Recidivism and Impulsivity Among Adolescents Who Offend Sexually

1. Recidivism and Impulsivity Among Adolescents Who Offend Sexually Christina Wilder, PsyD June 8, 2009

2. Acknowledgements and Disclosures Acknowledgements Frank DiCataldo, Alejandro Leguizamo, William Hazelett, Rachel Kalbeitzer, and Roger William students Disclosures I have no actual or potential conflicts of interest in relation to this presentation.

3. Objectives 1.      Appreciate the existing research on rates and risk factors, including impulsivity, of recidivism among adolescents who offend sexually 2.      Describe a risk assessment measure for juvenile sex offenders (the ERASOR) and a general violence risk assessment measure for adolescents (the YLS/CMI) 3.      Discuss a study underway to examine the predictive validity of the ERASOR and the YLS/CMI, as well as clinical factors, such as impulsivity 4.      Provide implications for treatment of adolescents who offend sexually

4. Definitions Sex Offense: purposeful sexual contact without consent by physical, verbal, or other force (APA, 1999) Juvenile: under the age of 18 years

5. Prevalence • 2-4% of adolescent males admit to committing sexually assaultive behaviors • 20% of all rapes and 30-50% of all child molestations are perpetrated by adolescent males • An estimated 70,000 boys and 110,000 girls are victims of sexual offenses by adolescents AACAP, 1999

6. OJJDP, 2007

7. Impact: Registry • Wetterling Act • Megan’s Law • Pam Lychner Act • National Sex Offender Registry (NSOR) • Adam Walsh Act of 2006 • There is no federal requirement to register juvenile sex offenders • Currently 38 states register juveniles convicted of a sex offense

8. States Registering Juveniles without Restrictions Adopted from http://www.adolpsych.org/presentations/Frierson_TheInclusionofJuvenileSexOffenders.pdf

9. Impact: SVP Laws • 18 states have passed SVP laws - At least 8 of the 18 allow juveniles to be committed - All 18 allow commitment based on juvenile sex offenses

10. Impact: Massachusetts Sex offenders comprise about 5% of the juveniles committed to DYS in MA but a. take up 50% of the secure treatment beds b. comprise about 25% of all mental health referrals c. are overly represented in residential treatment programs if released to the community Zaitchik, M. (2005)

11. Theories • Gottredson and Hirschi • Marshall and Barbaree • Ward and Siegart • Becker and Kaplan Barbaree & Marshall, 2006

12. Recidivism • 50% lifetime recidivism including sexual and nonsexual offenses • 8-30% lifetime sexual recidivism, with most studies around 10-15% (Righthand & Welch, 2006) • Lower recidivism rates among treated juveniles than treated adults (Alexander, 1999) • Lower recidivism rates among treated juveniles compared to untreated juveniles (Worling, 2001)

13. General Characteristics Heterogeneous group with diverse characteristics and needs but generally - male - first offense prior to age 15 - known victim - demonstrate arousal to wide range of stimuli - most common sexually offensive behavior is fondling

14. Empirically Supported Risk Factors • Deviant sexual interest • Prior legal sanctions for a sexual assault • Two or more past victims • Social isolation Barbaree & Marshall, 2006

15. Promising Risk Factors • Incomplete sex offender treatment • Problematic parent-child relationships • Attitudes support of sexual offending Barbaree & Marshall, 2006

16. Possible Risk Factors • High stress family • School problems • Antisocial interpersonal orientation • Interpersonal aggression • Negative peer associations • Sexual preoccupation • Male victim • Child victim • Threats, violence, or weapons during sexual offense • Environment supportive of reoffense • Impulsivity Barbaree & Marshall, 2006

17. Impulsivity as a Risk Factor Solo offenders are more impulsive than group offenders (Bijleveld & Hendriks, 2003) Scale II (Impulsivity/Antisocial Behavior) on the JSOAP differentiated those who reoffend in some way from those who did not reoffend Impulsivity or impulsive lifestyle increased likelihood of a new arrest, conviction, or parole violation among 14-19 year olds (Miner, 2002) High incidence of ADHD among juvenile sex offenders (Kavoussi, Kaplan, & Becker, 1988)

18. Risk Assessment Measures Static-99 JSOAP/JSOAP-II ERASOR JSORRAT-II YLS/CMI

19. ERASOR The Estimated Risk of Adolescent Sexual Offense Recidivism (ERASOR; Worling and Curwen, 2001) • Second most utilized risk assessment measure for juveniles who sexually offend • “An empirically guided checklist to aid clinical assessment” • Intended for juveniles 12-18 with a history of at least 1 previous sexual assault

20. ERASOR • 25 items; 9 historical and 16 dynamic • 5 categories • Sexual Interests, Attitudes, and Behaviors • Historical Sexual Assaults • Psychosocial Functioning • Family/Environmental Functioning • Treatment • Items are rated present, possibly/partially present, not present, or unknown • No total score, but clinicians give a “low,” “medium,” or “high” clinical rating

21. ERASOR Reliability - ICC at or above .70 for 22 out of the 25 items - ICC of .75 for the total ERASOR score - ICC of .91 for clinical judgments Validity - Moderately effective at differentiating adolescents known to offend after sanctioned by adult versus those who had never been sanctioned - Differentiated adolescents at community-based clinics from those in specialized residential facilities - No predictive validity studies to date Worling, 2004

22. YLS/CMI Youth Level of Service/Case Management Inventory (YLS/CMI; Hoge and Andrews, 2002) • Designed to identify risks and needs of juvenile delinquents or offenders for treatment or case planning • Used by probation officers, caseworkers, psychologists • Requires a clinical interview • Intended for youth ages 12 to 18

23. YLS/CMI • 42 items • 8 Domains • Prior and Current Offenses • Family Circumstances/Parenting • Education/Employment • Peer Relations • Substance Use • Leisure/Recreation • Personality/Behavior • Attitudes/Orientation • Scoring is dichotomous • Higher score equals greater recidivism

24. YLS/CMI Reliability - ICCs ranged from .61 (peer relations) to .85 (education/employment) across 7 of the 8 scales (no data for prior/current offenses) - ICC of .91 for total score Validity - Concurrent validity with the Total Problem and Externalizing scores on the Child Behavior Checklist and the Conduct Disorder score on the Disruptive Behavior Disorder Rating Scales - ROC of .61 for any reoffense and .67 for serious reoffense • Schmidt, Hoge, & Gomes (2005); Rowe (2002)

25. Current Study: Overarching Goals • Calculate interrater reliability of the ERASOR and YLS/CMI • Examine the predictive validity of the ERASOR for juvenile sexual offending and general delinquency • Determine the predictive validity of the YLS/CMI for juvenile sexual offending and general delinquency • Look at demographic and clinical factors in relation to the ERASOR, YLS/CMI, sexual recidivism, and general recidivism

26. Current Study: Measures • YLS/CMI • ERASOR • Data Collection Sheet • CORI

27. Current Study: Hypotheses about Impulsivity • Juveniles rated as being impulsive (present on ERASOR #19) were more likely to sexually recidivate than juveniles who were not rated as being impulsive (not present on ERASOR #19). • Impulsive juveniles were more likely to generally recidivate than non-impulsive juveniles. • Impulsive juveniles had a great number of general reoffenses than non-impulsive juveniles.

28. Current Study: Hypotheses about Impulsivity • Impulsive juveniles were more likely to have multiple sexual assault victims (ERASOR #5) than non-impulsive juveniles. • Impulsive juveniles were more likely to have sexually assault a stranger (ERASOR #10) than non-impulsive juveniles. • Impulsive juveniles were more likely to have offended solo (data sheet) than non-impulsive juveniles.

29. Current Study: Measuring Impulsivity ERASOR #19. Poor self-regulation of affect and behavior (Impulsivity). Present: During the past 6 months, the adolescent has demonstrated very poor self regulation of affect and behavior. Impulsivity is demonstrated by 3 more of the following: - Frequent difficulty delaying gratification - Frequent difficulty delaying responses (“blurting out answers”) - Frequent interrupting others - Frequent failure to listen to instructions or directions - Frequently becoming bored easily with routine - Frequently grabbing or touching things/others with permission - Frequent failure to consider consequences before engaging in activities Possibly or Partially Present: Possible or partial evidence that, during the past 6 months, the adolescent demonstrated very poor self-regulation of affect and behavior – is typically highly impulsive (2 or fewer of the above). Not present

30. Current Study: Participants Records of 60 male adolescents who have any history of sexual offense - most between the ages 12 and 18 - all referred by the Department of Youth Services (DYS) for evaluations of treatment needs, extension of commitment, or Youthful Offender commitment

31. Current Study: Procedure • Graduate students were trained in the scoring of the YLS/CMI and the ERASOR and did at least 3 practice scorings of each measure • Each student independently completed YLS/CMI, ERASOR, and data coding sheet for 10 out of the 60 de-identified records • There were two students for every record so inter-rater reliability could be calculated • Each pair of students then worked with a senior investigator to decide upon consensus ratings for the measures, and the consensus score was used in further analyses

32. Current Study: Results Stay Tuned

33. Impulsivity and Potential Implications for Treatment • Self instruction (Meichenbaum & Goodman, 1971) • Problem-solving skills training • Multisystem Family Therapy (MST, Borduin, 1999; Swenson et al., 1998)

35. References Alexander, M.A. (1999).  Sexual offender treatment efficacy revisited. Sexual Abuse: A Journal of Research and Treatment, 11(2), 101-116. American Academy of Child and Adolescent Psychiatry (1999). Practice parameters for the assessment and treatment of children and adolescents who are sexually abusive towards others. Retrieved from, http://www.aacap.org/page.ww?section=Practice+Parameters&name=Practice+Parameters Barbaree, H. E., & Marshall, W. L. (2006). Juvenile Sex Offender. New York: Guilford. Becker, J.V. (1998). What we know about the characteristics and treatment of adolescents who have committed sexual offenses. Child Maltreatment 3(4), 317-329. Bijleveld, C & Hendriks, J. (2003). Juvenile sex offenders: Differences between group and solo offenders. Psychology, Crime & Law, 9(3), 237-245. Borduin, C. M., & Schaeffer, C.M. (2001). Multisystem treatment of juvenile sex offenders: A progress report. Journal of Psychology and Human Sexuality, 13, 25-42. Caldwell, M. F. (2002). What we do not know about juvenile sexual reoffense risk. Child Maltreatment, 7(4), 291-203. Calley, N. G. (2008, December). Juvenile sex offenders and sex offender legislation: Unintended consequences. Federal Probation, 72 (3), Retrieved from, http://wwww.uscourts.gov/fedprob/December_2008/JuvenileSexOffenders.html

36. References DiCataldo, F. 2009. The perversion of youth: Controversies in the assessment and treatment of juvenile sex offenders. New York: NYU. Kavoussi, R.J., Kaplan, M., & Becker, J.V. (1988). Psychiatric diagnoses in adolescent sex offenders. Journal of the American Academy of Child and Adolescent Psychiatry 27(2), 241-243. Michenbaum D,H., & Goodman J. (1971). Training impulsive children to talk to themselves: a means of developing self-control. Journal of Abnormal Psychology, 77 (2), 115-126. Miner, M.H. (2002). Factors associated with recidivism in juveniles: An analysis of serious juvenile sex offenders. Journal of Research in Crime and Delinquency, 39, 421-436. Prescott, D. (2004). Emerging strategies for risk assessment of sexually abusive youth: Theory, controversy, and practice. Journal of Child Sexual Abuse, 13, 83-105. Righthand, S., & Welch, C. (2006). Juveniles who have sexually offended: A review of the professional literature. Rockville, MD: OJJDP. Schmidt, F., Hoge, R. D., & Gomes, L. (2005). Reliability and validity analyses of the youth level of service/case management inventory. Criminal Justice and Behavior, 32, 329-344.

37. References Worling, J. R. (2001). Personality-based typology of adolescent male sexual offenders: Differences in recidivism rates, victim-selection characteristics, and personal victimization histories. Sexual Abuse: A Journal of Research and Treatment, 13(3), 149–166. Worling, J. R. (2004). The Estimate of Risk of Adolescent Sexual Offenders Recidivism (ERASOR): Preliminary psychometric data. Sexual Abuse: A Journal of Research and Treatment, 16, 965-982. Zaitchik, M. (2005). Risk assessment of juvenile sex offenders: A case report. Journal of Forensic Psychology Practice, 5(4), 83-94.