A Brunswikian evolutionary-developmental theory of adolescent sex offending.

A Brunswikian Evolutionary-Developmental model was developed to relate the sex offending behavior of adolescents to other forms of social deviance, tracing a history of repeated frustration and failure in various competitive sexual strategies and escalation to more extreme means of obtaining sexual gratification. Four hypothetical constructs were proposed as stages in the development of sexual criminality: (1) Psycho-Social Deficiency (PSD); (2) Non-Criminal Sexuality (NCS); (3) Non-Sexual Criminality (NSC); and (4) Sexual Criminality (SC). Significant direct and indirect pathways led from PSD to SC through both NCS and NSC, each time facilitated by an interaction with PSD. Although the causal orders between stages remain equivocal, the current results are consistent with our theory and establish the heuristic value of our theoretical approach, providing empirical support for otherwise counterintuitive predictions. This interpretation also offers hope for focusing preventative intervention at one major root cause of this unfortunate cascade of consequences, Psycho-Social Deficiency.

Psychometric analysis of the Sexual Interest Cardsort Questionnaire.

Reliability, measured by Cronbach's coefficient alpha, and concurrent validity, measured by Pearson's r and polychoric correlation coefficients, were evaluated in this study. A sample of 371 sexual offenders referred to the Behavioral Medicine Institute of Atlanta for evaluation of sexual interests and behaviors by the courts were assessed using the Sexual Interest Cardsort Questionnaire (SI), a self-report measure of deviant and nondeviant sexual interest, as well as indicator variables obtained from classifications assigned by clinicians as a result of 2 hour-long, semistructured clinical interviews. Internal consistency of 75 items from the SI ranged from 0.71 to 0.96, across 15 categories of sexual interest and behavior. Additionally, the SI was shortened utilizing Cronbach's alphas to maintain a high level of internal consistency. The resulting questionnaire, the shortened SI (SIS), had 45 items and 15 categories. Cronbach's alpha ranged from 0.78 to 0.97. Utilizing Pearson's r and polychoric correlation coefficients, significant correlations were found for the 11 sexually deviant categories of the SI and indicator variables, and the 10 sexually deviant categories of the SIS and indicator variables. The SI and SIS showed a high level of reliability and concurrent validity. Clinical and research issues pertaining to the clinical assessment of male sexual offenders utilizing self-report and clinical interview data, both obtained as the result of comprehensive evaluations, are discussed.

Preventing sexual abuse and assault.

This article reviews prevention of sexual abuse and assault from a public health approach. The public health approach identifies three levels of prevention: primary, secondary, and tertiary. Several programs are reviewed in the area of primary prevention. The article discusses the efficacy of different approaches. Information from offenders and victims is reviewed to gain insight into primary prevention approaches. Review of innovative approaches to secondary prevention are introduced. This section focuses on changing the behavior of potential offenders rather than changing the behavior of potential victims. Special consideration is given to the role of alcohol in abuse and possible prevention strategies to reduce abuse risk by reducing high-risk alcohol use. Discussion of intervention strategies and offender characteristics are reviewed to address tertiary prevention.

Natural born killers?: the development of the sexually sadistic serial killer.

Today's society seems enthralled with serial killers in the news and the media. Forensic psychiatrists often interview serial killers after they have been caught. There are retrospective studies and case reports of individuals who have committed sexually sadistic serial murders. However, there exists a dearth of case reports on adolescents who have expressed serious fantasies about becoming serial killer prior to actualizing their fantasy. This article presents nine clinical cases of 14- to 18-year-olds who have clinically significant fantasies of becoming a serial killer. Similarities exist in these adolescent cases when compared with retrospective studies and case reports of serial killers on the role of sexually sadistic fantasies and actual killings. Since it has been established that sexual paraphilias may develop at a young age, one can surmise that sadistic paraphilias may also develop in some adolescents. The question is posed, can we predict which of these adolescents may go on to actually become serial killers? This article focuses on how the sexually sadistic fantasy can eventually be acted out and possible motives for the act to be repeated multiple times. Finally, recommendations are made about assessing and treating a youngster who expresses violent sexually sadistic killing fantasies so that attempts can be made to interrupt the progression to actual killing.

The Adolescent Sexual Interest Card Sort: test-retest reliability and concurrent validity in relation to phallometric assessment.

Test-retest reliability and concurrent validity studies on the Adolescent Sexual Interest Card Sort (ASIC) were conducted in two samples of 38 juvenile sexual offenders, each. Of the 64 items of the ASIC, 60 were found to be significantly correlated across test administrations. Cronbach's coefficient alpha was employed to determine the internal consistency of ASIC items. Coefficients ranged from .62 to .96 across categories, with an overall alpha of .97. Client ratings of sexual interests via the Card Sort were correlated with phallometric response to similar categories of stimuli. Significant correlations were found for only 4 of the 14 categories examined, suggesting little correspondence between client report of sexual interest on the ASIC and phallometric assessment of the same. Findings are consistent with the adult sex offender literature suggesting that self-report measures are particularly vulnerable to dissimulation and often at variance with more objective measurement. Clinical and research issues pertinent to the measurement of sexual arousal and interest in juvenile sexual offenders are discussed.

The relationship between phallometrically measured deviant sexual arousal and clinical characteristics in juvenile sexual offenders.

The current study examined the relationship between clinical characteristics and a phallometrically derived deviance quotient index in two samples of 44 and 54 juvenile sex offenders. Results support an association between higher measured deviant arousal and having a male victim only, consistent with the literature on adult child molesters. However, results reflected greater fluidity in the offense patterns of the juvenile offenders, and generally less correspondence between measured arousal and offense histories than what has been cited for adults. The authors review whether there is empirical support for a conditioning model of deviant arousal onset in juveniles, and suggest caution in the interpretation of phallometric data with this population.

Offenders: characteristics and treatment.

People who sexually abuse children are diverse in terms of age, occupation, income level, marital status, and ethnic group. At one time it was believed that sex offenders could be easily categorized along three dimensions: offending against either adults or children; offending against either members of their families or against acquaintances and strangers; offending in noncontact ways (for example, exhibitionism) or through bodily contact. There is growing evidence that a number of offenders offend across these categories. Many child sexual abusers are themselves adolescents, and many adult offenders first offended when they were adolescents. A review of the literature reveals a paucity of controlled therapy outcome studies on the effectiveness of treatment, and existing uncontrolled studies are marked by methodological problems. This has led some to conclude that there is insufficient evidence to prove the effectiveness of treatment for child molesters. However, there have been major changes in treatment programs over the years, and some more recent studies provide reason for optimism about the effectiveness of current treatment methods for some offenders.

Assessing suspected child molesters.

Clinical evaluations can play a useful role in making a variety of dispositional decisions concerning child molesters provided they are done carefully, using relevant techniques, and their limitations are clearly understood. Assessment instruments and techniques that can differentiate child molesters from other persons, that are related to treatment planning, and that predict the commission of future sexual offending are the most useful. Sex offense history and phallometric assessments are useful in planning treatment and supervision programs and in assessing risk. The Psychopathy Checklist is also a strong predictor of sexual recidivism but its usefulness in treatment planning is equivocal. Measures of attitudes and beliefs that support child molestation are suitable for designing treatment programs but their prognostic significance remains to be established. More general measures of personality and psychopathology have not been established as predictors of recidivism but can be used to address collateral clinical issues.

AIDS knowledge and beliefs, and sexual behavior of sexually delinquent and non-delinquent (runaway) adolescents.

This study assessed general knowledge of AIDS, beliefs about preventing AIDS, and sexual behavior among two groups of male adolescents at high risk of HIV/AIDS: 60 sexually delinquent males and 57 non-delinquent runaway males. Significantly fewer sexually delinquent than non-delinquent (runaway) males had experienced sexual intercourse with a consenting female partner (45 vs. 89 per cent). Sexually delinquent youths scored significantly lower than non-delinquent youths in general knowledge of AIDS (65 vs. 73 per cent) and were not able to discriminate safer behaviors from those which were less safe (42 vs. 71 per cent). Both groups reported moderate support for beliefs about preventing AIDS. These results suggest HIV/AIDS prevention programs that attempt to increase knowledge are needed by these youths, particularly for sexually delinquent youths.

The incidence of depressive symptomatology in juvenile sex offenders with a history of abuse.

Depressive symptomatology was assessed in a sample of 246 male juvenile sex offenders using the Beck Depression Inventory. Of these participants, the racial composition was black = 147, Hispanic = 62, Caucasian = 34. Three adolescents elected not to identify their racial origin. Subjects were divided according to their self-reports of having been sexually or physically abused. The mean Beck score across all subjects was 14.3, a value markedly higher than published norms and indicative of mild depression. Forty-two percent of subjects attained scores indicative of appreciable depressive symptomatology. A history of sexual or physical abuse was significantly related to high Beck scores; abused subjects had a mean Beck score of 16.4, as contrasted to 12.3 for nonabused subjects (Wilcoxon test: z = 2.82; p less than .005). This relationship was apparent across all racial groups. While Hispanic subjects tended to have higher Beck scores and Caucasians lower scores, racial differences were not statistically significant. Results indicate that juveniles who have committed sexual crimes, particularly those with a history of abuse, should be evaluated for depression.

Multiple paraphilic diagnoses among sex offenders.

The psychiatric literature suggests that paraphiliacs can be expected to participate in only one type of deviant sexual behavior. Using self-reports gathered with assured confidentiality from 561 nonincarcerated paraphiliacs, we discovered that most paraphiliacs have had significant experience with as many as ten different types of deviant sexual behavior without regard, in many cases, to gender, age, and familial relationship of the victim. The relevance of these findings to our understanding of paraphiliacs and their treatment is discussed.

Measuring the effectiveness of treatment for the aggressive adolescent sexual offender.

This paper has described a cognitive-behavioral outpatient treatment program for adolescent sexual offenders. The multicomponent treatment program consists of verbal satiation, cognitive restructuring, covert sensitization, social skills training, anger control training, sex education, and relapse prevention sessions. Data has been presented on 24 adolescents who completed treatment. Results indicated that adolescents involved with male victims significantly decreased deviant sexual arousal pre- and posttreatment, as measured by penile plethysmography. For those adolescents who molested female victims, a decrease in deviant arousal was also evidenced, although it was not statistically significant.

Level of postassault sexual functioning in rape and incest victims.

In a systematic study, 372 sexual assault survivors and 99 women with no history of sexual assault were interviewed with regard to their sexual histories to determine the incidence and types of sexual dysfunctions in these two samples. The women also completed the Sexual Arousability Inventory. Of the sexual assault survivors, 58.6% of the women were experiencing sexual dysfunctions, with 71% of them reporting that their sexual assaults were related to their development of sexual problems. In contrast, only 17.2% of the nonassaulted women reported experiencing any sexual problems. Differences in the types of sexual problems experienced by the two samples are noted, as are treatment implications. The sensitivity of the Sexual Arousability Inventory to assault-related sexual dysfunctions was affected by the educational level of the sexual assault survivors.

Depressive symptoms associated with sexual assault.

The Beck Depression Inventory was used to assess depressive symptoms in 178 sexual assault survivors and 50 control subjects who had never been sexually assaulted. The sexual assault survivors reported significantly more depressive symptoms than the control subjects, and further analyses strongly suggested that the depressive symptoms were caused by the sexual assault. Investigation of the relationships between depression scores and survivor and assault characteristics indicates that the nonspecifics of the assault and the use of a weapon by the assailant were most highly correlated with development of depressive symptoms.

Sexual problems of sexual assault survivors.

Attempts to downplay the sexual component of sexual assault may actually result in an injustice to sexual assault survivors as it may desensitize professionals working with sexual assault survivors to the possible development of sexual problems. Of 371 sexual assault survivors evaluated, more than 40% reported that they were experiencing sexual problems as a result of their assaults. In addition, these assault-related sexual problems can be chronic, enduring for many years. The need to screen for and provide treatment when necessary for such sexual problems is apparent.