

confidence and to be socially isolated, consistently

molested much younger children (at least 3 years

younger than themselves), and typically molested

girls. The sexual assault group typically assaulted

peers or older females. The undifferentiated group

committed a variety of offenses, and the ages of their

victims varied widely. This latter group engaged in

hands-off offenses (e.g., exhibitionism) in addition

to hands-on assaults. Compared with the other two

groups, they began their abusive behavior when

they were younger, had the most severe social and

psychological problems, were more antisocial, and

had more dysfunctional families.

Prentky et al. (2000) employed a rationally derived

classification system to describe their sample of male

juvenile sex offenders. They used the following six

categories: child molesters (69 percent of the

sample), rapists (12.5 percent), sexually reactive

children (6.25 percent), fondlers (3 percent),

paraphilic offenders (3 percent), and unclassifiable

(6.25 percent). In the child molester category, all

victims were under age 12 and offenders were at

least 5 years older than victims. In the rapist category, all victims were age 12 or older and the age

difference between offenders and their youngest

victims was less than 5 years. Sexually reactive children were under age 11, as were their victims. In the

fondler category (as in the rapist category), all victims were age 12 or older and the age difference

between offenders and their youngest victims was

less than 5 years; sexual acts in this category were

limited to fondling, caressing, or frottage (i.e., touching or rubbing against a nonconsenting person for

sexual arousal). Paraphilic offenders had no physical

contact with their victims; acts included, for example, exhibitionism and obscene phone calls.

Prentky et al. (2000) reported that these categories

also were used by Becker and Kaplan, who found

similar proportions of offenders in each category

(with the exception of a somewhat higher proportion of rapists).

Weinrott (1998a) suggested four general types of

juveniles who have sexually abused others. Three of

these types are those who are juvenile delinquents in

general, those who have deviant arousal, and those

who are psychopathic offenders. The other type

includes juveniles who fit none of these categories

and may only require limited interventions, such as

those that establish appropriate rules for future

sexual behavior.

Malamuth’s research with college students (as cited

in Miner and Crimmins, 1995) suggested that sexual

aggression resulted from the interaction of two pathways: hostile masculinity and sexual promiscuity.

Hostile masculinity involves beliefs that to be male

involves taking risks; being powerful, tough, dominant, competitive, and aggressive; and defending

one’s honor. The sexual promiscuity pathway reflects age at first intercourse and number of sexual

partners since the age of 14. High scores on both

pathways were associated with high rates of sexual

aggression against women.

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. Various
15

factors probably contribute to this apparent tendency to minimize the incidence of sibling abuse.

For example, in contrast to extrafamilial sexual

abuse, parents may be especially reluctant to report

to authorities that one of their children has sexually

abused another child in their home.

O’Brien (1991) emphasized the importance of

“Taking Sibling Incest Seriously” with the title of

his paper. He compared 170 juveniles who sexually

offended against siblings (including stepsiblings,

half siblings, and adoptive siblings) with extrafamilial offenders (those who offended against children other than their siblings), those who sexually

victimized peers or adults, and those whose victims

may have included a mix of sibling and extrafamilial

children and/or peers and adults.4 As a group, sibling offenders perpetrated the greatest number of

abusive acts (an average of 18 incidents, compared

with 4.2 for extrafamilial offenders, 7.4 for peer/

adult offenders, and 8.5 for the mixed group). The

duration of sex offending was greatest for sibling

offenders. Nearly 45 percent of the sibling offenders

had been committing offenses for more than a year,

whereas only 23 percent of the extrafamilial offenders and 24 percent of the adult/peer offenders

had been offending for this long. In addition, the

sibling offenders were more likely than the others

to vaginally or anally penetrate their victims (46

percent, compared with 28 percent of the extrafamilial offenders and 13 percent of the adult/peer

offenders). Sibling offenders also were more likely

to have multiple victims. O’Brien hypothesized that

specific issues, such as victim availability, the nature of the sibling relationship, and other factors,

may have contributed to such serious offending

histories. In spite of such abusive behaviors, only

about one-third of the sibling offenders had courtordered treatment, compared with three-quarters

of the other offenders.

Family factors such as an increased rate of physical

abuse were noted among the sibling offenders (61

percent, compared with 45 percent of the extrafamilial offenders and 37 percent of the adult/peer

offenders). Sibling offenders also were sexually

abused more frequently by their fathers than were

other offenders, although only a small number of the

sibling offenders had been sexually abused by any

family member (including fathers). Interestingly, 36

percent of the sibling offenders’ mothers and 10

percent of their fathers had been victims of sexual

abuse as children, compared with 9.1 percent of the

extrafamilial offenders’ mothers and 5.5 percent of

their fathers. Assessments also suggested that the

rate of family dysfunction was higher for sibling

offenders than for the other groups.

An early study of inner-city minority juveniles from

low socioeconomic backgrounds (Becker et al.,

1986) questioned the existing assumption that sibling offenders are significantly different from other

juvenile sex offenders. Becker et al. noted that 9 of

the 22 adolescents in their small sample also had

evidenced nonsibling paraphilic behaviors. In view

of the O’Brien (1991) study that found significant

group differences between sibling and nonsibling

sex offenders, it may be that, as in any group of sex

offenders, juveniles who perpetrate sibling abuse are

a heterogeneous mix. In fact, Becker and her colleagues noted that the juveniles in their sample included adolescents who engaged in consensual

sexual behavior with a peer-aged relative, those

whose sexual activity with a peer-aged relative began as consensual but became coercive when the

relative withdrew consent, those who had developed

deviant sexual interests, and those who engaged in

both nondeviant and deviant sexual behavior.

In their discussion of sibling abuse, Bonner and

Chaffin (1998) asserted that most interventions designed to address sibling sexual behavior assume a

victim-perpetrator model. They noted that such a

model may be appropriate when the sexual behavior

has been abusive but cautioned that it is progressively less appropriate (and may be damaging) when

sibling cases involve inappropriate mutual sexual

4 behavior or, especially, age-appropriate sex play. Information about the number of abusive acts was provided for

all groups. Information about the duration of offending and

other reported variables was provided for sibling, extrafamilial,

and peer/adult offenders but not for the mixed group.
16

Girls Who Have Committed

Sex Offenses

Incidence

Before 1986, references in the professional literature

to female sex offenders were few and limited. Since

then, some references have appeared, but research

studies continue to be few, and studies of adolescent

girls are relatively rare. Existing studies often are

limited by small sample sizes and retrospective

analysis of selected populations that may not be representative of the general population.

Lane and Lobanov-Rostovsky (1997) reviewed the

literature on young sex offenders and found that

adolescent female sex offenders represented between 2 and 3 percent of juveniles involved in two

different treatment programs. These authors also

cited the results of several statewide incidence studies conducted in the 1980’s. The studies revealed

that females represented 5 percent (19) of the juveniles arrested for sex offenses in Oregon in 1985, 8

percent (12) of the children identified as adolescent

sex offenders by the Vermont Social Rehabilitation

Services Department or Corrections Department in

1984, and 7 percent of the juveniles referred to juvenile court in Utah over a 5-year period. In a Maine

study (Righthand, Hennings, and Wigley, 1989),

females represented 11 percent (40) of the 348 juveniles identified as sex offenders by the Maine Departments of Human Services and Corrections

during a 12-month period between 1988 and 1989.

In a more recent study by the Washington State

Department of Social and Health Services, English

and Ray (as cited in Araji, 1997) found that of 200

juveniles identified as sexually aggressive, 9.3 percent of those age 13 or older were female, compared

with 19.1 percent of those age 12 and under. This

relatively high rate of sex offending by young girls

also was found by Johnson (as cited in Lane and

Lobanov-Rostovsky, 1997). Girls who had been

sexually abusive made up 21.6 percent of the children in her program for children ages 4 to 12 who

had engaged in inappropriate sexual behavior. Gray

et al. (1997) also found a relatively high rate of preadolescent girls who evidenced sexual behavior

problems. In their sample, 35 percent of the children

who evidenced such problems were girls.

Incidence reports on juvenile sex offenses may underestimate the extent of the problem for female

offenders even more than for male offenders. Underestimates may occur because there is a general tendency to underreport sex crimes committed by

females (Charles and McDonald, 1997). It has been

hypothesized that this underreporting might result

from a societal reluctance to acknowledge that girls

are capable of committing criminal offenses, particularly sex offenses; even professionals may be reluctant to report female disclosure of sex offenses

(Travin, Cullen, and Protter, 1990).

Characteristics of Female Offenders

and Their Offenses

Ray and English (1995) compared girls and boys

who were described as sexually aggressive and who

were actively involved with their State’s public social service agency. Findings indicated that the girls

tended to be younger than the boys and were less

likely to have perpetrated acts of rape. (Rape was

defined as involving force or no consent and vaginal,

oral, or anal penetration with a penis or object.)

Approximately 94 percent of the girls in the sample

had been victims of sexual abuse, compared with 85

percent of the boys. A greater percentage of girls

than boys (94 percent versus 86 percent) had experienced multiple types of abuse, including sexual

abuse, physical abuse, emotional abuse, and/or

neglect.

All of the children in the Ray and English sample

(1995) evidenced a wide range of behavior problems

while under the State agency’s supervision. Girls

were significantly more likely than boys to steal and

display temper tantrums. There also was evidence

that girls were more likely to be truant. Girls appeared to have more adequate social skills and more

empathy toward their victims, whereas boys tended

to be more coercive and sophisticated in their sex

offending. Use of sexual aggression appeared to be

escalating more in boys than in girls. Another noteworthy difference was that although approximately

one-third of all the juveniles studied were legally

charged with an offense, only 2 girls (as contrasted
17

with 93 boys) were charged. The study also found

that girls were significantly more likely than boys to

receive assessment and treatment for their experiences of being abused.

Fehrenbach and Monastersky (as cited in Bumby

and Bumby, 1997) found that, in their sample, most

adolescent girls who sexually victimized children

age 12 or younger frequently did so while engaged

in a childcare situation. In their sample, 53.6 percent

of the adolescent girls committed some form of penetration (oral, anal, or vaginal intercourse or other

forms of penetration); 46.4 percent engaged in fondling.

Hunter et al. (as cited in Bumby and Bumby, 1997)

conducted a descriptive study of 10 girls who had

sexually offended and who were in a residential care

program for juveniles with emotional and behavioral

problems. The study, although limited by the small

sample size and lack of a comparison group, is informative. The girls had high rates of previous mental

health services (80 percent). Many had a history of

suicide attempts or ideation (60 percent), running

away (60 percent), substance abuse (40 percent),

enuresis (bed wetting, 40 percent), and/or learning

disabilities (40 percent).

All of the girls reported a history of sexual victimization experiences, including the following:

◆ All had been sexually abused by more than one

offender; the number of offenders ranged from

two to seven.

◆ Experience of victimization began at early ages,

ranging from 1 to 8 years; the median age was 4.5

years.

◆ All of the girls reported being sexually abused by

a male; 60 percent also reported being abused by

a female.

◆ Ninety percent of the girls reported actual or

attempted vaginal penetration, 60 percent reported actual or attempted anal penetration, 70

percent reported having oral sex performed on

them, and all reported being fondled.

◆ Ninety percent reported that force was used in

their sexual victimization experiences, yet 80 percent reported that they experienced some sexual

arousal during at least one of their experiences as

a victim.

In regard to their sex-offending behavior, these girls

reported the following:

◆ They typically victimized younger children; victim ages ranged from 1 to 13 years, with a median

age of 5.5 years.

◆ Their victims most frequently were strangers

(39.4 percent); other victims were siblings (30.3

percent), other relatives (18.2 percent), and acquaintances (12.1 percent).

◆ They had fantasies about the deviant sexual behavior (in 89 percent of the cases).

◆ Their sexually offensive behavior included vaginal intercourse (70 percent), anal intercourse (10

percent), oral sex (70 percent), and fondling (100

percent).

Most of the girls in this sample also engaged in nonsexual delinquent behaviors such as stealing and

physical aggression. Most had not been formally

charged for these behaviors.

The findings of the above studies are fairly consistent with Bumby and Bumby’s (1997) findings from

their sample of 12 adolescent female offenders who

were inpatients at a psychiatric facility for children

and adolescents with emotional and behavioral disorders. Again, the girls in this sample tended to select young victims. Most often their victims were

family members (75 percent). In contrast to the

sample studied by Hunter et al. (as cited in Bumby

and Bumby, 1997), none of these girls victimized

strangers. Eleven of the twelve girls perpetrated

their offenses when providing childcare.

A review of the characteristics of the girls in the

Bumby and Bumby (1997) sample indicated that

most (83 percent) experienced academic difficulties,

although all but three fell within the average intellectual range; all but one had peer difficulties at

school; and two-thirds had been suspended or expelled for physical aggression toward peers or teachers or for other causes. Behavior problems were

common: 75 percent had abused alcohol, 58 percent

had abused drugs, 58 percent had run away from
18

home, 58 percent had been truant from school, and

33 percent had been arrested for stealing. Psychiatric

diagnoses included conduct disorders, oppositionaldefiant disorder, major depression, posttraumatic

stress disorder, adjustment disorder, and chemical

dependency. Most (83 percent) had received previous

mental health services, 33 percent had histories of

self-mutilation, and 58 percent had attempted suicide.

Anger control problems were described as common

(67 percent), as were low self-concepts (100 percent).

Peer relations were very strained; 75 percent of the

girls were described as significantly socially isolated,

which possibly was related to their high rate of aggressive behavior toward peers (67 percent). A significant number (58 percent) were described as

sexually promiscuous, having had many sexual relationships with older males. All of these girls had

been sexually victimized themselves. They tended to

have been sexually abused by more than one person.

Seventy-five percent had been physically abused,

and 42 percent had experienced emotional or physical neglect. In general, their families were described

as dysfunctional and chaotic.

To provide additional information about their adolescent sample, Bumby and Bumby (1997) compared 18 female sex offenders to a group of female

nonoffenders, male sex offenders, and male

nonoffenders of similar age. All juveniles were inpatients at a psychiatric facility for children and adolescents with emotional and behavioral disorders.

Psychological test results suggested that the adolescent female sex offenders experienced a number of

psychological symptoms and difficulties. They had

higher scores than the female nonoffenders on the

psychopathic deviate, paranoia, and psychasthenia

scales of the Minnesota Multiphasic Personality

Index-Adolescent (MMPI–A). They did not, however, differ significantly from the male sex offenders

and male nonoffenders.

The female sex offenders evidenced significantly

more symptoms of anxiety and depression (including suicidal thoughts and behaviors) than the female

nonoffenders but did not differ from the male sex

offenders in this regard. The female sex offenders

had higher rates of academic failure (having been

retained for one grade in school) and truancy than

the male sex offenders but did not differ from the

female or male nonoffenders on these measures.

Although delinquent behaviors, socially inappropriate behaviors, and status offenses were frequent

among female sex offenders, the frequency did not

differ significantly from that found in the other

groups, with the exception that female sex offenders

had higher rates of drug abuse and sexual promiscuity than the male sex offenders. In addition, although high rates of childhood sexual victimization

occurred across all groups, the female sex offenders

experienced significantly more sexual abuse than the

other groups.

Again, these findings are informative but are limited by the small sample size. The authors point

out, however, that their findings are consistent

with the limited available information. The authors

suggest that factors such as depression, suicidal

ideation, anxiety, poor self-concept, and childhood

sexual victimization are targets for assessment,

and possibly treatment, in girls who commit sex

offenses.

In perhaps the largest study to date, Mathews,

Hunter, and Vuz (1997) compared 67 girls who

were referred to community-based treatment or

residential treatment subsequent to histories of sex

offending with 70 boys who also had such histories.

Because the samples did not meet scientific standards of comparability, statistical tests of differences between groups could not be used. A review

of the findings, however, suggested some meaningful similarities and differences between the girls

and the boys. The girls’ offending behaviors were

similar to the boys’ in terms of offense types and

style of victim selection. For example, both girls

and boys committed the following types of offenses: fondling (77.6 percent girls, 75.4 percent

boys), oral sex (47.8 percent girls, 29.7 percent

boys), and vaginal or anal intercourse (26.9 percent girls, 54.5 percent boys). Also like the boys,

the girls tended to victimize young children of the

opposite gender. In contrast to the boys, and consistent with other studies, the girls typically had

more severe victimization experiences themselves.
19

These abusive experiences were characterized by

a higher average number of perpetrators, younger

age at the time of first victimization, and greater

likelihood of having been a focus of their perpetrator’s aggression. Girls also were three times

more likely than boys to have been victimized by

female perpetrators. Like boys, however, the girls’

victimization by a perpetrator of the same gender

seemed related to the girls’ having sexual identity

problems.

Other findings in Mathews, Hunter, and Vuz

(1997) indicated that in addition to experiencing

high rates of abuse and trauma, the girls in this

study typically came from families evidencing high

levels of dysfunction and an absence of parental

support. Their family environments usually appeared detrimental for the development of healthy

attachments and a positive sense of self. Although

a small subgroup of the girls evidenced little psychopathology and limited offending behaviors,

about one-third of the outpatient girls in the study

evidenced mild to moderate levels of psychopathology, and about half of the entire sample appeared

to have moderate to severe psychopathology. Problems included behaviors associated with conduct

disorders, impulsivity, substance abuse, suicidal

behaviors, and unprotected sex. A subgroup of the

girls also evidenced deviant sexual arousal patterns, posttraumatic stress disorder, depression,

and anxiety. In sum, the authors concluded:

Overall, the data from this study seem consistent with the authors’ impression that biological and socialization factors create a higher

threshold for the externalization of experienced developmental trauma in females than

males. In this regard, it may be that females

are generally less likely than males to manifest

the effects of maltreatment in the form of interpersonal aggression or violence and that

females who develop such patterns of behavior are generally those who have experienced

remarkably high levels of such developmental

trauma in the absence of environmental support for recovery and the presence of healthy

female role models. (p. 194)

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. Knopp (as cited in Araji, 1997) observed that

the 1980 Uniform Crime Reports identified 208

children under the age of 12 who were arrested for

rape. Thirty-seven of these children were age 10 or

younger. Knopp found somewhat higher rates for

1979: in that year, 249 children under the age of 12

were arrested for rape; 66 of these children were age

10 or younger. The Uniform Crime Reports stopped

reporting age ranges in 1980 (Araji, 1997).

Recent surveys of children with sexual behavior

problems (including nonajudicated children) reveal

substantially higher rates of sexually abusive behavior by preadolescent children than the rates cited in

the Uniform Crime Reports. For example, English

and Ray (as cited in Araji, 1997) reported that the

Washington Department of Social and Health Services had 641 active cases of children under age 12

who had raped, molested, or engaged in noncontact

sexual acts such as exposing, masturbating in public,

or peeping. Gray and Pithers’ Vermont studies (as

cited in Araji, 1997) identified 200 children under

age 10 who had sexually abused others between

1984 and 1989; even more striking, they identified

100 children who had sexually abused others in a

single year, 1991. In addition, in a sample of 616

juveniles who had been referred for evaluation or

treatment after the age of 12 for committing a sex

offense, 25.9 percent had been sexually abusive

prior to their 12th birthday (Ryan et al., 1996). This

apparent increase in the rate of preadolescent children who evidence sexually abusive behaviors probably reflects a greater awareness of the problem.

In an extensive review of the published and unpublished 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.

Araji’s point has relevance for the findings presented

in this Report: because this area of research is so
20

new, the findings presented must be considered preliminary and interpreted with caution.

Individual Characteristics

With this caution in mind, available studies (Araji,

1997) have reported that preadolescent children

who have been sexually aggressive include children

as young as 3 and 4, although the most common age

of onset appears to be between 6 and 9. Contrary to

findings regarding adolescent children who have

committed sex offenses, girls were represented in

much greater numbers among preadolescents who

have sexually abused. Furthermore, these girls had

often engaged in behaviors that were just as aggressive as the boys’ actions. The number of reported

victims for these preadolescent children ranged from

one to nine; many had multiple victims. Victims

tended to be quite vulnerable. They generally were

young (averaging between ages 4 and 7); typically

were siblings, friends, or acquaintances; and most

often were female.

Studies generally have found high rates of sexual

victimization histories among preadolescent children

who have sexually abused: 50–75 percent of the

boys and 100 percent of the girls in studies that provided this information by gender (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). English

and Ray (as cited in Araji, 1997) found that preadolescent children who have sexually abused have

significantly higher rates of abuse and neglect victimization experiences than their adolescent counterparts. Furthermore, Friedrich and Luecke (as

cited in Araji, 1997) also found severe sexual victimization experiences among sexually aggressive children when contrasted with two samples of children

who were not sexually aggressive (one with a history of sexual victimization and one without). The

children who were sexually aggressive experienced

more severe types of sexual abuse that generally

involved genital contact and penetration. Research

by Friedrich and Luecke (as cited in Araji, 1997)

and Pithers and Gray (as cited in Araji, 1997) also

suggests that the children who engaged in sexually

aggressive behaviors frequently experienced

academic and learning difficulties and impaired peer

relationships.

Family Characteristics

Studies described by Araji (1997) also suggest that

the families of children who engaged in sexually

aggressive behavior tended to be characterized as

dysfunctional, evidencing high rates of parental

separation, domestic violence, substance abuse,

highly sexualized environments (e.g., exposing children to sexual activity, pornography, and both covert and overt sexual abuse), unsatisfactory role

models, poor parent-child relationships, parental

histories of childhood abuse, and so on. After reviewing the available research, 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 children with sexual

behavior problems. These researchers used a

structured interview and standardized measures to

investigate the characteristics of these caregivers.

Findings indicated that the caregivers and their

families experienced much stress. Of the 72 children

in the study (75 percent of whom resided with biological parents and 25 percent with foster parents),

38 percent resided in families whose income fell

below the Federal poverty level (defined as a family

of four or more with an annual income of less than

$15,000). Comparisons between biological families

and foster families revealed that 72 percent of the

biological families and 28 percent of the foster families had incomes below the poverty level. Families

also had a high rate of single parenting: approximately half of the parents (51.4 percent) were living

with a partner.

The family environments of these children, particularly their biological families, were characterized as

disorganized and as requiring much effort to meet

the basic needs of the family. The families had a high

rate of sexual abuse histories. Most families (72 percent) included at least one sexual abuse victim

(other than the child being studied), and more than

half of the extended families (62 percent) included

at least one person (other than the child being studied) who had perpetrated sexual abuse. Sexual
21

abuse victims of the children studied typically were

relatives (94 percent). Very few of these children

assumed responsibility for their sexually abusive

behaviors (10.3 percent).

More than half of the children studied had witnessed domestic violence in the families with whom

they were currently residing. Most witnessed violence between their biological parents (70.2 percent). Some observed partner violence in their foster

homes (20 percent). In general, foster families

seemed to provide more functional environments,

experienced less conflict, and were more cohesive.

The individual functioning of the female caregivers5

was measured with the Brief Symptom Inventory

(Derogatis, as cited in Pithers et al., 1998a;

Derogatis and Spencer, as cited in Pithers et al.,

1998a). The results suggested that, as a group, these

women were significantly more psychologically distressed than most people in the general population.

The biological parents evidenced significantly more

distress than the foster parents. Parenting stress

among female caregivers was measured by the

Parenting Stress Inventory (Abidin, as cited in

Pithers et al., 1998a). Both biological and foster

parents appeared to experience significant parenting

stress that warranted referrals for professional care.

Again, the biological parents evidenced significantly

more stress than the foster parents. Both groups

cited their children as a major source of their

parenting stress, and both groups evidenced impaired attachments to their children. In spite of

these findings, parents typically denied having problems associated with parenting and appeared defensive about some personal difficulties.

Comparative Studies of Preadolescents

and Adolescents Who Have Committed

Sex Offenses

In one of the few existing comparative studies

involving children who committed sex offenses,

English and Ray (as cited in Araji, 1997) studied

271 juveniles who sexually offended by comparing

the preadolescents (32.8 percent) with the adolescents (67.2 percent). Although the researchers

found many similarities between the groups (e.g.,

previous aggressive behavior, psychiatric problems,

and levels of intellectual functioning), the adolescents evidenced significantly higher rates of aggression and coercion and greater sophistication in

committing their sex offenses. The older juveniles

also were less empathic, were more likely to minimize the seriousness of their abusive behavior, and

evidenced more escalating sexual violence. The adolescents also had higher rates of depressive symptoms and suicidal gestures. As Araji suggested, this

latter difference may reflect developmental differences between the groups, as the older juveniles may

have begun to internalize their difficulties in addition to expressing them outwardly.

English and Ray (as cited in Araji, 1997) also found

that both groups had a moderate to moderately high

number of risk factors that were considered by the

authors to be associated with repeat offending. (The

authors evaluated 32 risk factors in 3 categories:

family and environment, juvenile characteristics, and

victim characteristics.) The preadolescent children’s

families, however, evidenced significantly more family violence, anger management difficulties, blurred

boundaries regarding the privacy of family members, family abuse histories, and parental problems

coping with the child’s alleged sexual misconduct. In

addition, the younger group had significantly higher

levels of social isolation and current life stresses.

Types and Classifications

Although, as noted below, some research studies

have substantially advanced the body of knowledge

about younger children who are sexually abusive

and their difficulties, longitudinal studies following

these children over time are lacking. Thus, it is not

known whether childhood sexual behavior problems

continue or, more accurately, which children persist

in their sexual misconduct in adolescence or through

adulthood.

Children who have sexual behavior problems are a

heterogeneous group. Descriptions of these children

typically differentiate normative sexual behavior exhibited by children from a continuum of progressively

5 The authors (Pithers et al., 1998a) noted that psychometric test

results were reported for female caregivers only (94.5 percent of

the sample), to facilitate the comparison of their scores with

published norms.
22

more excessive and abusive sexual behaviors (Araji,

1997; Johnson, 1991).

For example, Johnson (1991) described children

referred for evaluation or consultation because of

reported sexual acting-out behavior and identified

four groups: normal sexual exploration, sexually

reactive, extensive mutual sexual behaviors, and

child perpetrators. Factors that distinguish these

groups are as follows:

◆ Normal sexual exploration is an “informationgathering process” that involves children looking

at and touching each others’ bodies and trying out

gender roles. The sex play is voluntary and typically involves same-age children. It usually is

spontaneous and light hearted.

◆ Sexually reactive children have been sexually

abused, have been exposed to pornography, and/

or live in highly sexualized households. The behaviors of these children include exposing, touching the genitals of other children or adults,

self-stimulating genitals or inserting objects, and

so on. The emotions associated with these behaviors may reflect confusion and shame.

◆ The children in the extensive mutual sexual behavior group participate in extensive sexual behaviors on a continuous basis, including oral sex,

vaginal intercourse, and anal intercourse. They do

not appear to experience anxiety, guilt, shame, or

confusion, and they evidence little desire to stop.

The sexual activity is mutual; there is no offender

or victim. Most of these children have previously

been sexually abused. Sometimes their sexual

behavior appears as a coping strategy in very

chaotic, dysfunctional, and/or sexually abusive

families. Some of these children have been placed

in multiple foster homes and appear to cling to

each other in this sexual way to assuage their

feelings of fear and loneliness.

◆ The child perpetrator group includes children

who engage in impulsive, compulsive, and aggressive sexual behavior. The sexual behaviors are not

mutual and involve coercion, trickery, bribery,

and force. The children in this group often associate feelings of anger and aggression (and sometimes rage) with sex. Other feelings associated

with sex include fear, loneliness, or abandonment.

These children typically have been exposed to

high levels of sexual violence (including incest),

promiscuity, pornography, and sexualized

relationships.

Based on her literature review and her own research, Araji (1997) also conceptualized a subgroup

of children who are comparable to children in

Johnson’s child perpetrators group. These “sexually

aggressive children” are at the extreme end of a

childhood sexual behavior continuum. Their sexual

behaviors tend to be more aggressive and involve

force, coercion, and secrecy. Their sexually abusive

behaviors typically are repetitive and may increase

in frequency over time. Araji also suggested that the

sexually abusive behaviors of these children may

indicate a need to reduce negative emotions (such as

anger, fear, or loneliness) and may also express a felt

need for power. Araji stated that these children require intense, specialized interventions and are

likely to be the most resistant to treatment.

In what appears to be the first attempt to develop empirically derived and clinically relevant classifications

of children with sexual behavior problems, Pithers et

al. (1998b) studied a sample of 127 children ages 6

to 12 who had evidenced sexual behavior problems.

The authors defined “problematic” as sexual behaviors

that were “(a) repetitive; (b) unresponsive to adult

intervention and supervision; (c) equivalent to adult

criminal violations; (d) pervasive, occurring across

time and situations; or (e) highly diverse, consisting

of a wide array of developmentally unexpected sexual

acts” (p. 386).

Pithers et al. (1998b) found that children who evidenced sexual behavior problems varied significantly on several factors, including historical,

demographic, behavioral, and diagnostic factors.

They also varied according to number of victims,

degree of aggression used during the sexual abuse,

sexual penetration, psychiatric diagnoses, and internalizing and externalizing behaviors. Five subtypes

were identified: sexually aggressive, nonsymptomatic, highly traumatized, abuse reactive, and rule

breaker. Factors that distinguish these subtypes are

as follows:
23

◆ The sexually aggressive children tended to have

the highest rates of conduct disorder diagnoses.

They were more likely to penetrate their victims

and less often were victims of sexual or physical

abuse themselves.

◆ The nonsymptomatic children were, as the classification name implies, within the normal range on

most test measures. They typically did not have

psychiatric diagnoses, evidenced low levels of

aggression in their sexual behaviors, and had the

fewest victims. These children were some of the

most likely children to have in their extended

family persons who had perpetrated sexual abuse.

◆ Both the highly traumatized children and the

abuse reactive children typically were among the

youngest and had the highest average number of

victims. These two groups of children also had

been victimized by the greatest number of sexual

and physical abuse perpetrators.

◆ The highly traumatized children had the highest

incidence of psychiatric diagnoses and posttraumatic stress disorders. Their parents were more

likely than other parents to report feeling less

attached to their children.

◆ The abuse reactive children had the shortest time

between their own personal victimization experiences and the onset of their abuse against others.

They experienced a high level of maltreatment and

had a high number of sexual abuse perpetrators.

This group had a high incidence of psychiatric

diagnoses and the highest incidence of oppositional

defiant disorders. They occasionally used aggression during their offenses.

◆ The rule-breaking group included a higher number of girls and had a greater time lag between

their own victimization experiences and the onset

of their abuse against others. These children had

higher levels of sexualized and aggressive behaviors and also were more likely to act out in nonsexual ways. They had the highest number of

sexual abusers within their extended families.

Across all five subtypes, certain factors were found

to be associated with the number of victims abused

by these children. The children who themselves had

been abused by more perpetrators and the children

who had impaired attachments with their parents

had greater numbers of victims.

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) compared sexual behavior problems in a sample of intellectually normal (defined by

the authors as borderline intellectual functioning or

higher) and mentally retarded (including mild and

moderate mental retardation) adolescents. The

sample included both outpatient and inpatient adolescents at an assessment and treatment center for

children and adolescents. The authors found that the

frequency of sexual behavior problems of the groups

studied did not differ significantly according to their

levels of intellectual functioning. They noted that,

for both the “intellectually normal” and “mentally

retarded” groups, the closer the adolescent was observed (e.g., within a residential setting), the greater

the number of sexual behavior problems recorded.

This finding was especially true for the mentally

retarded inpatient group. The authors suggested

that reports of a greater-than-expected number of

sexual problems among persons with mental retardation may be related to the increased levels of supervision these individuals receive.

Gilby, Wolf, and Goldberg (1989) found increased

levels of inappropriate, nonassaultive sexual behavior (e.g., exhibitionism and public masturbation)

among the adolescents with mental retardation. Although the rate of sexual assault did not vary between the intellectually normal and mentally

retarded groups, there were fewer “consented to”

sexual activities among the mentally retarded outpatient group. The authors suggested that this difference could reflect a lack of opportunity. The authors

also noted that sexual activity was frequent in both

groups of adolescents once they were placed in

residential settings. The adolescents with mental

retardation, however, reportedly were more indiscriminant in their sexual activity: they were more
24

likely to engage in both homosexual and heterosexual activities, whereas the adolescents with normal intellectual functioning were more likely to

engage exclusively in either heterosexual or homosexual activity.

Analysis of offense patterns in the intellectually normal and mentally retarded groups revealed that both

groups engaged in both consensual sexual behavior

and assaultive and other inappropriate sexual behaviors. Adolescents with mental retardation, however, had a higher rate of sexual assaults against

peers and were less likely to know their victims.

Adolescents with normal intellectual functioning

selected female victims more often, whereas those

with mental retardation were equally likely to select

male and female victims.

The Gilby, Wolf, and Goldberg (1989) study is informative. Additional research is needed, however,

to determine whether the findings in this study can

be generalized to other juveniles with mental retardation who have committed sex offenses.

Likelihood of being sexually victimized may be a

special issue among juveniles with mental retardation and other developmental disabilities. Cowardin

(as cited in Stermac and Sheridan, 1993) reported

that developmentally disabled persons are four times

more likely than nondisabled individuals to be sexually abused. Also, individuals with developmental

disabilities usually are not encouraged to date and

marry or to express their sexual needs (Brantlinger,

as cited in Stermac and Sheridan, 1993) and typically are relatively uneducated about sexual matters

(Edmondson, McCombs, and Wish, as cited in

Stermac and Sheridan, 1993).

Juveniles Who Have Committed

Sex Offenses Versus Other Types

of Offenses

Given limited resources (funding and availability of

treatment programs and providers) and reported

similarities between juvenile sex offenders and other

juvenile delinquents, the question arises as to how

extensive the differences are between individual sex

offenders and between sex offenders as a group and

other juveniles who have been abused and traumatized and have had very difficult lives. Are juveniles

who have committed sex offenses a distinct group in

need of specialized intervention, or can their needs

be best met through interventions that are effective

with juveniles who have committed other types of

offenses?

Again, research is limited. Available studies, however, suggest that juveniles who commit sex offenses

and juveniles who commit other types of offenses

share many characteristics (e.g., Miner and

Crimmins, 1995).

Milloy (1994) conducted a comparative study of 59

juvenile sex offenders and 132 other juvenile offenders as part of a needs assessment survey. She found

that although the juvenile sex offenders had some

unique characteristics, they shared many more characteristics with juveniles whose offenses were nonsexual. In contrast to the juveniles whose offenses

were nonsexual, the sex offenders were more likely

to have been victims of sexual abuse, have major

mental health problems, need health or dental hygiene education, lack appropriate peer relationships,

and have problems with sexual identity. They also

tended to have more adequate academic performance, fewer prior offenses and convictions, and

less substance abuse. None of the sex offenders was

convicted of a new sex offense. Their overall recidivism rate was lower than that of other offenders.

When they did reoffend, their crimes tended to be

nonsexual and nonviolent. By the end of a 3-year

followup period, only 22 percent of the sex offenders

had offense histories limited to sex offenses only.

Only 15 percent had been adjudicated for multiple

separate incidents of sex offenses. In contrast, 78

percent had been convicted of both sex offenses and

other types of offenses. Milloy noted, “These findings suggest that when a longitudinal perspective is

used, sex offending among juveniles appears to

be but one piece of a pattern of generalized

delinquency” (p. 9).

Miner and Crimmins (1995) compared juveniles in

juvenile sex offender treatment programs with juveniles who self-reported committing other types of

offenses and juveniles who reported no delinquent

behaviors in a national survey of juveniles. Few differences were found in the delinquency-related
25

attitudes of sex offenders and other offenders (e.g.,

whether it is okay to cheat on tests, be truant, use

drugs, be violent, and commit theft). The sex offenders differed, however, from the other offenders in

their overall negative attitude regarding most types

of delinquent behavior. They also were more disengaged from family interactions. The authors proposed that it may be their social isolation from peers

and family that allows juvenile sex offenders to violate a generally prosocial belief system and behave in

antisocial ways toward others.

A more recent study by Spaccarelli et al. (1997)

further supports findings suggesting that many

juvenile sex offenders also commit other types of

offenses and are difficult to distinguish from delinquents with no known history of sexual assault.

Spaccarelli et al. examined a sample of 210 chronic

delinquents, 24 of whom had been arrested for a sex

offense and 26 of whom self-reported committing

sex offenses for which they had never been arrested.

There were no differences on any of the measured

variables between the combined group of 50 juvenile

sex offenders and a group of 106 juveniles who had

been arrested for violent but nonsexual offenses.
27

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. This includes

assessment of each juvenile’s needs (psychological,

social, cognitive, and medical), family relationships,

risk factors, and risk management possibilities. To

emphasize this point, Dougher (1995) began his

chapter describing the process of assessing sex

offenders with the subtitle “Comprehensive, InDepth Assessment Is Prelude to Effective Treatment Planning and Implementation” and pointed

out that the literature emphasizes the varied, complex, and multidetermined nature of sex offending.

Dougher further emphasized that “[a]ccordingly,

any attempt to explain or treat sexually offensive

behavior must consider the specific factors pertinent to an individual’s offense and the psychological characteristics of the individual offender” (p.

11.2). He added that because many, “. . . if not

most, sex offenders tend to lie about their offenses

and are unreliable and deceptive in their verbal

reports, the value of a thorough assessment cannot

be overemphasized” (p. 11.2).

Gathering Multiple Sources of Information

Morenz and Becker (1995) noted that parents or

guardians of juveniles should be involved in the assessment and in the treatment process. Informed

consent should be obtained from the juvenile and

parent or guardian, and they should be clearly informed of the limits of confidentiality (Becker and

Hunter, 1997).

Recommended procedures for comprehensive

assessment of juveniles who commit sex offenses

include clinical interviews with the juveniles and

family members, psychological assessment, and, in

certain cases (according to some), phallometric assessment (Bonner et al., 1998; Morenz and Becker,

1995). Structured clinical interviews (Morenz and

Becker, 1995) and paper-and-pencil psychometric

tests and questionnaires (Becker and Kaplan, 1993)

also can be useful for assessing pertinent areas that

may be related to sex offending, such as attitudes

and values, social skills, psychological functioning,

and sexual knowledge.

Becker and Hunter (1997) also noted that evaluators should review victim statements, juvenile court

records, mental health reports, and school records

as part of their assessments. Kraemer, Spielman,

and Salisbury (1995) suggested that assessments

should address the juvenile’s beliefs regarding the

sex-offending behaviors; issues of aggression, impulsivity, withdrawal, and depression; attitudes toward

treatment; potential barriers to treatment; and approaches most likely to be effective. They also noted

that objective measures to assess the prognosis for

treatment outcomes are useful, citing as an example

personality tests, which can help to identify individuals who are unlikely to succeed in treatment.

Using Psychological Tests

Psychological testing of sex offenders has a long

history. Although not all of that history is positive,

psychological testing is an important part of a comprehensive assessment (Dougher, 1995). In the past,

testing was primarily used for identifying personality characteristics and psychological profiles of offenders; due to the heterogeneity of sex offenders,

such attempts were not very successful. As Dougher

pointed out, “Nevertheless, psychological tests can

be useful in combination with other assessment

Assessment
28

procedures to create a clinical picture of an offender

and to identify target areas for clinical interventions”

(p. 11.7). In fact, psychological tests have been described as adding a “critical dimension” to comprehensive evaluations of juveniles who have sexually

offended (Kraemer, Spielman, and Salisbury, 1995).

What they add is “a norm-based reference that can

assist in determining placement in an appropriate

treatment modality, developing a viable treatment

plan, and assessing treatment progress” (p. 11.2).

Bourke and Donohue (1996), in their article “Assessment and Treatment of Juvenile Sex Offenders: An

Empirical Review,” also observed that studies consistently reveal juvenile sex offenders to be a heterogeneous population. For example, they cited research

findings that juvenile sex offending coexists with

diagnoses of conduct disorders, attention deficit/

hyperactivity disorders, antisocial personality disorders, narcissistic personality disorders, learning disabilities, affective disorders, posttraumatic stress

disorders, and substance abuse. They concluded,

“The high rate of comorbid diagnoses found within

this population emphasizes the importance of utilizing

sensitive, comprehensive, standardized methods when

assessing and treating JSOs [juvenile sex offenders]”

(p. 50).

Kraemer, Spielman, and Salisbury (1995) described

four primary domains that require assessment: intellectual and neurological, personality functioning and

psychopathology, behavioral, and sexual deviance.

In addition, Becker and Hunter (1997) pointed out

that psychometric testing to assess intellectual functioning and reading ability is important to ensure

that the juvenile is able to understand both paperand-pencil tests and treatment experiences.

The Minnesota Multiphasic Personality InventoryAdolescent (MMPI–A) has been described as the

psychological test most widely used with juvenile

sex offenders (Bourke and Donohue, 1996). Because of the heterogeneity of juveniles who have

committed sex offenses, there is no MMPI sex offender profile that distinguishes these juveniles from

others (Bourke and Donohue, 1996; Dougher,

1995). The MMPI–A’s strengths include its validity

scales, which help the evaluator assess a juvenile’s

attitude and approach to the evaluation. As Dougher

pointed out, “The extent to which an offender is

dishonest, defensive, or malingering has obvious

implications for treatment amenability and prognosis” (p. 11.8). The MMPI–A also may be useful for

gaining insight into a juvenile’s personality and for

assessing possible psychopathology (Bourke and

Donohue, 1996; Dougher, 1995).

Bourke and Donohue (1996) also reviewed other

psychological tests that have psychometric properties and that may be useful for identifying clinical

issues and psychopathology relevant to the treatment of juvenile sex offenders. For example, the

Multiphasic Sex Inventory (MSI) is an assessment

instrument that is used with adult sex offenders to

evaluate issues such as sexual interests, knowledge,

fantasies, and behaviors. Bourke and Donohue expressed concern that only limited research has been

conducted with the MSI; however, their review pertained to a 1984 version of the instrument. There is a

juvenile version of the MSI, but it appears that even

less research has been conducted with it than with

the adult version. In their discussion of the adult

MSI, Milner and Murphy (1995) also addressed the

issue of limited validity data but stated that in spite

of this important weakness, the MSI may have clinical utility for descriptive purposes in known offender groups. Milner and Murphy did not discuss

the juvenile MSI.

A more comprehensive and promising approach

involves computerized assessment with the Multidimensional Assessment of Sex and Aggression

(MASA). The MASA, developed by Dr. Ray

Knight, Dr. Robert Prentky, David Cerce, and

Alison Martino, is a computerized, self-report inventory that covers multiple domains (Knight and

Cerce, 1999; Knight, Prentky, and Cerce, 1994;

Prentky and Edmunds, 1997). A juvenile version is

currently being validated (R.A. Knight, personal

communication, October 16, 2000). The questionnaire asks about attitudes and behaviors in many

areas of an individual’s life, including childhood

experiences, family and social relationships, school

and work experiences, alcohol and drug use, and

sexual and aggressive behavior and fantasies. The

questionnaire includes items that have been associated with different classifications of offenders and

with recidivism and includes sophisticated methods

for assessing response biases, random responding,

and dissimulation.
29

Studies have demonstrated that psychopathy is a

strong predictor of violent behavior in general

among adult offenders (e.g., Harris, Rice, and

Quinsey, 1993; Quinsey, Rice, and Harris, 1995;

Salekin, Rogers, and Sewell, 1996; Serin, 1996) and

juvenile offenders (Forth, Hart, and Hare, 1990;

Hare, 1991; Forth and Burke, 1998). Studies also

have documented an association between psychopathy and sexual violence among adult offenders

(Quinsey, Rice, and Harris, 1995; Serin et al., 1994).

Studies investigating psychopathy and juvenile sex

offending are more limited.

Gretton et al. (as cited in Forth and Burke, 1998)

found that adolescent sex offenders who were diagnosed as psychopathic used more threats and more

severe violence during their sex offense than those

adolescent sex offenders who were classified as

nonpsychopathic. Although relatively small proportions of adult sex offenders have been found to be

psychopathic (Serin et al., 1994), adult sex offenders

who are diagnosed with psychopathy and phallometrically assessed sexual deviance have been described as particularly dangerous (Hare, 1996).

Most studies of psychopathy use the Psychopathy

Check List-Revised, a reliable and valid psychometric instrument specifically designed to assess psychopathy. Publication of the juvenile version of the

Psychopathy Check List is expected soon (Forth,

Kosson, and Hare, in press).

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 (penile plethysmography). Becker et al.

(as cited in Becker and Kaplan, 1993) reported preliminary research findings involving phallometric

assessment that suggested deviant erectile responding was common in adolescents who had abused

young boys and who had been sexually abused

themselves.

Others, however, have discussed potential ethical

concerns related to using phallometry with juveniles

who have committed sex offenses (Bourke and

Donohue, 1996; Cellini, 1995). Concerns include the

invasive nature of phallometric assessment, possible

exposure of juveniles to sexual material beyond their

experience, and limited research documenting the

validity of phallometric assessment with juveniles.

The limited research regarding the utility of

phallometric assessment with juveniles who have

committed sex offenses is partly due to ethical issues

related to obtaining control groups. Weinrott

(1998a) noted, however, that many of these issues

could be addressed by using stimuli that are less

sexually explicit in detail and language, because

adolescents typically have strong responses to most

sexually explicit stimuli. In addition, less explicit

stimuli may increase the validity of phallometric

assessment with juveniles.

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 a computer-driven assessment approach that provides an evaluation of a juvenile’s sexual interest

patterns based on his or her reaction times when

viewing slides of potentially sexually evocative

stimuli. This methodology is significantly less invasive than phallometric assessment. Good reliability

and significant correlations with diagnoses and selfreported arousal patterns have been reported (Abel

Screening, Inc., 1996). 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.

Using Other Assessment Strategies

Substance abuse assessment. In addition to the

assessment of personality functioning and deviant

arousal, it is also important to assess whether the

individual has a substance abuse problem and, if so,

whether it is a risk factor for that individual’s sex

offending. The importance of using valid and reliable assessment tools to screen for substance abuse

difficulties has been emphasized (Becker and

Hunter, 1997; Lightfoot and Barbaree, 1993).
30

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 with some juveniles to

facilitate more complete disclosures of sexually abusive behaviors and to monitor compliance with treatment. The National Task Force on Juvenile Sexual

Offending noted that “[i]t is critical that submissions

to polygraph examinations be voluntary and with

full informed consent of the youth, parent, or guardian” (NAPN, 1993, p. 85). When disclosures during

polygraph testing reveal previously unreported information, additional investigations can result. Furthermore, the Task Force pointed out that some

professional organizations’ ethical requirements

preclude the use of instruments without empirical

evidence of reliability and validity. Research regarding the reliability and validity of the polygraph for

assessing juvenile sex offenders is very limited

(Hunter and Lexier, 1998). Some researchers have

seriously questioned the validity of the polygraph

(Cross and Saxe, as cited in Bonner et al., 1998;

Saxe, Dougherty, and Cross, as cited in Bonner et

al., 1998). Both false positives and false negatives

occur, and the emotional impact of polygraph administration on juveniles and the resulting effects on

the therapeutic process remain unknown (Hunter

and Lexier, 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) investigated the

sex offense histories of 49 juveniles who sexually

assaulted peer or adult females and 45 juveniles

who sexually abused younger children. They reported that 61 percent of those who sexually assaulted peers or adults had histories of prior sex

offenses and that 40 percent of those who abused

younger children had histories of prior molestation.

Fehrenbach et al. (1986) found that 57.6 percent of

the 297 juvenile sex offenders in their sample had

perpetrated other sex offenses prior to their referral

offense.

Rates of Recidivism

One prospective study followed juvenile offenders

(19 who had committed sex offenses and 58 who

had committed other types of offenses) into adulthood (Rubinstein et al., as cited in Sipe, Jensen, and

Everett, 1998). Findings revealed that 37 percent of

those who had committed sex offenses as juveniles

went on to have criminal records for sexual assaults

as adults, in contrast to 10 percent of those who had

committed other types of offenses as juveniles. A

weakness of this study was the relatively small

sample size for sex offenders. A strength of the

study was its relatively long followup period of 8

years. It may not be possible to generalize the

study’s findings to other juveniles who have committed sex offenses, not only because the sample of sex

offenders was small but also because it included

juveniles described as very assaultive (a trait not

representative of many juvenile sex offenders).

In contrast to the Rubinstein et al. study (as cited in

Sipe, Jensen, and Everett, 1998), most studies have

suggested that once a juvenile’s sex offending has

been officially recognized, subsequent detected

sexual recidivism is relatively infrequent (Bremer,

1992; Hagan, King, and Patros, as cited in Kramer

et al., 1997; Kramer et al., 1997; Miner, Siekert, and

Ackland, 1997; Rasmussen, 1999; Sipe, Jensen, and

Everett, 1998; Weinrott, 1996). Sipe, Jensen, and

Everett (1998) found that only 9.7 percent of their

sample of 124 juveniles who had committed “nonviolent” sex offenses against children under 16 years

old were subsequently arrested for a sex offense as

an adult. Interestingly, 3 percent of a sample who

had committed nonsexual offenses as juveniles were

also arrested for a sex offense as an adult. Both

groups were more likely to be arrested for nonsexual

offenses as adults (16.1 percent of the juvenile sex

offenders and 32.6 percent of the other juvenile offenders). Followup periods in the study ranged from

1 to 14 years, with an average of 6 years.

Smith and Monastersky (1986) examined the juvenile justice records of 112 juvenile sex offenders.

During a 17-month period of time when they had

the opportunity to commit an offense while in the

community, 16 (14.3 percent) committed another

sex offense and 39 (34.8 percent) committed a nonsexual offense.
31

Schram, Milloy, and Rowe (1991) followed 197

juvenile sex offenders after they completed 1 of 10

different treatment programs. The followup period

ranged from 2 to 7 years. The study found that 37

percent had no new arrests. Of the 63 percent who

had new arrests, only 12 percent were arrested for a

sexual offense. Similarly, relatively few were subsequently arrested for violent felonies (15 percent).

Most rearrests were for either nonviolent felonies

(40 percent) or misdemeanors (53 percent). (The

offense categories were not mutually exclusive, and

the juveniles may have been rearrested for more

than one type of offense.) The 2 years immediately

following discharge from treatment represented the

period of highest risk, especially for those treated in

institutions. Although some of the juveniles may

have offended later, results suggested that most

reoffending occurred when the subjects studied

were still juveniles. A very small subset of offenders

(seven, or 4 percent of the sample) were deemed, for

the purpose of the study, to be “chronic” offenders

(defined as having two or more sex offense arrests

after the referral offense or one prior and one subsequent sex offense arrest). The researchers found

that most of the juveniles in their sample desisted

from sex offending after their first sex offense arrest,

adjudication, and treatment. They concluded that

very few who commit sex offenses as juveniles go on

to commit such offenses as young adults. This finding is consistent with that of Sipe, Jensen, and

Everett (1998), who, as noted above, found that

only 9.7 percent of their juvenile sex offender

sample were arrested for sex offenses as adults.

Kahn and Chambers (1991) described 221 juvenile

sex offenders identified by Schram and Rowe (as

cited in Kahn and Chambers, 1991), who only included 197 in the study reported above (Schram,

Milloy, and Rowe, 1991). The subjects in this

sample were in the community with the opportunity

to reoffend for an average time of 20.4 months. Not

surprisingly, recidivism rates were similar to those

found by Schram, Milloy, and Rowe (1991). Nearly

45 percent of the 221 juveniles in this sample were

convicted of one or more subsequent offenses. Of

those who recidivated, only 6.6 percent had new

convictions for nonsexual violent crimes and only

7.5 percent had convictions for sex crimes.

More recently, Miner, Siekert, and Ackland (1997)

followed 96 juveniles who participated in the Minnesota Department of Correction Juvenile Sex Offender Program. The average time at risk for the

followup was 19.3 months. During the followup

period, 27.2 percent were arrested for a crime that

did not involve a person, 10.4 percent were arrested

for a new crime against a person, and only 8.3 percent were arrested for a new sex offense.

Rasmussen (1999) also recently reported findings on

factors related to recidivism rates among first-time

juvenile sex offenders. Rasmussen’s results were

consistent with previous research in that 54.1 percent (N=92) of the sample committed a new nonsexual offense, whereas only 14.1 percent (N=24)

committed a new sex offense. The relatively higher

reoffense rates may reflect the comparatively long

followup period of 5 years.

Table 2 summarizes results of the recidivism studies

reviewed above. Two of the studies included comparison groups of juveniles who apparently committed only nonsexual offenses. As the table indicates,

recidivism involving nonsexual offenses was consistently and significantly higher than recidivism involving sex offenses, for both juvenile sex offenders

and comparison groups. Weinrott (1996) provided

a more extensive review of studies investigating

recidivism rates among juvenile sex offenders. The

findings summarized herein are consistent with

Weinrott’s overall findings.

Methodological variations clearly influence recidivism rates (Prentky et al., 1997). These variations

include issues such as the definition of recidivism

(i.e., a new arrest versus a new adjudication), the

adequacy of delinquency or criminal records, and

the duration of the followup period (Prentky et al.,

2000). Yet, as Weinrott noted:

What virtually all of the studies show, contrary

to popular opinion, is that relatively few JSOs

[juvenile sex offenders] are charged with a

subsequent sex crime. Whether this is due to

deterrence, humiliation, lack of opportunity,

clinical treatment, increased surveillance, or

inadequate research methodology is difficult to

ascertain. (p. 67)
32

Factors Associated With Recidivism

Becker (as cited in Friedrich, 1990) suggested that

adolescent sex offenders were probably more likely

to reoffend if one or more of the following factors

were present: initial offending was pleasurable,

consequences for the offense were minimal, the deviant sexual behavior was reinforced through masturbation or fantasy, and/or the offender had social

skills deficits. These factors appear to have good

face validity but require additional assessment.

Sexual Recidivism Nonsexual Recidivism

Sex Other Sex Other

Study Followup Period Offenders Offenders Offenders Offenders

Kahn and M: 20 monthsa 8%b

Chambers, 1991 (N=221)c

Miner, Siekert, and M: 19 monthsa 8% 38%

Ackland, 1997 (N=96) (N=96)

Rasmussen, 1999 M: 5 yearsd 14% 54%

(N=170) (N=170)

Rubinstein et al., M: 8 yearsd 37% 10%

as cited in Sipe, (N=19) (N=58)

Jensen, and Everett,

1998

Schram, Milloy, R: 2–7 yearse 12% 15% (violent

and Rowe, 1991 (N=197) felonies), 40%

(nonviolent

felonies), 53%

(misdemeanors)f

(N=197)

Sipe, Jensen, M: 6 yearsd 10% 3% 16% 33%

and Everett, 1998 R: 1–14 yearse (N=124) (N=132) (N=124) (N=132)

Smith and M: 17 monthsa 14% 35%

Monastersky, 1986 (N=112) (N=112)

Table 2: Sexual and Nonsexual Recidivism by Juvenile Offenders

Notes: a M=mean time at risk in the community. b Percentages have been rounded off to the nearest whole number. c N=the total number of subjects in

the group sample. d M=mean number of months or years followed by the study. e R=range. f Offense categories were not mutually exclusive, and the

juveniles may have been rearrested for more than one type of offense.
33

As noted above, Smith and Monastersky (1986)

examined the juvenile justice records of 112 juvenile sex offenders. They found that very few selected predictor variables were associated with

reoffending. Offenders described as having “unhealthy” attitudes regarding sexuality (i.e., those

who naively denied normal adolescent sexual behavior) were less likely to reoffend by committing a

sex offense and somewhat less likely to reoffend by

committing a nonsexual offense. The only other

statistically significant findings involved nonsexual

reoffenses. Offenders who appeared to understand

the exploitive nature of their sex offenses were less

likely to reoffend nonsexually, and those who were

unable to identify their personal strengths were

more likely to reoffend nonsexually. Interestingly,

a lack of depression and a willingness to explore

the referral sex offense nondefensively were both

marginally related to an increased rate of sexual

reoffending and a reduced rate of nonsexual

reoffending.

In the Smith and Monastersky study, some offense

characteristics also were marginally associated with

reoffending in general. Rapists were less likely to

reoffend than those who committed seemingly less

serious crimes. Those who offended against substantially younger victims (4 or more years younger than

the offender) were less likely to reoffend. In contrast, those who committed offenses against strangers were more likely to reoffend sexually (and less

likely to reoffend nonsexually) than those who offended against relatives or acquaintances. Lastly,

those who had at least one recent offense against

boys were described as “somewhat” more likely to

reoffend sexually than those who offended only

against girls.

Schram, Milloy, and Rowe (1991) found that juvenile

sexual recidivists had higher rates of truancy, higher

rates of thinking errors (erroneous perceptions, ideas,

and beliefs that justify abusive behavior—e.g., blaming victims), and at least one prior sex offense. They

also were much more likely to have deviant sexual

arousal patterns, although this was not assessed with

physiological measures. Sexual recidivism was not

related to the type of referral sex offense, treatment

location, or type of treatment received.

In Schram, Milloy, and Rowe (1991), those who did

not reoffend generally were older, had less previous

contact with the juvenile justice system, and were

less likely to have school behavior problems or truancy. They also were significantly less likely to have

been sexually abused or have a sibling who was

abused. They were more likely to have social skills

deficits and were significantly less likely to blame

their victims or exhibit deviant arousal patterns.

Kahn and Chambers (1991) found (in Schram and

Rowe’s sample, as cited in Kahn and Chambers, 1991)

that only two variables were significantly positively

associated with sexual reoffending: using verbal threats

during the commission of the offense and blaming the

victim for the crime. Surprisingly, denial of the offense

was negatively associated with reoffense rates: none

of the eight offenders who completely denied their

offenses sexually reoffended. Although offenders with

“therapist-identified” deviant arousal (i.e., assessed by

clinical judgment) reoffended at a higher rate than

those without deviant arousal (13 percent versus 6

percent), this difference was not statistically significant.

Similarly, although offenders who victimized a child

they knew but were not related to were more likely

to be adjudicated delinquent for a new sex offense

than those who were related to their victims, the difference was not statistically significant. It also is important to note that more than 50 percent of the adolescent

sex offenders in this study had histories of nonsexual

criminal offenses.

In their 1997 study of juvenile sex offenders, Miner,

Siekert, and Ackland indicated that predictors of

reoffending included penetrating the victim during

the original sex offense and coming from an unstable

home. In Rasmussen’s 1999 study of juvenile sex

offenders, multivariate analyses revealed that sexual

recidivism was associated with perpetrating sex offenses against multiple female victims; i.e., juveniles

with a history of multiple female victims, as contrasted with a single female victim or multiple male

victims, were more likely to sexually reoffend. This

finding is contrary to Smith and Monastersky’s

(1986) finding suggesting that juvenile sex offenders

who sexually abused male victims may pose a higher

risk of sexual reoffending. In addition, Rasmussen

(1999) found that nonsexual recidivism among
34

juvenile sex offenders was related to having a relatively high rate of previous nonsexual offenses and

to not completing treatment.

In spite of the various descriptions of characteristics

identified in juveniles who have sexually offended,

Weinrott (1998b) reported that very few characteristics have been empirically associated with sexual

recidivism. He noted that these characteristics include the following (Weinrott, 1998b, p. 1):

◆ Psychopathy.

◆ Deviant arousal.

◆ Cognitive distortions.

◆ Truancy.

◆ A prior (known) sex offense.

◆ Blaming the victim.

◆ Use of threat/force.

Weinrott (1998b) reported that in contrast to what

has been commonly thought, factors such as denial,

abuse histories, and empathy deficits (among others)

either have not been empirically associated with

sexual recidivism (i.e., have not statistically accounted for significant variance in outcomes) or

have simply not been investigated.6 This is not to

say that interventions designed to address these

factors (e.g., 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.

For example, a recent study (Hunter and Figueredo,

1999) found that nearly 75 percent of the juveniles

who did not evidence any denial of their sex offenses

when beginning treatment successfully complied

with treatment requirements during the 12-month

period under study. In contrast, only 25 percent of

the juveniles who evidenced full denial complied

with treatment during the same period. The authors

reported that “attitudes of openness and accountability proved to be the best predictors of a positive

treatment outcome” (p. 65). It is important to note

that adjudication may have been a confounding variable in this study, given that most of the juveniles

who were adjudicated completely acknowledged

their offense and relatively few of those who had not

been adjudicated did so. Thus, the adjudication process and its consequences may have contributed

significantly to treatment compliance. Furthermore,

this study did not investigate whether openness and

accountability were related to reduced recidivism

rates.

Prediction of Recidivism

In a recent commentary, 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. As

noted above, empirically based typologies have received some attention; however, an actuarial risk

assessment schedule with adequate empirical validation is lacking (NAPN, 1993).

Two studies have investigated the accuracy of recidivism predictions by program staff. Schram, Milloy,

and Rowe (1991) found that treatment staff members very accurately identified offenders who presented a low risk for sexual reoffending, but some of

these juveniles reoffended in other ways. In contrast,

only 18 percent of juveniles who were identified by

program staff as “at risk” or “dangerous” sexually

reoffended during the period under study. It is possible, of course, that some of these at-risk or dangerous offenders actually reoffended but were not

detected. This finding is consistent with others (e.g.,

Smith and Monastersky, 1986) and suggests that

treatment providers may tend to overpredict sexual

recidivism (and therefore keep offenders in treatment) rather than risk the dire consequences associated with failing to predict recidivism that comes to

pass.

There are a number of explanations for the relatively

poor accuracy of attempts to predict sexual (and

violent) recidivism (Smith and Monastersky, 1986).

6 Weinrott (1998b) listed the following factors as lacking empirical evidence: “(a) denial of offense or sexual intent, (b) low

motivation for treatment, (c) introversive or antisocial personality traits, (d) low intelligence, (e) social-skills deficits, (f) impulsiveness, (g) pornography use, (h) conduct disorder, (i) abuse

history, (j) minority race, (k) family relationships/structure,

(l) delinquency, (m) alcohol/drug abuse, (n) lack of empathy,

and (o) length and type of treatment” (p. 1).
35

Sex offending is a relatively infrequent event. Predicting any low-frequency event is difficult. The

hidden nature of sexual abuse may contribute to low

reoffense rates because reoffending may tend to go

undetected; however, juveniles who have already

been identified as sex offenders may be followed

more closely and have less opportunity to reoffend.

Too short followup periods also may account for low

predictive accuracy; some offenders may offend

sometime in the future, but after the study period.

Further, as Smith and Monastersky observed, “It

may be that the low rate of sexual reoffending is due

to lasting changes in the offender and/or his family

as a result of being identified, evaluated, treated,

adjudicated, and/or sentenced” (p. 135).

Other problems associated with poor predictive

accuracy include the absence of pertinent information needed for decisionmaking and clinicians’

overreliance on inadequate predictors (MacArthur

Violence Risk Assessment Study, 1996). An additional confounding factor is conservative decisionmaking that occurs to avoid predicting that someone

will not reoffend, when in fact they might (Smith

and Monastersky, 1986). As researchers have noted

(Smith and Monastersky; Webster et al., 1997), to

enhance predictive accuracy, professionals should

balance historical and actuarial information with

clinical and situational information. Assessment of

risk should address a variety of factors that pertain

to the individual juvenile and the juvenile’s environment and situational factors that could increase or

reduce risk.

Ageton and her colleagues (as cited in Prentky et al.,

2000) investigated the predictive utility of several

measures and found that four variables correctly

classified 77 percent of the juveniles who reoffended

sexually: involvement with delinquent peers, history

of crimes against persons, attitudes toward rape and

sexual assault, and family normlessness. Subsequent

analysis revealed that only one variable—involvement

with delinquent peers—was necessary to correctly

classify 76 percent of the cases.

Prentky et al. (2000) have developed and conducted

initial testing of an actuarial risk assessment schedule designed to assess the risk of reoffending among

juvenile sex offenders. The schedule includes four

factors: sexual drive/preoccupation, impulsive/

antisocial, clinical/treatment, and community adjustment. The factors and individual items are based on

literature reviews of studies pertaining to juvenile

sex offenders, adult sex offenders, and juvenile delinquents in general. The risk assessment schedule

was evaluated by following 96 juvenile sex offenders

who had received treatment on an outpatient basis.

The followup period was 12 months. Only 11 percent of the offenders who were studied committed

any type of criminal offense during the followup

period, and only three of these juveniles (4 percent

of the sample) committed another sex offense. In

evaluating the validity of the risk assessment schedule, Prentky et al. reported that, overall, the interrater reliabilities for the items (which indicate

consistency in scoring between individual raters)

were good to excellent and the scale alphas (which

provide a conservative estimate of a measure’s reliability) were quite good. Because of the very low

base rate of sexual recidivism, the researchers were

unable to evaluate predictive validity. Overall, however, the findings were encouraging. Data collection

continues at a number of different sites to gather

sufficient cases to permit a proper look at the usefulness of the schedule for assessing risk and predicting

reoffending.

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 on which to

base such instruments. Sufficient staff training and

supervision also are important to ensure appropriate

and reliable risk assessment.
37

Treatment

The National Task Force on Juvenile Sexual Offending consists of 20 members and 20 advisory

members (NAPN, 1993). The Task Force was

formed in 1986 after National Adolescent Perpetrator Network (NAPN) members (treatment providers and intervention specialists from more than 800

programs) supported the idea of creating a group to

develop standards for the assessment and treatment

of juvenile sex offenders. Recognizing that sufficient

research did not yet exist to warrant a presentation

of intervention standards, the National Task Force

(as cited in NAPN) articulated a set of assumptions

intended to reflect the current thinking relevant to a

comprehensive systems response to juveniles who

have sexually offended. 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. For example, Utah established a

multidisciplinary team of professionals who developed a manual establishing guidelines for treatment

and service delivery (Utah Task Force of the Utah

Network on Juveniles Offending Sexually [Utah

NOJOS], 1996).

Treatment programs for juvenile sex offenders have

proliferated during the past decade. According to

NAPN (1988), there were only 20 such programs in

the United States in 1982. The 1994 Safer Society

Program’s national survey (Freeman-Longo et al.)

identified 684 programs.

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. Such a continuum, as described in the Oregon

Report on Juvenile Sex Offenders (Avalon Associates,

1986), may include:

◆ Short-term, specialized psychoeducational

programs.

◆ Community-based outpatient sex offender treatment programs for juveniles remaining at home or

in foster care.
38

◆ Day treatment programs.

◆ Residential group homes or residential facilities.

◆ Training schools for short-term placements providing assessments and facilitating readiness for

community-based treatment.

◆ Secure units providing comprehensive, intensive

treatment, including daily unit groups; two to

three small daily groups focusing on interpersonal

skills; weekly sessions on a variety of topics, such

as sex offending issues, stress cycles, anger management, and social skills; parent groups; family

therapy; individual treatment; substance abuse

therapy, if needed; and more.

The Oregon Report recommended individualized assessments, although the comprehensiveness of the

assessments might vary depending on individual

needs. Such assessments guide appropriate placement along the continuum of care and also guide

individualized interventions and treatment.

Bengis (1997) also described a comprehensive continuum of care with similar components, such as:

◆ Locked residential treatment facilities.

◆ Unlocked residential treatment units made secure

by staff.

◆ Alternative community-based living environments, such as foster care, group living homes,

mentor programs, or supervised apartments.

◆ Outpatient groups, day programs, and special

education schools.

◆ Diagnostic centers and services specifically

designed to provide assessments tailored to sex

offenders in addition to traditional diagnostic

assessments.

Bengis (1997) pointed out that at different points

during their treatment, juveniles may require different levels of supervision and treatment intensity. He

stressed that to be most effective, the components of

the continuum should have consistent treatment

philosophies and approaches and, whenever possible, should provide stability in treatment providers

as the juvenile moves along the continuum.

The Utah Task Force (Utah NOJOS, 1996) also

recommended a continuum of care. In addition to

the placements described above, the task force included inpatient assessment and stabilization and

psychiatric treatment. It described a continuum for

both adolescents and preadolescent children.

Treatment Approaches

Overview

The NAPN (1993) stressed that the primary objective of interventions with juveniles who have sexually offended is community safety. Cellini (1995)

described the primary goals of treatment interventions with these juveniles as helping them to gain

control over their sexually abusive behaviors and to

increase their prosocial interactions with peers and

adults. Similarly, Becker and Hunter (1997) described the main treatment objectives as preventing

further victimization, halting the development of

additional psychosexual problems, and helping the

juvenile develop age-appropriate relationships with

peers.

To accomplish these goals, highly structured interventions, frequently involving written treatment

contracts, are recommended (Morenz and Becker,

1995). Treatment approaches include individual,

group, and family interventions. Although group

therapies often are described as the treatment of

choice (NAPN, 1993), empirical support for this

claim is lacking (NAPN, 1993; Weinrott, 1996).

Similarly, cotherapy teams, preferably involving a

female therapist and a male therapist, also are recommended (NAPN, 1993), but the necessity of such

teams has not been demonstrated.

As Marshall and Barbaree (1990) noted in their

review of the effectiveness of adult cognitivebehavioral sex offender treatment programs, most

cognitive-behavioral programs combine individual

treatment approaches with group therapy. Individual treatment typically addresses sexual preference interventions and some aspects of social

functioning. Marshall and Barbaree pointed out,

however, that individual therapy is expensive and

often is not cost effective. Group therapy can be a

more efficient means of concurrently presenting the
39

educational components of treatment to a number of

offenders. Furthermore, male-female therapist teams

can model egalitarian relationships between the

sexes for group members, and group members may

be able to draw on their own experiences as offenders to provide valuable insights into other offenders’

difficulties. Marshall and Barbaree also noted that

group processes can facilitate new ways of thinking

and social interaction that are unavailable in “traditional individualized treatment.” On the other hand,

the potential advantages of group therapies must be

weighed against the possible disadvantages related

to negative peer group associations, as have been

identified in the juvenile justice field (e.g., Fagan

and Wexler, as cited in 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). A number of

factors (e.g., legal defense strategies and parental

disbelief), however, can make this a difficult task.

Minimizing and denying abusive behavior are common responses and are typically viewed as problematic (NAPN, 1993). Barbaree and Cortoni (1993)

noted that denial is so often considered such an obstacle to effective treatment that many programs will

not accept individuals who are unremitting in their

denial. Barbaree and Cortoni also observed, however, that once the juvenile sex offender’s denial and

minimization are reduced, the offender can begin to

empathize with the victim. Barbaree and Cortoni

consider the reduction of denial and minimization

and the development of empathy with the victim to

be the necessary “first step” in facilitating the

offender’s motivation for treatment and behavior

change.

Recommended treatment content areas for juveniles

who have sexually offended 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). Other

relevant interventions include training in vocational

and basic living skills, assistance with academics,

resolution of personal victimization experiences,

assistance with coexisting disorders or difficulties,

resolution of family dysfunction and impaired sibling relationships, and development of prosocial

relationships with peers, dating skills, and a positive

sexual identity (Becker and Hunter, 1997; Hunter

and Figueredo, 1999; NAPN, 1993). Research

comparing adolescent sex offenders with a group

of runaways found that the former were especially

deficient in their general knowledge about AIDS

and safe sex practices (Rotheram-Borus, Becker,

Koopman, and Kaplan, as cited in Becker and

Kaplan, 1993). Given this finding, the importance

of focusing treatment on sexually transmitted diseases and safe sex is obvious.

Goocher (1994) noted that leaders in the field of juvenile sex offender treatment, such as Judith Becker

and John Hunter, have argued that programs designed to focus exclusively on sex-offending behaviors are of limited value and have recommended a

more holistic approach. Goocher further pointed out

that, in view of the individual needs and developmental histories of these juveniles, “quasi-corrections

models” of addressing sex offending are not adequate.

Goocher noted that many residential treatment programs for juvenile sex offenders have been based on

quasi-corrections models of treatment adapted from

work with adult sex offenders. Goocher also observed

how, in one program, staff seemed to replicate the

juveniles’ power and control behaviors and secretive

behavior in the staff’s own interactions among themselves and in their interactions with the institution’s

managers, with other units, and with the juveniles.

He recommended that the staff in such programs be

sensitive to their positions as role models and guides

for juveniles who are attempting to move beyond

their life experiences and offense histories and that

staff receive adequate training to enable them to

perform this function.

Miner and Crimmins (1995) identified social isolation from positive interactions with peers and families as a possible factor that may explain why some

seemingly prosocial juveniles engage in sexually

aggressive acts. They suggested that treatment efforts should break the process of social isolation

and noted that most programs do this through group
40

and social-cognitive interventions. They further

recommended family interventions and facilitation

of positive school attachments and positive emotional attachments in general as treatment goals.

Weinrott (1998a) noted that some treatments that

are theoretically sound but have not been empirically related to sexual recidivism may also be appropriate for juvenile sex offenders. For example,

Weinrott, noting that truancy is empirically associated with sexual recidivism, recommended that

treatment actively target improved school performance. In addition, because appropriate and effective dating skills can increase access to appropriate

sexual partners, Weinrott and others (e.g., Bourke

and Donohue, 1996) emphasized development of

dating skills as a treatment component. Weinrott

also encouraged more aggressive interviewing techniques, such as interrogation approaches used by

law enforcement, to get through denial quickly so

that treatment can proceed in a more timely fashion.

Although psychopharmacological interventions,

including sex-drive reducing medications such as

medroxyprogesterone, have been found to be effective in reducing sex offending in adult offenders,

they can have serious side effects. Such medications,

when used with juveniles, can have possible negative

effects on normal development and growth. Consequently, ethical concerns related to the use of these

medications with juveniles are substantial (Hunter

and Lexier, 1998).

Other medications sometimes are used with juveniles as part of a comprehensive treatment approach.

For example, Hunter and Lexier (1998) noted reports from the professional literature that describe

the utility of selective serotonin reuptake inhibitors

(SSRI’s). Lane (as cited in Hunter and Lexier,

1998) reported that SSRI’s often have sexual dysfunction side effects such as suppressed sexual desire and delayed ejaculation. However, as Hunter

and Lexier noted, the role of serotonin in regulating

sexual behavior is not fully understood. Many questions concerning psychopharmacological approaches

remain. These questions include which juveniles are

likely to benefit from such an approach and at what

dosages (Hunter and Lexier, 1998).

Addressing Deviant Arousal

Weinrott (1998a) stressed that juvenile sex offenders with deviant sexual arousal should be provided

with treatment that effectively addresses this problem. 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). Weinrott raised the concern that this technique, as typically used, may not be vivid enough to

be effective for adolescents who might not have the

language abilities to design effective fantasies to

counter deviant thoughts or who may simply find

the task too boring. He also stated that behavioral

conditioning with noxious stimuli, such as ammonia

and, possibly, low-intensity electric shock, may be

effective. The National Task Force on Juvenile

Sexual Offending, however, advised that use of

aversive therapies with juveniles is controversial

(NAPN, 1993). It recommended that, when used,

aversive stimuli should be self-administered by the

juvenile, with appropriate consent from the juvenile,

parent, and referring authority. Although the National Task Force advised against electric shock, it

did not elaborate as to why adequate safeguards

cannot be effectively applied.

Some treatment approaches that have been used

with sex offenders, such as masturbatory satiation,

are designed to render deviant fantasies or thoughts

boring through repetition (Becker and Kaplan,

1993). Masturbatory conditioning, however, has

presented practical as well as ethical concerns, because the approach requires asking the juvenile to

masturbate, and may include masturbating to deviant stimuli with the goal of ultimately reducing such

arousal (Becker and Kaplan, 1993; Bourke and

Donohue, 1996; Morenz and Becker, 1995). Furthermore, as Hunter and Lexier (1998) observed,

empirical findings concerning the effectiveness of

any arousal conditioning approach are confounded

by the inclusion of these approaches as part of a

comprehensive treatment program. Consequently,

Hunter and Lexier concluded that very little is

known about the effectiveness of these approaches

for reducing deviant arousal or about the types of

juveniles for whom they may be most effective.
41

Vicarious sensitization (VS) is a relatively new treatment technique that may avoid some of the ethical

concerns presented by other approaches. VS is a form

of aversive conditioning that pairs deviant arousal

with negative experiences. It involves exposing the

juvenile to audiotaped crime scenarios designed to

stimulate arousal and then, immediately afterwards,

showing an aversive video that presents the negative

social, emotional, physical, and legal consequences of

sexually abusive behavior. Weinrott, Riggan, and

Frothingham (1997) reported a study comparing a

group of juvenile sex offenders who were administered a course of VS with a group who were on a

waiting list but who had not yet received VS. Both

groups received standard cognitive therapy during

the study period. Phallometric assessment and selfreport measures at 3 months revealed significantly

reduced deviant arousal for the juveniles who had

received VS. Furthermore, although the juveniles

on the waiting list did not improve during the study

period, they evidenced improvement after they received VS treatment. Although noting the limitations of a 3-month followup period, Weinrott and

colleagues described VS as a technique that, used

in conjunction with specialized cognitive therapy,

may be an effective approach for reducing deviant

arousal in juveniles who are sexually aroused by

prepubescent children. As in all areas of sex offender treatment, additional research is needed to

assess the effectiveness of this approach, including

its long-term effectiveness.

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 those 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 that parents found the following approaches useful:

(1) written information on relapse prevention,

cognitive distortions, and the consequences of

sexual abuse; (2) educational videotapes of adolescent abusers discussing their relapse process

and the need to be held accountable; (3) literature on the recovery process of sexual abuse

victims; (4) referrals to treatment groups for

adult survivors of sexual abuse; (5) the opportunity to be included periodically in sessions of the

adolescent abuser group; (6) support groups for

parents of abusive adolescents; and (7) attention

to the concerns of the juvenile’s siblings in the

treatment process. (p. 314)

Lee and Olender (1992) described a teaching-family

model of community-based residential treatment

that has been used with juvenile sex offenders and

other children. They noted that this specialized foster care approach can be very restrictive and can

provide intensive treatment in a more homelike atmosphere, depending on the program components

required for a particular child at a particular time.

Through this approach, juveniles receive interventions in a more naturalistic setting, enabling them to

acquire and practice prosocial life skills in situations

similar to everyday life. The approach focuses directly on behaviors and uses a systematic reward

program (a token economy) to enhance positive

motivation. It also uses cognitive-behavioral approaches to facilitate behaviors such as impulse control, effective problem solving, moral and ethical

decisionmaking, and so on. Foster parents trained to

be “teaching parents” use techniques that have been

researched and found useful for managing intense

and emotionally volatile behaviors, and they use a

curriculum to facilitate skills necessary for social

competence and independent living. Foster parents

are provided with support services, and juveniles

participate in group counseling interventions. Lee

and Olender reported that initial implementation

research, conducted as part of the Ohio Youth Services Network’s evaluation of sex offender treatment

programs throughout the State, found that the program provided “high quality, appropriate care of

adolescent offenders and emotionally disturbed

youth” (p. 74). Outcome research is under way.

Using a Relapse Prevention Model

Relapse prevention initially was designed to help

substance abusers prevent reoccurrence of substanceabusing behavior. Then Pithers, Marques, Gibat, and

Marlatt (as cited in Barbaree and Cortoni, 1993)
42

applied relapse prevention to adult sex offenders to

reduce sexual reoffending. Gray and Pithers (1993)

applied relapse prevention to the treatment and supervision of children and adolescents with sexual

behavior problems.

Relapse prevention 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. Gray and Pithers (1993) noted, however:

A high degree of motivation and integrity is

required for a client to continually monitor

signs of his relapse process and to invoke coping strategies, even when it feels like a sacrifice

to do so. Without the dedication derived from

the empathy for sexual abuse victims developed in treatment, RP [relapse prevention]

risks becoming an intellectual exercise that

educates offenders about what they need to do

to avoid reoffending but that finds offenders

lacking the motivation to use this knowledge.

(p. 299)

When relapse prevention is applied to children,

greater emphasis is placed on external supervision

to prevent further victimization (Gray and Pithers,

1993). The relapse prevention approach is theoretically sound; however, as with other components of

treatment for juveniles who have sexually offended,

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 above 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 commit sex offenses, whenever the interventions are indicated. Similarly, as Rasmussen

(1999) stressed, “Treatment programs should be

structured to address the factors that contribute to

and maintain all criminal behavior, not just sexual

offending” (p. 81).

Prentky (1995, 1997) presented potential target

areas of treatment for juvenile and adult sex offenders and corresponding modalities for intervention.

Although most of the modes of treatment presented

by Prentky are discussed in this literature review, a

few have not been mentioned, such as childhood

victim survivors’ group therapy and expressive

therapy.

Table 3 provides a guide to treatment intended

to reduce offending behaviors. It incorporates

Prentky’s (1995, 1997) work, treatment and modalities discussed in this literature review, and the authors’ clinical understanding of these issues. The

table presents clinical interventions but does not

cover other strategies such as supporting appropriate academic placements, school attendance, and

vocational training. As emphasized throughout this

literature review, individualized assessment should

guide the development of an appropriate treatment

plan for each individual; the information presented

in table 3 should not be rigidly applied.

Research on Treatment Efficacy

Specialized Treatment for Juveniles Who

Have Committed Sex Offenses

In spite of the proliferation of programs specifically

designed for juvenile sex offenders, evaluation of

these specialized approaches has been limited. For

example, as Weinrott (1996) observed, most sex

offender treatment programs have learning about

the “sexual assault cycle” at their core. The cycle is

used to help juveniles conceptualize their offending

behaviors, including the associated feelings and distorted thinking that contribute to and follow their

abusive acts. Becker (1998) described the cycle concept that was developed by Ryan, Lane, Davis, and

Isaac (as cited in Becker, 1998). The concept is

based on the premise that offending is preceded by

a negative self-image that contributes to negative

coping strategies when the juvenile anticipates

negative responses from others, perceives such responses, or both. To avoid such negative anticipated
43

Target Areas of Treatment

Consequences

of Personal

Impaired Deviant Problematic Impulsive/ History of

Social Empathy Cognitive Sexual Management Antisocial Child

Modes of Treatment Relationships Deficits Distortions Arousal of Emotions Behaviors Maltreatment

Anger Management X XX

Assertiveness

Training X X

Aversion Therapy X

Childhood Victim

Survivors’ Group X XX X X

Cognitive

Restructuring X XX X X X

Covert Sensitization X

Expressive Therapy X XX

Family Interventions X XX X X X

Group and

Individual Therapy X XXX X X X

Multisystem

Interventions (e.g.,

MST and MTFC) X XX X X X

Pharmacotherapy XX X

Positive Identification

Development XX X

Relapse Prevention

and Offense Cycles XX X X

Self-Control and

Impulse Management XX X

Self-Help Groups X XX

Sex Education and

Dating Skills X

Social Skills Training X

Stress and Anxiety

Management X XX

Substance Abuse

Education and

Treatment X X

Systematic

Desensitization X X

Vicarious Sensitization X

Victim Empathy

Training X XX X

Table 3: Treatment To Reduce Offending Behaviors
44

or perceived reactions, the juvenile withdraws, becomes socially isolated, and fantasizes to compensate

for resulting feelings of powerlessness and a lack of

control. This process culminates in the sex offense,

which results in more negative experiences, more

feelings of rejection, and an increasingly negative

self-image; and the cycle continues.

Weinrott (1996) pointed out that in spite of the fact

that the sexual assault cycle has been used in sex offender treatment for nearly 20 years, this model has

not been empirically validated. Furthermore, as

Weinrott noted, although the cycle may fit many juveniles who have committed sex offenses, it does not

explain the abusive behavior of all such offenders,

including those described as “naive experimenters,”

those who desist from their abusive behavior, those

who perpetrate sex offenses as part of a group, and

those whose sexual behavior may be a result of significant psychopathology or deviant sexual arousal.

In their editorial, “Don’t Shoot, We’re Your Children: Have We Gone Too Far in Our Response to

Adolescent Sexual Abusers and Children With

Sexual Behavior Problems?” Chaffin and Bonner

(1998) cautioned against the “conviction” that those

working in the field have found the right approach.

They wrote that such “dogma” might include the

following beliefs:

That sex offender-specific treatment is the only

acceptable and effective approach and that all

teens and children who have performed inappropriate sexual behaviors must receive it; that

a history of personal victimization is usually

present, is a direct cause of abusive sexual

behaviors, and must be a focus of treatment;

that denial must be broken; that hard, inyour-face confrontation is synonymous with

good therapy; that treatment must be long

term and involve highly restrictive conditions;

that deviant arousal, deviant fantasies, grooming [of victims] and deceit are intrinsic features; that parents and families of offenders

are generally dysfunctional; that long-term

residential placement is commonly required;

that behaviors always involve an offense cycle

or pattern that must be identified; that these

teenagers and their parents must face the fact

that they have a compulsive, incurable, life-long

disorder; and that these youngsters are such

dangerous predatory criminals that neighborhoods must be notified of their presence. Despite their wide acceptance, it is our opinion

that clear, empirical scientific support for each

and every one of these conventional wisdoms is

either minimal or nonexistent. (p. 314)

Chaffin and Bonner (1998) reported that they

knew juveniles who felt required to “confess” to sex

offenses they did not commit and to deviant fantasies they did not have, because they thought they

would be discharged from the treatment program if

they did not comply. The authors also expressed

concern that “overly broad applications” of fantasy

journals, addiction/compulsion programs, shaming

approaches, and programs that aggressively encourage empathy with victims could negatively affect

these juveniles. Chaffin and Bonner further pointed

out that although rates of detected sexual reoffenses

appear relatively low (around 5 to 15 percent), the

lack of untreated comparison groups prevents us

from knowing whether treatment has been effective.

In fact, they stressed, “Empirically, we cannot say

whether treatment helps, hurts, or makes no difference” (p. 316). Chaffin and Bonner’s views are consistent with Weinrott’s (1996), who stated:

The prevailing view is that early clinical intervention is needed to break the cycle of sexual

deviance, and that intervention should take the

form of lengthy, offense-specific, peer-group

therapy. There is not a shred of scientific evidence to support this stance. (p. 85)

Chaffin and Bonner (1998) and Weinrott (1996)

have observed that at this point, it is not possible

to say whether one type of treatment is better than

another, with the possible exception of delinquencyfocused multisystemic treatment, which appears to

be more effective than individual counseling with

juveniles who have committed sex offenses. Furthermore, as Weinrott noted, there also is no evidence

to support a “heavy handed” correctional or justice

response.

A study that appears to raise questions about the

efficacy of specialized treatment for juveniles who

have committed sex offenses was conducted by Lab,

Shields, and Schondel (1993). The researchers
45

compared the recidivism rates for juveniles treated

in a specialized sex offender treatment program with

rates for juveniles referred to community-based

treatment programs generally lacking specialized

programs for sex offenders. The study found that

recidivism rates for both groups were low and that

the outcome for juveniles treated in the sex-offensespecific program was no better than that for those

treated in non-offense-specific programs. Like

Chaffin and Bonner (1998), Lab, Shields, and

Schondel concluded, “These results suggest that the

growth of interventions has proceeded without adequate knowledge of how to identify at-risk youth,

the causes of the behavior, and the most appropriate

treatment for juvenile sex offending” (p. 543). Methodological problems, however, may have compromised the utility of this study (Weinrott, 1996).

In contrast to the Lab, Shields, and Schondel (1993)

findings are results from a study by Kimball and

Guarino-Ghezzi (1996), who compared 75 juvenile

sex offenders treated in sex-offense-specific programs with sex offenders treated in non-offensespecific programs. Although placement in treatment

programs was not randomized, juveniles did not

vary significantly on their prior record, previous

sexual deviance, or exposure to sexual, physical, and

substance abuse. Findings revealed that juveniles

placed in sex offender treatment demonstrated more

positive attitudes and greater skill acquisition than

those in nonspecific treatment. They were more

likely to accept full responsibility for their offenses,

to express remorse related to victim impact, and to

articulate practical relapse prevention concepts and

strategies. They also were significantly more successful in completing their first aftercare placements

(70.6 percent, versus 41.2 percent for nonspecific

treatment placements). At the time of this report,

followup results were limited to 6 months. Findings

suggested that participation in sex offender treatment contributed to lower rates of reoffending.

Although the Kimball and Guarino-Ghezzi (1996)

treatment outcome results appear encouraging, these

findings are tempered by other findings indicating

that participants in the sex offender programs received more treatment than those in nonspecific

programs. Those placed in sex-offense-specific treatment programs received significantly more therapy

sessions, including group sessions that focused

specifically on offending behavior. They also received significantly more family therapy (51.8 percent, versus 30.8 percent for those in nonspecific

treatment). In addition, they received more treatment for nonsexual factors contributing to their sex

offending; such treatment included family therapy,

interpersonal skills training, stress and anxiety management, and relapse prevention. They also remained in treatment for significantly longer periods

than those who received nonspecific programming

(an average of 15.7 months, versus 7.1 months in

nonspecific treatment). Thus, it is unclear whether a

non-offense-specific treatment program comparable

to a sex offender treatment program in terms of intensity and breadth of services would yield outcome

results comparable to those of the Kimball and

Guarino-Ghezzi study, especially for offenders who

do not evidence patterns of deviant arousal.

In another study, Becker (as cited in Weinrott, 1996)

described the effectiveness of cognitive-behavioral

treatment used with a sample of juveniles who abused

children younger than themselves. In addition to

psychoeducational and cognitive approaches, this

treatment used interpersonal skills training and behavioral interventions to reduce deviant arousal. Results indicated a 10-percent recidivism rate for sex

offending. This finding, however, was based only on

juveniles who completed the program. Furthermore,

the followup period was relatively short (1 year), and

no control group was used.

Weinrott (1998a) noted that in spite of the limited

treatment research, empirically based approaches

should be emphasized in the treatment of juvenile

sex offenders. For example, he encouraged practitioners to provide juvenile sex offenders who engage

in various types of delinquent behaviors with empirically based treatment approaches that have been

designed specifically for delinquent populations.

Treatment for Juveniles Who Are

Delinquent

The following studies describe research that has

assessed the effectiveness of interventions with

juveniles who commit various types of offenses, not

just sex offenses. As previously noted, because general delinquency and antisocial attitudes and behavior are frequently found in juveniles who have
46

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 suggested that programs

based on cognitive therapy were twice as effective as

those using other approaches. They defined cognitive therapy as approaches that employed one or

more of six intervention modalities: problem solving,

negotiation skills training, interpersonal skills training, rational-emotive therapy, role playing and modeling, and cognitive behavior modification.

More recently, Lipsey and Wilson (1998) conducted

a meta-analysis of 200 experimental or quasiexperimental studies to assess the effectiveness of

treatment interventions used with juvenile offenders.

Because of variability between treatment approaches

and sample characteristics, the findings from this

meta-analysis require further study and should in the

meantime be considered to be suggestive only. The

findings are, however, consistent with reviews of the

literature (Tolan and Guerra, 1994) and previous

meta-analytic results (Lipsey, as cited in Lipsey and

Wilson, 1998).

In sum, Lipsey and Wilson (1998) found that among

noninstitutionalized juveniles, treatments that focused

on interpersonal skills (e.g., social skills training, anger management, and moral education) and used

behavioral programs consistently yielded positive

effects. Contrary to findings from previous studies

(Lipsey, as cited in Lipsey and Wilson, 1998; Tolan

and Guerra, 1994), individual counseling also showed

consistent positive effects. This surprising finding

may be a result of the types of interventions that this

study considered as “individual counseling.” One

approach involved a 12-week reality therapy program

that emphasized client accountability and responsibility, behavior assessments, and action plans.

The other treatment that was included in the “individual counseling” category was multisystemic

therapy (MST) (Lipsey and Wilson, 1998). MST

is an empirically based intervention that has been

validated with chronic juvenile delinquents and

substance-abusing juveniles (Henggeler et al.,

1998). It is also the only approach that has been

empirically validated as effective with juvenile sex

offenders (Borduin et al., 1990), although the

sample size in the validation study was small and

the comparison treatment did not involve current

treatment approaches. MST confronts antisocial

behavior in juveniles by targeting their “socialecological context” (i.e., their family, neighborhood, school, and community) (Henggeler et al.,

1998). Thus, although interventions may (or may

not) involve individual interventions with the juveniles, this approach certainly cannot be considered

individual counseling in the usual sense. MST individual interventions, for example, may involve parent figures, with or without the juvenile present.

The importance of MST for juvenile sex offenders

has increasingly been noted (Bourke and Donohue,

1996; Cellini, 1995; Swenson et al., 1998).

Results of the meta-analysis (Lipsey and Wilson,

1998) further indicated that other interventions with

noninstitutionalized juvenile offenders have shown

positive but less consistent evidence of effectiveness.

These interventions include programs that provide

multiple services (e.g., vocational training, skillsoriented education, job placement, community supervision) and those that require restitution or

supervision through probation and parole. Mixed

but generally positive effects were found in some

studies for the following interventions: employmentrelated services, academic programming, advocacy

and casework approaches, and family and group

counseling. In contrast, weak or no effects were

consistently found for early release, deterrence,

vocational, and wilderness/challenge programs.

Findings regarding institutionalized juvenile offenders indicated consistent, positive effects for programs that focused on interpersonal skills (Lipsey

and Wilson, 1998). One treatment approach, the

teaching-family home model mentioned previously

(Lee and Olender, 1992; Lipsey and Wilson, 1998),

involves juveniles who frequently are referred from

detention facilities or placements more restrictive

than foster care. The teaching-family home model

uses “teaching parents” to help juveniles develop

necessary life skills and enhance social competence.

Positive but less consistent results were found for

behavioral programs, community residential

approaches, and programs that provided multiple
47

services. Inconsistent evidence of mixed but generally positive effects was found for individual counseling, guided group interventions, and group

counseling. In contrast, weak or no effects were

consistently found for milieu therapy approaches.

Lipsey and Wilson (1998) noted that the impact

of the most effective treatments on recidivism was

substantial:

The most effective treatment types had an impact on recidivism that was equivalent to reducing a .50 control group baseline to around

.30. In other words, we estimated that without

treatment the recidivism would have been 50%.

If they received the most effective of the treatments reviewed in this meta-analysis, their

recidivism would have dropped to about 30%.

(p. 333)

Chamberlain and Reid (1998) contrasted traditional

community group placements with multidimensional

treatment foster care (MTFC) to investigate an alternative to MST for juveniles whose parents were

unable, for various reasons, to provide the “corrective or therapeutic parenting” the juveniles needed.

Like MST, MTFC involves multiple treatment

modes and targets, including individual therapy,

family therapy, and interventions at home, at school,

and among peer groups. In the Chamberlain and

Reid study, chronic juvenile delinquents, including

some juvenile sex offenders, were randomly assigned

to either MTFC or traditional community-based

group care settings. Results indicated that juveniles

in MTFC had significantly fewer justice system referrals and returned home to relatives more often

than those in community-based group care settings.

Multiple regression analysis showed that assignment

to the MTFC treatment condition was a better predictor of reduced offense rates (official and selfreported) than other well-known predictors.

Attrition From Sex-Offense-Specific

Treatment

Studies of treatment programs for juveniles who

have sexually offended have demonstrated high

rates of treatment dropouts. For example, Becker

(1990) found that only 27.3 percent of her sample

attended 70 to 100 percent of scheduled therapy

sessions and only 45.4 percent completed at least

half of the sessions. Kraemer, Salisbury, and

Spielman (1998) reported that completion rates for

residential juvenile sex offender programs in Minnesota appeared to range from 30 to 50 percent. Their

study suggested that older age and impulsivity were

associated with treatment dropout. Rasmussen

(1999) found that only half of the subjects in her

sample completed the initial stage of their treatment

and one-third failed to complete the full course of

treatment once they began. (The remaining subjects

either were not referred for treatment or did not

follow through on the referral.) Schram, Milloy, and

Rowe (1991) found that most offenders terminated

treatment as soon as their sentence or court order

ended. Only 39 percent of their sample completed

treatment.

Similarly, Hunter and Figueredo (1999) reported

that more than 50 percent of the subjects in their

sample terminated or were terminated from treatment during the first year. Although 20 percent of

these juveniles ended treatment for reasons unrelated to their behavior or attitudes (e.g., family relocation), 33 percent were expelled from the program

as treatment failures. Of the “treatment failures,”

more than 75 percent were terminated because they

were noncompliant with attendance and therapeutic

directives. Only 11.4 percent of the “treatment failures” were terminated because of recidivism (4.9

percent for sex offenses, 6.6 percent for other types

of offenses).

In another study, O’Brien (as cited in Weinrott,

1996) found that only 6 percent of 200 juvenile sex

offenders who completed a treatment program committed another sex offense after being referred to the

program. Although the study did not provide information about the number of juveniles who dropped

out of treatment prematurely, the researchers did

note that half of the juveniles who reoffended did so

before they completed the treatment program.

High rates of treatment attrition are extremely important. Studies with juvenile sex offenders (Hunter

and Figueredo, 1999) and adult sex offenders (Becker

and Hunter, as cited in Rasmussen, 1999; Hanson

and Buissière, 1998; Marques, Day, Nelson, and
48

West, as cited in Hunter and Figueredo, 1999;

Marshall et al., as cited in Rasmussen, 1999) 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, as some of the studies reviewed

above suggest, other approaches (e.g., MST and

MTFC) may be more beneficial. Noting the absence

of significant differences between groups of juvenile

sex offenders and other juvenile offenders in the

research that they and others have conducted,

Jacobs, Kennedy, and Meyer (1997) concluded,

“The similarities are indicative of commensurate

therapeutic needs for both types of offenders”

(p. 201).

Milloy (1994) asked the question, “But what is specialized sex offender treatment?” She pointed out

that “specialized” treatment for sex offenders typically includes components such as sex education,

social skills, anger management, acceptance of responsibility for one’s offenses, and empathy for victims. Yet these components may be appropriate for

juvenile offenders in general.

As Milloy (1994) pointed out, one of the arguments

in favor of specialized and segregated sex offender

treatment programs is that these offenders frequently intimidate staff and other residents through

their manipulative or aggressive behaviors. The results of Milloy’s study, however, suggested that juveniles who committed sex offenses were not more

likely to be exploitative, manipulative, or aggressive

than juveniles who committed other types of offenses. The frequency of verbal and physical threats

did not differ between the groups, and the sex offenders did not present increased management risks

or security risks within the institution.

In conclusion, Milloy (1994) indicated that no controlled studies have been published investigating the

effect of segregating juvenile sex offenders from the

general delinquent population. She stated, “This

fact, coupled with the findings from this study, suggest that the segregation of juvenile sex offenders is

a costly approach whose worth is unproven” (p. 10).

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. Clearly, other

factors must be considered when designing appropriate treatments and treatment settings. Among these

factors is the safety of all juveniles involved, since the

juveniles who have committed sex offenses might become targets themselves or might target others.

Another factor cited as supportive of segregated treatment units is the reduction of staff training needs that

results when intensive training in sex-offending issues

is provided only to those whose jobs involve this specialized treatment (Bengis, 1997). Other arguments

in favor of segregated units include the possibility

that such units may form stronger and more effective

treatment cultures (Bengis). On the other hand, research has suggested that delinquent peer group association may increase risk (Ageton, as cited in Prentky

et al., 2000). Controlled studies using random assignment to comparison groups are necessary to help

resolve the issue of whether juveniles who have committed sex offenses should be segregated from other

juveniles in residential care.

In the meantime, the importance of individualized

assessment and treatment planning cannot be overemphasized. As Kavoussi, Kaplan, and Becker

(1988) point out, the heterogeneity of juvenile sex

offenders “suggests that no single treatment regime

will be effective in all cases” (p. 243). Furthermore,

a one-size-fits-all approach can be costly and may be

harmful to the juveniles and their families (Becker,

1998). As Chaffin and Bonner (1998) point out,

[P]erhaps it is time to emphasize some

flexibility and compassion in which treatments

we choose and to which individual youngsters

we apply them and to realize that individual

need, not dogma, should dictate what must be

accomplished (p. 316).
49

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. These recommendations suggest

that such programs should ensure the following:

1. A systems based program design for sexual

abuse prevention in the institutional setting,

which includes (a) policies and procedures

reflecting an open and safe system that addresses safety, children’s rights, and familial

rights; (b) procedures for selecting, screening,

training, and supervising staff to decrease the

risk of sexually abusive behavior; (c) staff

guidelines for interventions with residents;

(d) safety education for residents; (e) protocols

ensuring environmental safety; (f) procedures

addressing allegations or disclosures of sexual

abuse; and (g) internal evaluations and external reviews.

2. A strong, structured behavior management

program where management and control of

behavior is maintained through program structure and staff/patient interactions.

3. A safe therapeutic environment and an effective therapeutic milieu.

4. Close staff supervision based on a high staffpatient ratio and continuous monitoring by

staff of all interactions. Video and audio monitors and sensors may also be in use in common

areas but do not replace staff presence.

5. A therapeutic milieu which includes a facility

safe environment, secure space, a strong peer

culture, and a program philosophy which is

consistent throughout.

6. A structured, well-balanced program which

provides modalities developed to impact on

adolescent problems and which allows very

little unstructured time.

7. Highly trained staff who have received specialized training in child sexual abuse issues,

with emphasis on treatment of youthful victims

and sexually abusive youth.

8. A multidisciplinary, multimodal design to

impact on the treatment issues of both victims

and sexually abusive youth.

9. A positive human sexuality program that

emphasizes the development of positive attitudes about sexuality, healthy relationships,

and safe sexual practices.

10. Ongoing, planned program evaluations.

(pp. 75–76)

Other recommendations from the National Task

Force on Juvenile Sexual Offending (as cited in

NAPN, 1993) include having clear rules about personal space boundaries and touching. Recommendations also include having night staff who remain

awake and monitor residents both randomly and at

frequent, planned intervals throughout the night.

Ross and Villier (1993) provided more detailed recommendations related to screening program applicants, selecting staff, and designing and supervising

living units in a way that maximizes the safety of

residents and staff.

Special Populations

Treatment of Young and Preadolescent

Children With Sexual Behavior Problems

Gray (as cited in Araji, 1997) proposed that treatment

goals that balance community safety and the promotion of developmentally appropriate competencies are

most effective in treating children with sexual behavior problems. More specifically, Gray and Pithers

(1993) suggested that abusive behaviors might be

most effectively addressed by targeting risk factors

that predispose a child to sexual behavior problems or

that precipitate or perpetuate the problems. Gray and

Pithers proposed the following approaches:

1. Enhancing self-management skills of sexually

aggressive children.

2. Resolving trauma resulting from the child’s

own victimization.
50

3. Addressing compensatory reactions often associated with externalization of difficult emotions

through problematic behaviors.

4. Increasing the extent to which prevention team

members model abuse-preventive beliefs and

intervene when abuse-related behaviors are

observed. (p. 308)

Another component of treatment for children with

sexual behavior problems is the “prevention team”

(e.g., selected family members, care providers, and

community advocates) (Gray and Pithers, 1993).

The prevention team is of primary importance when

intervening with young children who do not have

the developmental capacity for self-monitoring.

According to Johnson (1991), interventions with

children who are sexually abusive and aggressive

should involve reporting the sexual behaviors to

appropriate agencies, such as protective services and

the police; working with appropriate agencies to

ensure the safety of the victim, potential victims, and

the abusing child; and working with the courts responsible for juveniles. Johnson observed that interventions should begin with an assessment of the

child’s treatment needs, to facilitate appropriate

placement and treatment.

In her book, Araji (1997) described 10 treatment

programs and practices for children with sexual

behavior problems, including Johnson’s (as cited in

Araji). Araji identified these programs by reviewing

the professional literature and attending workshops

and through personal correspondence. She stated

that the programs described simply represent current treatment efforts and trends, noting that the

effectiveness of most of the programs has not been

demonstrated. The federally funded work of Pithers

et al. (1998a, 1998b), as described below, and the

ongoing work of Bonner, Walker, and Berliner (as

described in Araji, 1997) are important exceptions.

Most of the programs reviewed by Araji use theories

from the sex abuse literature. Some appear to emphasize personal histories of sexual abuse as a factor contributing to sexual behavior problems in children,

although the literature suggests that this issue may

be overemphasized in the context of multiple risk

factors.

The programs reviewed by Araji also used child

development literature and designed interventions

that were appropriate to different ages and cognitive

and developmental levels. Programs typically targeted prevention of perpetration. Techniques frequently involved modifications of approaches used

with adults or adolescents who commit sex offenses,

such as the relapse prevention and assault cycle approaches discussed previously.

All of the programs reviewed used a cognitivebehavioral approach, although some also used

other orientations, such as those based on psychodynamic and attachment theories. Cognitivebehavioral interventions included skill development

to promote prosocial coping and problem solving,

age-appropriate interpersonal relationships and

sexual behaviors, and abuse prevention strategies.

In her review, Araji noted that because no treatment approach has been demonstrated to be superior to others, treatment that combines theories

and methods might better meet the needs of these

children and their families.

Treatment modalities in the programs reviewed by

Araji include individual, group, pair, and family

therapy. Most providers appeared to prefer group

therapies. Araji’s views appear consistent with those

of Johnson (1991), who stated: “The group format

allows the therapists to use the group members

to help each other understand and work on the

‘touching’ problems. The aim is to help the children

interact without being sexually or behaviorally inappropriate” (p. 11). Araji also noted that groups can

help reduce children’s social isolation and are efficient

in terms of cost and time. Others (Friedrich and Gil,

as cited in Araji, 1997) consider pair therapy (two

children treated together) more beneficial. Advocates

of the pair therapy approach believe that it may

minimize anxieties, avoid rejections, and enhance

controlled peer interactions.

Developmental issues. Other factors considered of

great importance when intervening with children

who have been sexually abusive are developmental

issues. As Friedrich (as cited in Araji, 1997) noted,

substantial differences may exist between a 6-yearold child who has been sexually aggressive and a

10-year-old child who has been sexually aggressive.

Even if the acts appear similar, differences may
51

include the meaning the child attributes to the act,

differences in peer relationships, and other factors

(including, for a child who has been the victim of

sexual abuse, the length of time between the victimization and the child’s abusive behavior).

Friedrich (as cited in Araji, 1997) also argued that

sexual aggression in children reflects difficulties

with a child’s ability to modulate emotions and behavior. Sexual aggression is considered to be similar

to other behavioral and psychological problems or

disorders, such as fire setting, stealing, and posttraumatic stress disorders. Interventions found effective

with these other forms of behavioral and emotional

dysregulation—such as increasing parental supervision and positive interactions with parents—can be

valuable for children who have been sexually abusive and may be sufficient for eliminating such behaviors in some children. Friedrich also argued that

when children have suffered traumas, the underlying issues that may have resulted require intervention if positive, lasting changes are to be achieved.

Family involvement. Although the programs reviewed by Araji (1997) varied in terms of the range

of interventions they provided to parents or other

caregivers, all of them involved parents or other

caregivers, either in group interventions or through

other approaches. Treatment goals with caregivers

typically included improving parental supervision

and parenting skills and increasing parental knowledge about sex abuse; in some programs, treatment

goals also included providing specific training to

help parents help their children succeed at relapse

prevention. In view of the high levels of stress, personal and interpersonal difficulties, and impaired

parent-child attachments found in their study (as

described previously, in the section on “Young Children Who Have Committed Sex Offenses: Family

Characteristics”), Pithers et al. (1998a) noted the

need for group treatment for parents of children

with sexual behavior problems. Pithers et al. suggested that such groups address issues of parental

attachment, parental training, social-relational skills,

trauma resolution, and, when indicated, the opportunity to grieve the loss of an idealized child and

family.

Specialized therapeutic foster homes have been developed in some areas to provide interventions for

children who are sexually abusive and require outof-home placement but not residential care. One

small study (Ray et al., 1995) involved 15 children

who came from chaotic, violent, and abusive homes

and were placed in therapeutic foster homes. These

youngsters typically were under 13 years old, but

occasionally older children with cognitive difficulties

were accepted into the program. Researchers found

that the children evidenced improvements in behavior, emotional adjustment, social functioning, family

relationships, and overall adjustment. Improvements

in life skills were not statistically significant but appeared to be moving in the expected direction. Although four of the children displayed inappropriate

sexual behavior early in treatment, none of the children continued to do so at the completion of treatment. Followup interviews indicated that the

children continued to have serious emotional and

behavioral problems, but with the exception of two

of the children, their sexually abusive behavior appeared to have subsided. This study is limited by its

small sample size, lack of a comparison group, and

other problems. In spite of these limitations, however,

the advantages of foster care approaches in helping

to stabilize a child and provide appropriate interventions warrant further study.

As Araji (1997) noted in her book, “Sexually abusing behavior by children is a complex phenomenon

presented by multiproblem youth and, frequently,

multiproblem families. . . . The programs, agencies,

and practices reviewed all recognize the importance

of developing individualized treatment plans” (p. 184).

In addition, Araji noted that although a variety of

interventions may be required, ranging from community-based approaches to residential care, “helping families to create safe, predictable, and growth

promoting relationships among family members is

key to helping the sexually reactive and sexually

aggressive child” (p. 187).

A comparative study. As noted previously (in the

section on “Young Children Who Have Committed

Sex Offenses: Types and Classifications”), Pithers et

al. (1998b) identified five subtypes of children with

sexual behavior problems: sexually aggressive, nonsymptomatic, highly traumatized, abusive reactive, and

rule breaker. Their investigations also revealed some

differences in how children in various subtype classifications responded to different types of treatment.
52

At intake, the children and their families were randomly assigned to one of two 32-week treatment conditions. One treatment involved expressive therapy,

reportedly recommended by some national experts as

the treatment of choice for children with behavioral

problems. The other treatment was a substantially

modified form of relapse prevention. Both approaches

involved parents in parallel group interventions. The

Child Sexual Behavior Inventory-3 (CSBI–3) was

used to measure progress.

Results indicated that children in most of the subtypes evidenced similar degrees of change regardless

of treatment modality. The highly traumatized children, however, benefited significantly more from

modified relapse prevention than from expressive

therapy. In fact, highly traumatized children who

were in expressive therapy actually evidenced a

slight increase in sexualized behavior. The number

of children classified as sexually aggressive evidencing a reduction in sexual behavior problems was

slightly larger in expressive therapy than in modified

relapse prevention therapy, but this finding was

tempered by the fact that a similar number of children in expressive therapy who were classified as

sexually aggressive had an increase in sexual behavior problems.

Results further indicated that children in some subtypes responded well to treatment, whereas those in

other subtypes did not. For example, more than half

of the highly traumatized children evidenced significant reductions in problematic sexual behavior after

the first 16 weeks of treatment. In contrast, only 7

percent of the sexually aggressive children demonstrated significant decreases in their sexual behavior

problems.

Treatment of Juveniles With Cognitive or

Developmental Disabilities

Special interventions may be necessary for juveniles with intellectual and cognitive impairments.

Furthermore, these juveniles may be difficult to engage in standard treatment approaches. Langevin,

Marentette, and Rosati (1996) proposed that learning

difficulties may affect therapy in at least two ways.

First, during therapy sessions, a person with learning difficulties may not be able to process the same

information that a person of average intellectual abilities could. Second, individuals with learning difficulties may have developed negative attitudes toward

learning situations and, “in particular, avoid classroom type experiences where they may have met

failure and derision from other students” (p. 145). As

a result, these individuals may prefer to avoid therapeutic situations that resemble their negative experiences, such as psychoeducational programs and other

cognitive-behavioral approaches.

Langevin, Marentette, and Rosati (1996) found

some support for these theories in their study of

adult sex offenders. Although they did not find that

the subjects’ attitudes toward therapy were significantly related to education or level of intelligence,

they did find a negative correlation between attitude

and Halstead Reitan Impairment Index scores. In

other words, individuals who evidenced significant

neuropsychological impairment on the Halstead

Reitan Index evidenced more negative attitudes

toward therapy.

A review of the literature (Stermac and Sheridan,

1993) regarding treatment of “developmentally disabled” adults and adolescents revealed a “dearth of

work in this area” (p. 237). Most studies have focused

on adult offenders and have stressed behaviorally

oriented interventions. Pharmacological approaches

also have been used with developmentally disabled

sex offenders. As noted previously (in the section on

“Treatment Approaches: Overview”), sex-drive reducing medications such as medroxyprogesterone can

be effective in reducing sex offending, but because of

potentially serious side effects and ethical concerns,

the use of these medications for juveniles requires

appropriate informed consent from guardians; additionally, the appropriateness of these medications for

juveniles who have committed sex offenses has been

questioned (Hunter and Lexier, 1998).

Most interventions involving adolescents with

developmental disabilities who have committed

sex offenses have used approaches modified from

adult sex offender treatment programs (Stermac and

Sheridan, 1993). Strategies to enhance learning and

generalizing skills and coping strategies are recommended. Modified relapse prevention strategies have

been found to be effective with some cognitively impaired sex offenders. Yet, as Stermac and Sheridan
53

(1993) pointed out, relapse prevention emphasizes

self-management and therefore may not be appropriate for all intellectually or cognitively impaired sex

offenders.

Langevin, Marentette, and Rosati (1996) urged

treatment professionals to reach out to these juveniles. They suggested the following steps:

◆ Address the juvenile’s learning difficulties and

attitudes at the outset.

◆ Use an individualized treatment and problemsolving approach that helps the juvenile resolve

practical problems first before focusing on sexoffending issues.

◆ Reward strengths rather than focusing on

weaknesses.

Research concerning intellectual, cognitive, and

neurological impairments in juvenile sex offenders

(previously discussed in the section on “Characteristics: Academic and Cognitive Functioning”) also

points to the necessity of developing individualized

interventions that are tailored to the special needs

of these juveniles. Although a more indepth discussion of specialized interventions with juveniles who

have intellectual, cognitive, and neurological problems is beyond the scope of this Report, Ferrara and

McDonald (1996) provide a detailed discussion of

treatment strategies and techniques that may be

useful. These authors draw on work from other related fields, such as the treatment of persons with

brain injuries, and apply this knowledge to interventions designed for juveniles who are sexually aggressive. For example, Ferrara and McDonald describe

techniques designed specifically to facilitate learning, promote attention and concentration, and improve recall. Treatment approaches described are

multimodal, applied in multiple settings, and tailored

to the juvenile’s individual needs.

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 training before they begin

their interventions. Training should then take place

on a continuing basis, so providers can stay current

with this evolving field.

More specifically, Goocher (1994) stressed the importance of “adequate training in normal adolescent

development, the etiology and behavior manifestations of psychiatric disorders, and how to reinforce

initial efforts of young people to learn new patterns

of behavior and to come to terms with their own

personal histories” (p. 249). Goocher also recommended additional training in how to help juveniles

develop adequate verbal and personal skills and

problem-solving abilities.

To be effective, Friedrich (as cited in Araji, 1997)

suggested that therapists who work with sexually

aggressive children should receive good training in

issues pertaining to victimization and the development of violence and aggression. Araji (1997) noted

that therapists also must be well aware of normative

childhood sexual behaviors. Furthermore, the importance of developmental issues regarding attachment and the capacity for moral reasoning, empathy,

and autonomy cannot be ignored (Pithers, Kashima,

Cummings, Beal, and Buell, as cited in Araji, 1997).

These suggestions clearly are important for those

who treat adolescents and those who treat younger

children.

Working with juveniles who have sexual behavior

problems is a challenging job. In addition to concerns about protecting community safety, providing

sound treatment, and dealing with significant human

suffering, individuals who work with these juveniles

are exposed to a great deal of distorted thinking and

deviant sexual behavior. 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).
55

Program Evaluation

Adequate program evaluation involves at least two

primary approaches. First, implementation research

is conducted to ensure that the components necessary for effective treatment exist and are implemented. Second, outcome research is necessary to

determine whether the interventions have been effective. In spite of the important functions that program evaluation serves, evaluations of sex offender

treatment programs have been few, and those that

have been conducted often have had inadequate

designs (Camp and Thyer, 1993). The literature

provides some examples and ideas for future

endeavors.

Most outcome studies have used recidivism rates to

assess treatment effectiveness. Yet generally low

rates of recidivism, short followup periods, variability in outcome measures (e.g., arrest or adjudication), 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 the effectiveness of treatment programs. Hains,

Herman, Baker, and Graber (as cited in Camp and

Thyer, 1993) conducted pretreatment and posttreatment tests with adolescents in a residential sex offender program and with those on a waiting list. The

researchers found significant improvements in social

competency following treatment. In addition to examining recidivism data and parole violations, Miner,

Siekert, and Ackland (1997) conducted pretreatment

and posttreatment assessments with psychological

measures such as the Jesness Behavioral Checklist

and the Multiphasic Sex Inventory-Juvenile Revised

(MSI–JR). As Kraemer, Spielman, and Salisbury

(1995) noted, such self-report and objective measures

provide a norm-based reference group that can be

useful in assessing treatment progress.

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. Because initial

group assessment indicated that treatment group

members were very concrete in their thinking and

had significant difficulties with verbal reasoning,

researchers used visual aids to facilitate the goal

attainment and treatment process. When a juvenile

successfully completed each identified goal, a staff

member would check it off on a written list. When

all the goals were met, the juvenile’s inpatient treatment was completed.

Goal attainment scaling (GAS) also was used in a

study of hospitalized adult sex offenders (Lang, Lloyd,

and Fiqia, 1985). In this study, patients and therapists

developed individualized scaled descriptions of goals,

which were measured to assess treatment outcome.

Goals and treatment outcomes were measured on a

scale ranging from –2 (least favorable outcome) to

+2 (most favorable outcome), with 0 representing the

expected treatment outcome. At followup, 38 patients

had exceeded the “expected” success level, whereas

8 patients were found to have made minimal progress.

The authors collapsed 176 of the 180 treatment goals

into 4 primary content areas: sexual deviation (30

goals), anger and emotional expression (64 goals), selfconcept (31 goals), and poor interpersonal relations

(51 goals). The authors concluded: “As an adjunct to

therapy, GAS can provide data on desired change over

time on each patient’s interpersonal, social, and psychosexual adjustment” (p. 536). They also noted that

program quality assurance may be enhanced through

retrospective reviews of goal attainment profiles and

program improvements that result from the reviews.
56

The importance of program evaluation cannot be

overemphasized. Also, as this literature review suggests, effective and humane interventions for juveniles with sexual behavior problems should be

individualized, be empirically based whenever possible, facilitate family involvement, and, when program participation is indicated, promote program

completion. As Rasmussen (1999) suggested, “Administrators in the juvenile justice system would do

well to provide support for those treatment programs that involve families, have specific goals and

objectives, and carefully monitor successful completion of treatment” (p. 82).
57

Conclusions

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. There currently are no empirically

validated and accepted classification schemes for

differentiating types of juveniles who have sexually

offended. However, the relatively low known rates

of recidivism and existing studies suggesting that a

substantial proportion of these juveniles desist from

committing sex offenses following the initial disclosed offense and intervention appear to support

theoretical classifications. It may be that relatively

smaller groups commit additional offenses, including

sex offenses, other offenses, or both.

The literature on assessment and treatment 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. Treatment effectiveness is

likely to be enhanced by interventions that motivate

the juvenile to make positive changes and that facilitate efforts to do so by being responsive to learning or

personality styles or other individual characteristics.

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). In addition, appropriate targets of

intervention include those that appear theoretically

relevant but that either have not yet been studied or

have not been demonstrated to be consistently related to risk (e.g., inadequate dating skills).

When selecting appropriate treatment programs and

interventions, Chaffin and Bonner’s (1998) cautionary remarks should be remembered. They observed

that efficacy has not been established for many sex

offender interventions considered standard and required. On the other hand, as this literature review

has described, there is a wide range of interventions

with more of an empirical basis, particularly within

the juvenile justice field (such as MST), 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

certainly should not be harmful.

Lastly, it should be remembered that the goal when

working with juveniles who have committed sex

offenses is to help them stop their abusive behaviors.

To label them “juvenile sex offenders” at a time

when they are developing their identity may have

deleterious effects. There is no evidence pertaining

to these juveniles that suggests once a sex offender,

always a sex offender, as Chaffin and Bonner (1998)

point out in their editorial “Don’t Shoot, We’re Your

Children: Have We Gone Too Far in Our Response

to Adolescent Sexual Abusers and Children With

Sexual Behavior Problems?” Instead, it is important

to remember that they are children and adolescents

first—they are young people who have committed

offenses and who deserve care and attention.
59

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Children as Victims. 2000, NCJ 180753 (24 pp.).

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Kids and Guns. 2000, NCJ 178994 (12 pp.).

Predictors of Youth Violence. 2000, NCJ 179065

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Promising Strategies To Reduce Gun Violence.

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Race, Ethnicity, and Serious and Violent Juvenile Offending. 2000, NCJ 181202 (8 pp.).

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