Differentiating youth who sexually abuse: applying a multidimensional framework when assessing and treating subtypes

Contemporary Risk Assessment Tools: Should We Use Them for Sexually Abusive Children Ages 4 to 12 Years?

Empirical findings are reported on an age group of sexually abusive youth (4-12 years) not commonly studied. Findings are from major studies employing the ecologically framed MEGA ♪ risk assessment tool: MEGA ♪ Combined Samples Studies (N = 3901 [1979-2017] (Miccio-Fonseca Journal of Child Sexual Abuse: Special Issue on Risk Assessment of Sexually Abusive Youth, 2018a, Journal of Child and Adolescent Trauma, 2018b) and MEGA ♪ Combined Cross Validation Studies (N = 2717). Samples consisted of male, female, and transgender-female, ages 4-19 with coarse sexual improprieties and/or sexually abusive youth, including youth with low intellectual functioning. Findings provided normative data, with cut-off scores according to age and gender, establishing four (calibrated) risk levels: Low, Moderate, High, and Very-High. The fourth risk level, Very-High Risk, sets MEGA ♪ apart from other risk assessment tools by the ability to assess those few most seriously concerning and/or dangerous youth, whereas other risk tools (with three risk levels) do not make this differentiation.

What happened to Eric? The derailment of sexual development

A variety of theoretical approaches, from the individual to ecological levels, was applied to the following clinical case in order to understand why a five-year-old boy demonstrated sexual behavior. Inappropriate sexual behavior in children is presented as symptomatic of problems in intrapersonal and interpersonal boundaries, relationship capabilities, and superego consolidation. The case material emphasizes that only when the child is helped to stop his sexual acting out can he access the sources of his emotional distress. The theoretical underpinnings that are relevant to this case will be shown as instrumental in the therapy of this child and his family. By integrating theory with practice, we hope to highlight this sensitive and prevalent issue as well as aid in the early identification and treatment of sexually problematic behavior.

Young people who sexually abuse: a historical perspective and future directions

This article presents a historical overview of research on sexually abusive youth. The evolution of the field over the past 30 years is discussed-from the initial development of treatment interventions to contemporary efforts of professionals to move from traditional, adult-oriented interventions toward developmentally sensitive assessment strategies and practice models. Focus is on two critical areas: risk assessment and trauma-informed care. The article reviews contemporary research on risk assessment tools, stressing the need for validated tools that can accurately assess youth and follow changes in risk over time. Etiological models for understanding effects of trauma (Trauma Outcome Process Assessment and Family Lovemap) are presented. Discussed are new ecologically based therapy models for working with sexually abusive youth that approach the youth holistically and are attuned to youths' needs, including providing interventions to address effects of past trauma.

Assessment and treatment of adolescent sexual offenders: implications of recent research on generalist versus specialist explanations

OBJECTIVE

Adolescent sex offenders (ASOs) are commonly considered a special kind of juvenile offender, with distinct risk and etiological factors from other adolescent offenders. However, a growing body of research suggests that ASOs are more similar to other adolescent non-sex offenders than they are different (e.g., Awad, Saunders, & Levine, 1984; Elliott, 1994; France & Hudson, 1993). The purpose of the present article is to review recent literature pertaining to the distinction between generalist and specialist adolescent sex offenders (ASOs).

METHOD

This article summarizes the findings from Seto and Lalumière's (2010) meta-analysis on theoretically derived risk and etiological factors for adolescent sexual offending. Based on these findings, recommendations for the assessment and treatment of this population are made.

RESULTS

The results of Seto and Lalumière's (2010) meta-analysis suggests the majority of ASOs are generalist offenders who are similar to other adolescent non-sex offenders, while a minority of ASOs are specialist offenders, who have unique risk and etiological factors including childhood sexual abuse/maltreatment and atypical sexual interests.

CONCLUSIONS

A clear distinction has been shown between generalist ASOs and specialist ASOs. Assessment measures and treatment targets geared toward one of these groups may be less effective with the other group, which means that this distinction is clinically important. It is expected that if treatment is matched to ASO type, sexual and nonsexual recidivism will be reduced and positive changes in other clinically important areas will be evident.

Treatment for juveniles who sexually offend in a Southwestern state

A 25-item questionnaire was mailed to sex offender treatment providers from counties with 60 or more reported juvenile sex offenders in a Southwestern state to determine the most effective treatment for juvenile sex offenders. Results indicated that cognitive behavioral therapy was the most successful reported approach to treatment with an average success rate of 87%. The most commonly used approach was cognitive behavioral therapy with relapse prevention. The most common sexual offense was indecency with a child involving sexual contact, contrary to studies that found that in the Probation Commission data, aggravated sexual offense was the most common. These results have ramifications for state policies on treatment for juvenile sex offenders.

The trauma outcome process assessment model: a structural equation model examination of adjustment

This investigation sought to operationalize a comprehensive theoretical model, the Trauma Outcome Process Assessment, and test it empirically with structural equation modeling. The Trauma Outcome Process Assessment reflects a robust body of research and incorporates known ecological factors (e.g., family dynamics, social support) to explain internalizing distress (e.g., anxiety, depression), externalizing distress (e.g., aggression), and recovery outcomes following traumatic events. Results revealed that expected relationships among the variables were significantly related in the expected direction, and the measures mapped well onto the expected latent constructs. Following optimal specification of the relationships within the Trauma Outcome Process Assessment, structural equation modeling revealed strong support for the Trauma Outcome Process Assessment as a comprehensive identification and treatment model to explain the differential outcomes of those exposed to traumatic stressors.

Paradigm shift: implementing MEGA, a new tool proposed to define and assess sexually abusive dynamics in youth ages 19 and under

Previous definitions of sexually abusive behavior in children and adolescents were deficient in failing to (1) highlight salient neuropsychological elements and antisocial behaviors that may contribute to a youth's functioning; (2) discriminate among possible types of coercion (e.g., manipulation, threats, physical force, and use of weapons); and (3) include predatory elements of sexual abuse against strangers or casual acquaintances. This article discusses a new comprehensive assessment tool that assists in defining sexually abusive youth. This tool, the Multiplex Empirically Guided Inventory of Ecological Aggregates for Assessing Sexually Abusive Children and Adolescents (Ages 19 and under) (MEGA; Miccio-Fonseca, 2006b), encompasses neuropsychological elements, coercive aspects, and predatory elements as essential factors to consider in comprehensive assessments of sexually abusive youth.

Multi-family group therapy for sexually abusive youth

Although Multi-Family Group Therapy (MFGT) has been a researched intervention for nearly 40 years, clinicians working with sexually abusive youth and their families have only more recently begun to utilize the intervention. We believe MFGT for a sexual offense-specific treatment population is a sophisticated and powerful clinical intervention with unique advantages including economical use of clinician resources, family-to-family transfer of knowledge and mentoring, community-based resourcefulness, and accelerated catalyzing of emotions. This article will provide direction on establishing the MFGT format as well as discuss its goals, curriculum, facilitation priorities, and strategies.

Testing an etiological model for male juvenile sexual offending against females

Research on the origin of sexual aggression has identified several important contributing factors: (a) early abuse (physical and sexual), (b) personality/behavioral traits (callousness and unemotionality, antisocial behavior/impulsivity, and hypersexuality), and (c) attitudinal/cognitive variables (negative masculinity, hostility toward women, misogynistic fantasies). We developed and tested an etiological model of sexual coercion on adult samples of sexual offenders and community controls. The model proposes three major causal pathways to sexual coercion. Using data gathered from a computerized interview, we employed this same model to predict sexually coercive behavior in a sample of 218 juvenile sexual offenders. The cross- sample consistency of the model provides support for a unified theory of sexual aggression against women.