Epidemiology and treatment of juvenile sexual offending

Scoping Review of the Definitions Used to Describe and Understand Harmful Sexual Behaviors in Children and Young People

There is a growing body of evidence that adolescents, and other children, are responsible for a significant proportion of sexual abuse against children. However, there are substantial differences in how this phenomenon is defined and conceptualized between and within sectors. This scoping review explored the current definitions of harmful sexual behaviors (HSB), and other similar terms, used across a range of stakeholder groups. In all, 141 papers were reviewed from both empirical and gray literature sources, including key policy and practice documents. Included papers needed to list a clear definition for the behavior of interest. There was disagreement and inconsistency across the included papers in their conceptualization of harmful, abusive, or problematic sexual behavior (PSB) in children and adolescents. Although the term HSB has been adopted as an umbrella term or continuum in many policy, practice, and research settings, there is a large variance in behaviors, treatment needs, etiology, and harms present across different types of sexual behavior. Relying solely on one term to describe a wide range of sexual behaviors in children and young people may limit the understanding of this issue and imply similarities between groups that are not present. We suggest that clearly defined subsets of HSB, such as sexual abuse, technology-assisted HSB, and PSB, may give more context to the behavior of concern and may be helpful in informing further research, prevention, and best practice approaches.

The Sexual Grooming Behaviors of Youth Who Engage in Harmful Sexual Behaviors

Little is known about the extent to which youths who commit harmful sexual behaviors (HSBs) against another minor utilize sexual grooming during the offense process. This study examined sexual grooming behaviors reported by adults (n = 250) who experienced HSBs by another minor during their childhood. Participants completed a self-report survey which included the Sexual Grooming Scale - Victim Version (SGS-V). The results showed that most participants (n = 242; 96.9%) reported at least one sexual grooming behavior, with an average of 11.3 behaviors reported. These findings will be discussed as they pertain to the identification and prevention of HSBs among youth.

The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders

Objectives: The primary aim of these guidelines is to evaluate the role of pharmacological agents in the treatment and management of patients with paraphilic disorders, with a focus on the treatment of adult males. Because such treatments are not delivered in isolation, the role of specific psychotherapeutic interventions is also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients, including sexual offenders, with paraphilic disorders. The aim of these guidelines is to bring together different views on the appropriate treatment of paraphilic disorders from experts representing different countries in order to aid physicians in clinical decisions and to improve the quality of care.Methods: An extensive literature search was conducted using the English-language-literature indexed on MEDLINE/PubMed (1990-2018 for SSRIs) (1969-2018 for hormonal treatments), supplemented by other sources, including published reviews.Results: Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. The type of medication used depends on the severity of the paraphilic disorder and the respective risk of behaviour endangering others. GnRH analogue treatment constitutes the most relevant treatment for patients with severe paraphilic disorders.Conclusions: An algorithm is proposed with different levels of treatment for different categories of paraphilic disorders accompanied by different risk levels.

Compulsive sexual behavior and sexual offending: Differences in cognitive schemas, sensation seeking, and impulsivity

BACKGROUND AND AIMS

People from the community seeking treatment in frameworks such as Sexaholics Anonymous (SA) and sex offenders are preoccupied with sex, sexual fantasies, and behaviors. The rates of compulsive sexual behavior disorder (CSBD), however, are reported to be substantially lower among sex offenders than SAs. In this study, we examined differences between SAs and sex offenders in CSBD and in processes that might be at the core of CSBD - maladaptive schemas about the self and others, impulsivity, and sensation seeking.

METHODS

The study comprised 103 sex offenders, 68 SAs, and 81 violence offenders who served as controls aged 18-74 years, who completed self-report measures regarding CSBD, maladaptive schemas, impulsivity, and sensation seeking.

RESULTS

SAs were higher on CSBD, maladaptive schemas, impulsivity, and sensation seeking than sex offenders. Sex offenders were higher on CSBD and impulsivity than violence offenders. Among all groups, maladaptive schemas were linked with higher CSBD.

CONCLUSIONS

High rates of CSBD among SAs might partially be accounted by differences in maladaptive schemas. We discuss the implication of the study to the understanding of CSBD, sexual offences, and therapy for CSBD and sexual offending.

Juvenile Sex Offenders

Sexual offending by juveniles accounts for a sizable percentage of sexual offenses, especially against young children. In this article, recent research on female juvenile sex offenders (JSOs), risk factors for offending in juveniles, treatment, and the ways in which these youth may differ from general delinquents will be reviewed. Most JSOs do not go on to develop paraphilic disorders or to commit sex offenses during adulthood, and as a group, they are more similar to nonsexual offending juvenile delinquents than to adult sex offenders. Recent research has elucidated some differences between youth who commit sex offenses and general delinquents in the areas of atypical sexual interests, the use of pornography, and early sexual victimization during childhood.

The Lived Experience of the Adolescent Sex Offender: A Phenomenological Case Study

Treatment for adolescents with sexually maladaptive behaviors is a continuing intervention that is changing and developing as greater understanding about this population of adolescents is obtained. The majority of treatment programs for adolescent sexually maladaptive behavior contain programming components that include cognitive distortions/thinking errors. Interviews including a conceptual mapping exercise were conducted with four adolescents adjudicated to a secure care program for sexual behaviors. All four boys completed an interview and a conceptual map of their perceived experiences as an adolescent with sexual maladaptive behaviors. All interviews were audio recorded. Analysis of the interviews and conceptual mappings yielded five themes present in the boys' experience as well as a consideration of the role early trauma may have in the establishment of cognitive distortion development. Contributing environmental and familial factors also play an important part in sustaining cognitive distortion. Main themes include: loss of responsible father or father figure, inability to regulate emotion, lack of personal and parental boundaries, and early exposure to pornography. The contributing influence of responsible male father figures may play an even greater role in the lives of young males than originally thought. How the adolescent inaccurately perceives his environment--in essence what he tells himself and continues to tell himself to make sense of his world--are building blocks in the development and continuation of thinking errors/cognitive distortions used to commit and justify sexual offending behaviors.

The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the treatment of adolescent sexual offenders with paraphilic disorders

The primary aim of these guidelines was to evaluate the role of pharmacological agents in the treatment of adolescents with paraphilic disorders who are also sexual offenders or at-risk of sexual offending. Psychotherapeutic and psychosocial treatments were also reviewed. Adolescents with paraphilic disorders specifically present a different therapeutic challenge as compared to adults. In part, the challenge relates to adolescents being in various stages of puberty and development, which may limit the use of certain pharmacological agents due to their potential side effects. In addition, most of the published treatment programmes have used cognitive behavioural interventions, family therapies and psychoeducational interventions. Psychological treatment is predicated in adolescents on the notion that sexually deviant behaviour can be controlled by the offender, and that more adaptive behaviours can be learned. The main purposes of these guidelines are to improve the quality of care and to aid physicians in their clinical decisions. These guidelines brought together different expert views and involved an extensive literature research. Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for efficacy, safety, tolerability and feasibility. An algorithm is proposed for the treatment of paraphilic disorders in adolescent sexual offenders or those who are at risk.

Evaluation of multisystemic therapy pilot services in Services for Teens Engaging in Problem Sexual Behaviour (STEPS-B): study protocol for a randomized controlled trial

BACKGROUND

Clinically effective and cost-effective methods for managing problematic sexual behaviour in adolescents are urgently needed. Adolescents who show problematic sexual behaviour have a range of negative psychosocial outcomes, and they and their parents can experience stigma, hostility and rejection from their community. Multisystemic therapy (MST) shows some evidence for helping to reduce adolescent sexual reoffending and is one of the few promising interventions available to young people who show problematic sexual behaviour. This paper describes the protocol for Services for Teens Engaging in Problem Sexual Behaviour (STEPS-B), a feasibility trial of MST for problem sexual behaviour (MST-PSB) in antisocial adolescents at high risk of out-of-home placement due to problematic sexual behaviour.

METHODS/DESIGN

Eighty participants and their families recruited from five London boroughs will be randomized to MST-PSB or management as usual with follow-up to 20 months post-randomization. The primary outcome is out-of-home placement at 20 months. Secondary outcomes include sexual and non-sexual offending rates and antisocial behaviours, participant well-being, educational outcomes and total service and criminal justice sector costs. Feasibility outcomes include mapping the clinical service pathways needed to recruit adolescents displaying problematic sexual behaviour, acceptability of a randomized controlled trial to the key systems involved in managing these adolescents, and acceptability of the research protocol to young people and their families. Data will be gathered from police computer records, the National Pupil Database and interviews and self-report measures administered to adolescents and parents and will be analysed on an intention-to-treat basis.

DISCUSSION

The STEPS-B feasibility trial aims to inform policymakers, commissioners of services and professionals about the potential for implementing MST-PSB as an intervention for adolescents showing problem sexual behaviour. Should MST-PSB show potential, STEPS-B will determine what would be necessary to implement the programme more fully and at a scale that would warrant a full trial.

TRIAL REGISTRATION

ISRCTN28441235 (registered 25 January 2012).

Current concepts in the pharmacotherapy of paraphilias

Concerns about paraphilia and its treatment have grown in the past few years. Although the aetiology of paraphilia disorder is still not completely understood, pharmacological treatments have been proposed for this disorder. Paraphilias are a major burden for patients and society; nevertheless, only a few individuals with paraphilias voluntarily seek treatment. Antidepressants have been used in the treatment of certain types of mild (e.g. exhibitionism) and juvenile paraphilias. Antilibidinal hormonal treatments, such as steroidal antiandrogens and gonadotrophin-releasing hormone (GnRH) analogues, have also been studied and they seem to be effective in paraphilic disorders, although caution should be taken in the prescription of these treatments in order to avoid or minimize adverse effects and the risk of victimization. The combination of psychotherapy and pharmacological therapy is associated with better efficacy compared with either treatment as monotherapy. Paraphilia is a chronic disorder and a minimal duration of treatment of 3-5 years is highly recommended for severe paraphilia with a high risk of sexual violence. In conclusion, this review of the literature provides suggestive evidence that paraphilias are well characterized disorders marked by pathological dimensions. Although further research is necessary to confirm treatment efficacy and to improve our knowledge of long-term tolerance, available data on the use of selective serotonin reuptake inhibitors, steroidal antiandrogens and GnRH analogues strongly suggest the efficacy of these treatments for paraphilic disorders.

The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of paraphilias

OBJECTIVES

The primary aim of these guidelines was to evaluate the role of pharmacological agents in the treatment and management of paraphilia, with a focus on the treatment of adults males. Because such treatments are not delivered in isolation, the role of specific psychosocial and psychotherapeutic interventions was also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients with paraphilia. The aim of these guidelines is to improve the quality of care and to aid physicians in clinical decisions.

METHODS

The aim of these guidelines was to bring together different views on the appropriate treatment of paraphilias from experts representing different continents. To achieve this aim, an extensive literature search was conducted using the English language literature indexed on MEDLINE/PubMed (1990-2009 for SSRIs) (1969-2009 for antiandrogen treatments), supplemented by other sources, including published reviews.

RESULTS

Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability and feasibility.

CONCLUSIONS

An algorithm was proposed with six levels of treatment for different categories of paraphilias.

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.

Male juveniles with sexual behavior problems: are there differences among racial groups?

This study used archival data on a sample of 186,492 referrals from a southwestern state Juvenile Probation Commission to compare the characteristics of 5,439 male Black, Hispanic, and White juveniles with sexual behavior problems on the five most common sexual offenses in the data set. The characteristics of 181,053 juveniles of the three races without sexual behavior problems were also compared on the basis of the seven most common nonsexual offenses. The bases of comparison were the seven variables: reported incidence of sexual offenses, the primary caregivers or living arrangements, age, suspected sexual abuse, suspected emotional abuse, suspected physical abuse, and special education status, on which racial differences were found. Prevention and treatment implications of findings are discussed.

Sex offender care for adolescents in secure care: critical factors and counseling strategies

Sexual offenses perpetrated by adolescents have reportedly reached epidemic proportions. Adolescent sex offenders have been transferred to secure care facilities for their primary care. The elevated awareness and recognition of the problematic growth of adolescent sexual offenses has stimulated discussion among psychologists concerning the etiology, characteristics, classification, assessment, treatment interventions, and risk of recidivism. This article explores the critical factors and counseling strategies of those adolescents who have been adjudicated of sexual offenses.

Review of medical reports on pedophilia

The present report is a review of all 554 papers published on Medline on pedophilia. The first discussion is the history of the disorder from ancient Greece to the present time, especially the influence of the liberal country of the Netherlands, the North American Man-Boy Love Association, and the sexual crisis in the Catholic Church. One important question is the relationship between homosexual pedophilia and adult homosexuality. Evidence for and against this relationship is presented. Next discussed are the characteristics of the victim and the long lasting serious effects of sexual abuse. Laboratory correlations are included, especially phallometric tests in order to objectively measure the physical responses to sexual stimuli. Electrophysiological and radiographic tests are also mentioned, including electroencephalography, computed tomography, magnetic resonance imaging, and positron emission tomography scans. An important section is the characterization of pedophiles with emphasis on their frequent previous sexual abuse, their past, their present, and their anticipated future. The final topic is treatment of this disorder with surgery, medication, behavioral therapy and the combination of medication and behavioral therapy.