Juvenile Child Molesters

NATE GALBREATH, PH.D., MFS Disclaimer

The opinions expressed are those of the presenter and do not reflect the official policy of the Department of Defense. Learning Objectives

— Understand key differences between juvenile and adult child molesters — Identify current assessment, diagnosis, and treatment approaches — Recognize recidivism and registration issues for juvenile sex offenders.

— Juvenile Child Molester ¡ Descriptive of a problematic range of reported and unreported behaviors — Juvenile Sex Offender ¡ Descriptive of the result of an adjudicative process following a report Juvenile Child Molesters

— Population Description — Dimensions of Sexual Differences — Prevalence — Assessment — Treatment — Legal Considerations Heterogeneous Population

— Mostly male (~93%) — Varied Age ¡ <9 ~5% ¡ 9-11 11% ¡ 12-14 38% ¡ 15-17 46% — Great variation in ¡ Race and socioeconomic level ¡ Offense types ¡ Number of victims and frequency of offenses ¡ Motivation ¡ Future risk Sexual Differences

• People Differ Sexually on Four Dimensions: • The kinds of behaviors they find arousing • The kinds of partners they find arousing • The intensity of their sexual desires • Attitudes about their own sexual feelings

• Become problematic when they: • Lack consent of all parties involved or “targeted” • Interfere with family, social or work functioning • Violate laws, policies or ethical boundaries Prevalence of Juvenile Molesters

— Unknown Prevalence ¡ Most data comes from reported offense statistics ¡ Offensive behavior occurs much more often than reported — Limited studies ¡ 5% of 17 to 20 year-olds admitted lifetime coercive sexual behaviors (Kjellgren, 2010) ¡ 3 to 5 per 1,000 of birth cohorts arrested for sexual offense during adolescence (Lussier, 2015) ¡ Implication: Prevalence of molesters roughly about 12 times higher than reported offenders Sexual Offense “Funnel”

“Crime” Occurrences

Crime Reports

Crimes Charged

Crimes Convicted

Crime Convictions with Incarceration Not To Scale Differences from Adult Molesters

Juvenile offenders are: — More likely to offend in groups — Slightly more likely to offend acquaintances — More likely to commit contact/oral offenses, less likely to rape — More likely to have a male victim

• FINKELHOR, 2009, DEPT OF JUSTICE Offenders by Victim Age A process view of offending: An organizing framework.

Published in: Patrick Lussier; Sex Abuse 29, 51-80. DOI: 10.1177/1079063215580966 Copyright © 2015 Association for the Treatment of Sexual Abusers Assessment

— Most do not present for treatment — Most come into treatment as a result of: ¡ Police or juvenile justice system referral ¡ School misconduct allegations ¡ Sentencing evaluation ¡ Recidivism risk assessment — A chief concern: Who is the client? ¡ Child ¡ Child and Family Services ¡ Juvenile Court Assessment Approach

— Behavioral History ¡ Client ¡ Parent or Caregiver ¡ Teachers, Administrator or other Authorities — Collateral information ¡ Justice system ¡ School records — Standardized Testing ¡ Intelligence, Achievement, Aptitude, Psychological — Medical History and Assessment ¡ Rule out hormonal, genetic or other biological abnormalities Diagnostic Considerations

— Maladaptive Behavior Patterns:

¡ Externalizing – acting “out” against others

÷ More common in adult sex offenders

÷ More common in juveniles in non-sexual offenses

¡ Internalizing – acting “in” against themselves

÷ More common in juvenile sex offenders

÷ History of previous abuse

¡ Actual maladaptive behavioral patterns may depend on “solo” vs. “group” juvenile sex offenders Diagnostic Considerations

— Compared to Juvenile Offenders in general, Juvenile Sex Offenders:

¡ Have a less extensive criminal history

¡ Have less substance abuse

¡ Have fewer delinquent friends

¡ Are more likely have been physically, emotionally, and sexually abused

¡ Have early exposure to sex or pornography

¡ Have exposure to sexual violence within the family

¡ Have atypical sexual interests (sexual fantasies involving young children or coerced sex) Seto & Lalumiere (2010) Diagnostic Considerations

— Chief Diagnostic Consideration:

¡ Is diagnosis appropriate?

¡ Consider V-codes for life circumstances

— DSM-V - Externalizing

¡ Conduct Disorder (5%*) ÷ A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated ÷ 3 of 15 criteria in past 12 months, with one in past 6 months

÷ “Has forced someone into sexual activity”

*N=130 JSO in residential treatment; California Coalition on Sex Offending (2013) Diagnostic Considerations

— DSM-V - Internalizing

¡ Mood Disorders (33%*)

¡ ADHD (25%*)

¡ Anxiety/PTSD (20%*)

¡ Other (Adjustment or v codes) (18%*)

— Other, older studies have found evidence of psychopathy, thought disorders, substance abuse, low intelligence, and social skills deficits

*N=130 JSO in residential treatment; California Coalition on Sex Offending (2013) Diagnostic Considerations

— DSM-V Paraphilic Disorders

¡ Recurrent, intense, sexually arousing fantasies, urges, or behaviors

¡ Distressing or disabling experience

¡ Involve inanimate objects, children or nonconsenting adults, or suffering or humiliation of oneself or the partner

¡ Most juvenile sex offenders are not diagnosed with paraphilias, nor are they likely to develop one.

¡ NOTE: Many adults diagnosed with paraphilia endorse the beginning of paraphilic behavior in adolescent and teen years Diagnostic Considerations

— DSM-V Paraphilic Disorders

¡ Pedophilic Disorder requires:

÷ Patient ≥16 years old

÷ Target ≤ 12 years old

÷ ≥5 year age difference between patient and ”target” Diagnostic Considerations

— Pornography

¡ Difficult to assign a causal role to development of sexual offending

¡ Juveniles are involve in 3 to 15% of child pornography cases (Aebi, 2014)

÷ Data may be confounded by the juvenile producing/sending images of themselves Treatment

— “One size fits all” treatment approaches not recommended — Plan should assess and address dynamic risk factors ¡ Mood state ¡ Access to victims ¡ Coping strategies ¡ Substance use — Legal system may provide limited data to therapists for assessment and treatment Treatment

— Treatment with Evidence of Effectiveness ¡ Cognitive Behavioral Therapy ÷ Cognitive distortions, relapse prevention, family counseling ¡ Multisystemic Therapy ÷ Intrapersonal, familial, and extra-familial factors associated with offending ¡ Pharmacological Treatments ÷ SSRIs (fluoxetine, sertraline) ÷ Anti-androgens (Depo-Provera, Depo-Lupron) — Generally, juvenile sex offenders have better treatment outcomes and recidivate at lower rates than adult sex offenders. Legal Considerations

— Recidivism ¡ Assessed primarily by three actuarial instruments: ÷ The Juvenile Sex Offender Assessment Protocol-II (J-SOAP-II) ÷ Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR), ÷ Psychopathy Check List: Youth Version (PCL:YV) ¡ Most actuarial studies reliably predict greater recidivism for any offense, but not specifically a sexual offense ¡ Caution must be used in interpreting actuarial results: ÷ Actuarial instruments depend on static factors in records ÷ However, dynamic factors are more highly predictive of re-offense Legal Considerations - Registration

DoJ SMART Office, 2015

Not all states require juvenile sex offender registration on their SORNA websites. Resources

— General Reviews: ¡ Ryan & Otonichar (2016). Juvenile Sex Offenders. Current Psychiatry Reports, 18: 67. ¡ Finklehor, Ormrod & Chaffin (2009). Juveniles Who Commit Sex Offenses Against Minors. Juvenile Justice Bulletin. Dept of Justice. — Juvenile Offending – Developmental Perspective ¡ Lussier (2015). Juvenile Sex Offending Through a Developmental Life Course Criminology Perspective: An Agenda for Policy and Research. Sexual Abuse, 29, 51-80. — Normative Sexual Development: ¡ Wurtele & Kenny (2011). Normative sexuality development in childhood: Implications for developmental guidance and prevention of childhood sexual abuse. Counseling and Human Development, 43(9),1-24. Key Take Aways

— Juvenile sex offenders are a varied group that are quite different from adult sex offenders in a number of domains. — Generally, few have sexual disorders, but are more likely to have a variety of mental health and daily living problems. — Unlike adult offenders, juvenile sex offenders have better treatment outcomes and may “age out” of offending behavior.

Questions? Juvenile Child Molesters

BACK UP SLIDES Normative Sexual Development

From Wurtele & Kenny (2011) and Friedrich (2002) Sexual Development

— Ages 0 to 2 – Infants to Toddlers — Ages 3 to 6 – Preschool — Ages 6 to 9 – Early School Age — Ages 9 to 12 – Preadolescents — Ages 13 and up - Adolescents Infants to Toddlers – Ages 0 to 2

— Infants can have erections and lubricate — Intimacy gained through physical contact/breast feeding — Genital manipulation ¡ Boys discover penis (6 to 8 months) ¡ Girls discover vulva (10 to 11 months) — Gender identity by aged 2 or 3 — Parental concerns about child sexual abuse: ¡ Genital redness, irritation *Note: “Concerning” means the behavior may need parental attention, child education, clinical intervention, or a referral for child sexual abuse evaluation. Severity of the behavior is typically the driver.

TABLES FROM WURTELE & KENNY (2011) Preschool – Ages 3 to 6

— Curious about others’ bodies — Gender identity constancy — Normative: ¡ Exhibitionism ¡ Voyeurism ¡ Boundary curiosity ¡ Self-stimulation ¡ Mimicking adult sexual behavior (hugging and kissing) Preschool – Normal Sexualized Play

— Exploratory & spontaneous — Occurs infrequently — Mutual, non-coercive — Occurs between playmates and other familiar children — Fun and playful – no negative emotions — Ceases when asked to stop Preschool – Concerning Behaviors

— Person not a “match” – age, size, development, etc. — Type of play – painful insertion, harmful — Dynamics of Play – intense, coercion, frequency — Quality of Play – too similar to adult (oral-genital contact) — Unceasing sexualized play — Coercive — Pressured secrecy *Note: “Concerning” means the behavior may need parental attention, child education, clinical intervention, or a referral for child sexual abuse evaluation. Severity of the behavior is typically the driver.

TABLES FROM WURTELE & KENNY (2011) Early School – Ages 6 to 9

Normative Sexual Behavior — Less overtly sexual – “modesty” — Curious about sex – avoid getting caught — Cuddling and hugging still important — Organize into same-sex groups for play/talk — Teasing, chasing, kissing games — Looking for sex information — Burp, fart, poop, and pee jokes Early School – Ages 6 to 9

Concerning Behavior — Advanced sexual knowledge — Continued or persistent sexual/obscene language — Coercive and demanding sexual behavior — Masturbation that includes penetration — Seeking out nudity on television/internet — Chronic peeping/exposing – despite being told to stop TABLES FROM WURTELE & *Note: “Concerning” means the behavior may need parental attention, child education, clinical KENNY (2011) intervention, or a referral for child sexual abuse evaluation. Severity of the behavior is typically the driver. Preadolescence – 9 to 12 Years

— Two “substages” of sexual development ¡ Preadolescence – before age 10 – sexual thoughts ¡ Early adolescence- 10 to 13 years – physical development — Changes before age 12: ¡ First Masturbation to orgasm ÷ 40% of women ÷ 38% of men ¡ First Sexual Attraction ÷ 10 to 12 years ÷ Sexual Fantasies occur about one year later Preadolescence – 9 to 12 Years

— Physical Development ¡ Girls early = psychosocial problems ¡ Boys late = psychosocial problems Preadolescence – 9 to 12 Years

— “Changing” and “Frequent” Relationships — Intercourse rare – only 7% have sex before age 13 — Same sex relationships or crushes common – but not indicative of being gay later — Internet ¡ Use internet for sexual health info ¡ About 2/3rds have accessed pornography ÷ Greater acting out ÷ More permissive sexual norms ÷ Higher rates of sexual intercourse Preadolescence – 9 to 12 Years

— Sexual Bullying ¡ Inappropriate touching ¡ Name calling/rumors/graffiti ¡ Coercive sexual behavior ¡ Electronically mediated Preadolescence – 9 to 12 Years

— Problematic sexual behaviors – juvenile sex offenders ¡ Greater than expected frequency ¡ Interfere with development ¡ Coercion, intimidation, and force ¡ Involve emotional distress and non-agemates ¡ Repeated occurrence in secrecy ¡ Not likely due to sexual gratification, but rather: ÷ Curiosity ÷ Imitation ÷ Attention seeking ÷ Other reasons 17

behaviors: drinking, doing drugs, having intercourse, and (“Do I really want to do these sexual things with this boy getting pregnant. Parents should be cautious about allowing now?”), recognizing risky social situations and potential their middle-school children to date, especially if their chil- dangers of dating (i.e., sexual pressure, date rape, dating dren are dating someone much older. Parents need to care- violence), and treating partners—whether sexual or roman- fully monitor their young teens’ dating and romantic activi- tic—with respect. Given that sexual harassment increases ties and communicate more with their young teens about during the early adolescent years and is evidenced at school sex, love, and relationships. Topics of importance for tweens (in “hostile hallways”; AAUW, 1993), parents, teachers, and include making decisions in the context of relationships counselors can help adolescents establish appropriate ways

TABLE 5 Early Adolescence (9–12 years)

Normal Behaviors Concerning Behaviors/Signs Educational Implications

• Shows sexual interest in peers of simi- •Engages in adult-type sexual activities • Provide broad-based sexual health lar age (feelings of sexual attraction) with younger children education. •Begins dating(hanging out, going with) •Forcing a younger child to have oral, • Provide information about sexual usually in groups vaginal, or anal sex issues (e.g., reproduction, pregnancy), • Start of sexual attraction/interest in • Preoccupied with sex and relationships even if a child does not ask for it. peers • Frequents sexually explicit websites •Discuss dating (relationship) rights and • Puberty begins or continues; body • Shows pornography to younger chil- responsibilities. changes can result in anxiety and con- dren •Review body-safety rules when inter- fusion; need reassurance that changes •Difficulty adjusting to sexual orientation acting with younger children. are normal •Masturbation interferes with academic • Respect child’s desire for privacy •May have fantasies about ideal partner; or social life •Help tweens develop decision-making, likely to be a celebrity • Simulating intercourse with dolls, communication, and assertiveness •Some youth begin to engage in kissing peers, animals (i.e., humping) skills. and fondling with peers or other affec- •Manually stimulates or has oral or geni- •Help tweens recognize and respond to tionate behavior with peers (e.g., flirt- tal contact with animals peer pressure. ing) •Child exhibits sexual bullying, whether •Discuss family values about dating and •Asks questions about sex in real life or online love and the role of sexuality in rela- •Displays more advanced knowledge •Child touches adults in a manner more tionships. about sexuality (draws sexual parts, like adult–adult sexual contact, offers • Keep conversation going. uses sexual words, talks about sexual him- or herself as a sexual object, •Develop media literacy skills to under- acts, looks at nude photos) solicits sexual touch from adults stand, interpret, evaluate sexual mes- • Seeks out sexual information from •Child sexualizes nonsexual things or sages and imagery. media and internet (wants to see pho- sees people as sexual objects •Discuss appropriate and inappropriate tos of naked or partially naked people) •Uses coercion, force, bribery, manipu- uses of electronic devices before pur- •Listens to music, watches movies with lation, or threats to engage another chasing new technologies. sexual themes child in sexual behavior •Emphasize safe connections and •Desires more privacy, may want bed- •Exposes genitals and/or masturbates boundaries whether in person or room door locked in public online. •Awareness of own and others’ sexual •Discuss internet safety and teach kids orientation to be respectful of others online and • Shows secondary sex characteristics not to engage in “sex talk” online or (signs of puberty) electronically bully others. •Menstruation and nocturnal emissions •Talk about how to recognize and avoid •Masturbates (in private) for pleasure risky social situations. and orgasm • Provide information about basic physi- •Most early sexual experiences are with cal changes of puberty. the opposite sex but may engage in • Provide tweens with age-appropriate same-sex activity (does not indicate sexuality books. homosexuality) •Discuss family values about pornogra- phy (e.g., the way women and children are viewed as sexual objects, only to be used for sexual satisfaction; the association of sex with violence).

TABLES FROM WURTELE & *Note: “Concerning” means the behavior may need parental attention, child education, clinical KENNY (2011) intervention, or a referral for child sexual abuse evaluation. Severity of the behavior is typically the driver. Adolescence – 13 to 19 years

— Heterosexual Intercourse ¡ Between Grades 9 to 12 (CDC, 2000) ÷ 48% Females ÷ 52% Males ¡ Men typically have intercourse earlier than women ¡ Social factors can delay first intercourse: ÷ Intact family structure ÷ Church attendance ÷ Parents education level ÷ Neighborhood employment rates Adolescence – 13 to 19 years

— Homosexual Experience ¡ Adolescent males – 5 to 10% ¡ Adolescent females – 6% — Two Developmental Stages Completed in Later Adolescence: ¡ Gender role stabilizes – for most ÷ Cisgender ÷ Transgender ¡ Sexual identity emerges: ÷ Heterosexual ÷ Homosexual ÷ Bisexual Adolescence – 13 to 19 years

— Info about managing physical and emotional intimacy: ¡ #1: The Media ¡ #2: Parents, Peers, Sex Ed, and Professionals — “Brain” Adolescence ¡ Executive functioning not fully developed until age 25 Sexual Differences

• People Differ Sexually on Four Dimensions: • The kinds of behaviors they find arousing • The kinds of partners they find arousing • The intensity of their sexual desires • Attitudes about their own sexual feelings

• Become problematic when they: • Lack consent of all parties involved or “targeted” • Interfere with family, social or work functioning • Violate laws, policies or ethical boundaries Problem Behaviors

• Exhibitionism • Fetishism • Frotteurism • Sexual Masochism • Sexual Sadism • Transvestic Fetishism • Voyeurism

While the practice of these behaviors may be problematic, they are not always illegal, nor are they diagnostic of a Paraphilic Disorder; see DSM-IV for diagnostic criteria. Problem Partners

• Bestiality • Necrophilia • Pedophilia

While the practice of these behaviors may be problematic, they are not diagnostic of a Paraphilic Disorder; see DSM-IV for diagnostic criteria. Problem Intensity

• Sexual Drive Intensity • High: Sexual addiction vs. Sexual compulsion • Low: Hypoactive Sexual Desire Disorder • “Low intensity” deviant sexual drive • Internet-based sexual problems • Triple-A Engine (Cooper, 1998) • Affordability, • Accessibility • Anonymity (Perceived)

While the these behaviors may be problematic, they are not always illegal, nor are they diagnostic of a Paraphilic or Sexual Disorder; see DSM-IV for diagnostic criteria. Problem Attitudes

• Ego-dystonic • The person is troubled by their sexual desires • Ego-syntonic • The person has generally positive views about their sexual desires

Neither of these descriptors are diagnoses. However, they describe features that may complicate treatment of paraphilic disorders. For example, a man who has eg0- syntonic feelings about his pedophilic disorder may be resistant to treatment.