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...a plethora of literature on the effects and treatment of child sexual abuse, very little has been written to date on treatment outcomes of sex offenders, particularly juvenile offenders. Research on adolescent sex offenders is vital because of the high offending rate of this group as compared with the general population. According to the U.S. Department of Justice (see Weinrott, Riggan, & Frothingham, 1997), 20% of all rapes and approximately 25% of sexual abuse arrests involve perpetrators under the age of 21. Valliant and Bergeron (1997) reported that 30% to 50% of child sexual abuse cases are perpetrated by juveniles. In fact, at least a half million juveniles commit a sex crime every year (Weinrott et al., 1997). It is estimated that, without treatment, the average adolescent sex offender will go on to commit 380 sex crimes during his or her lifetime (Barbaree, Hudson, & Seto, 1993). This rate is most likely higher because not all offenses are discovered or disclosed by victims, and even when discovered by third parties, not all such offenses are reported to the authorities (Vizard, Monck, & Misch, 1995).
Unfortunately, some studies have not shown the efficacy of treatment for child sexual abusers. For example, O'Reilly et al. (1998) found that not all sex offending adolescents responded to treatment. Rather, low-risk cases showed treatment effects, whereas high-risk cases were found to have lower ability levels, lower levels of maternal and paternal care, and poorer levels of psychological and psychosocial functioning. Hall (1995) reported that in a meta-analysis of studies that examined recidivism after treatment, 19% of the sex offenders committed additional sexual offenses. However, the author suggested that any reduction in recidivism is important because it reduces the harm done to victims and the monetary costs to society. It is also important to note that the base rate for recidivism is between 15% and 35% for untreated sex offenders (Craissati & McClurg, 1997). Another longitudinal study investigated the effectiveness of cognitive-behavioral treatment with sex offenders. Marques, Day, Nelson, and West (1994) found that when compared with groups receiving no treatment, the treatment group had the lowest reoffense rates for both sex crimes and other violent crimes. Main effects analyses did not yield conclusive results regarding the program's effectiveness. However, the authors explained that methodological errors (i.e., inappropriate comparison groups, using tests without adequate statistical power) may have interfered with finding statistically significant treatment outcomes.
Adolescent sex offenders enter treatment with various demographic characteristics that act as risk factors and may interfere with the success of treatment. These risk factors may include sexual and physical abuse; neglect; alcohol and drug use; dysfunctional family relationships; parental history of substance abuse, incarcerations, and psychiatric illness; criminal record; low social competence; problems at school; and previous placements. In reviewing the literature, Vizard et al. (1995) found that adolescent sex offenders have been reported as (a) being more socially isolated than their peers, (b) having dysfunctional families in which violence between parents and toward the children was common, (c) having parents with victimization in their own childhood, (d) displaying academic and behavioral problems in school, and (e) having low self-esteem and depressive/anxious symptoms. Knight and Prentky (1993) reported that sex offenders had significantly lower social competence, demonstrating significantly greater lifestyle impulsivity, criminal acts, and previous placements. Furthermore, sex offenders were more likely to come from abusive, dysfunctional families and to have had problems in school. Juvenile sex offenders also were more likely than delinquents who had non-sex-related problems to be diagnosed with a non-sex-related conduct disorder (France & Hudson, 1993). Breer (1996) reported that adolescent sex offenders tended to have criminal records that included non-sex-related offenses.
Alcohol use has been found to have a strong relationship with sexual offenses, including rape and pedophilia (Lightfoot & Barbaree, 1993). Approximately 40% to 50% of sex offenders have reported that they were drinking at the time they committed the offense, and about 50% were considered to have abused alcohol (Monson, Jones, Rivers, & Blum, 1998). One possible reason for this relationship is the abuser's desire to reduce inhibitions, thereby making it easier to commit the sexual acts. The overt act of exercising personal power interacts with the physiological effects of alcohol on human cognition to increase the likelihood that interpersonal violence will occur after drinking (Lightfoot & Barbaree, 1993). Adolescent sex offenders who also are classified as chemically addicted create a challenging task for treatment interventions. Lightfoot and Barbaree recommended that treatment modalities be geared specifically to deal with added risk factors, such as substance abuse.
Criminal behavior of the father and parental substance abuse are two of the stronger and more consistently demonstrated characteristics of parents of aggressive and antisocial youths (Kazdin, 1994). When parents have experienced psychiatric problems, have a criminal history, and have had substance abuse problems, such a background is likely to interfere with both their ability to form attachment bonds with the child and with their parenting skills. These parents tended to show more periods of indifference, hostility, and rejection toward their children. When attachment bonds are characterized by insecurity, rejection, a lack of warmth, inconsistency, abuse, or disruptions in continuity, the child has a greater likelihood of developing a maladaptive interpersonal style (Marshall, Hudson, & Hodkinson, 1993).
However, the literature does not describe how risk factors may prevent the adolescent sex offender from benefiting from treatment. Therefore, the purpose of the present study is to identify the risk factors that may negatively and positively affect treatment. It is important to determine what factors may prevent successful treatment outcomes so that new intervention strategies can be developed. Risk factors may point to behavioral excesses and deficits that may be addressed therapeutically. By monitoring risk factors during treatment, therapists may be better able to confront and inform clients about elements of their relapse processes (Gray & Pithers, 1993). Such monitoring allows the clinician to assess the efficacy of treatment in an ongoing fashion. Our study correlated several risk factors of adolescent sex offenders with treatment outcome. We hypothesized that specific risk factors would be correlated with poor treatment outcome. These risk factors included psychiatric history of the mother, criminal history of the father, substance abuse of the mother, the child's history of substance abuse, and the...
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