At the time I finished my child psychiatry training 25 years ago, I stepped into a job as Medical Director (and later, Clinical Director) of a large residential treatment center that offered treatment programs for teens (with and without intellectual disabilities) who had been adjudicated for sexual offenses. At the time, the vast preponderance of kids in our programs were themselves victims of sexual abuse. We spent considerable time trying to figure out why some kids who were abused went on to offend while other victims didn’t, and we were also interested in what treatments worked best in reducing the risk of reoffending. Some of our internal research was presented at a couple of major conferences…the most important predictor of positive outcomes (no reoffending) in our cohort was the extent to which families of the kids we treated were actively engaged in the treatment process…when the kids we were treating still had families.
Needless to say, the controversy swirling around Josh Duggar’s admission that he fondled as many as five underage girls as a teenager growing up in Northwest Arkansas led to great consternation among those who viewed the Duggar family as a model of exemplary Christian living. More recently, the disclosures in the aftermath of the Stanford rape trial and the outrage in response to a letter from the rapist's father that trivialized his behavior focused the attention of the media on sexual violence that is far too common on college campuses.
I thought it might be helpful to look at the available research into kids and teens who commit sexual offenses to better understand their backgrounds and the impact that treatment may have on reducing their risk of harming other kids in the future.
The scope of the problem: According to the US Department of Justice, juveniles account for 25.8% of sexual offenders known to law enforcement personnel, and commit 35.6% of offenses to minors. 15% of rapes are perpetrated by minors. Data from victim reports suggests juvenile offenders may perpetrate as many as 40% of sexual assaults.
The role of trauma: One frequently cited study of 68 juveniles in a residential treatment program for sexually offending behavior noted that ALL of the kids in treatment had been victimized sexually. Another study of 193 juveniles from a variety of inpatient treatment facilities suggested that a pattern of continuous sexual abuse between the ages of 3-7 was associated with the most damage and the age of victimization and duration of abuse contributed to patterns of offending behavior in the teen years. Rates of sexual victimization are much higher among teens who molest children than in those who molest same-age females.
Family systems influences: Kids who became perpetrators of inappropriate sexual behavior were more likely to have experienced a longer delay in having their own sexual victimization reported, and were more likely to experience a lower level of perceived family support after their own abuse was disclosed according to a study conducted in 2000 with 235 adolescents. Another study looking at family factors associated with sexual aggression in adolescent males found that paternal physical abuse and sexual abuse by males increased sexual aggression among adolescents and that the quality of the child’s attachment to his mother had a protective effect.
Mental health conditions: A descriptive study of 667 boys and 155 girls involved with social services as a result of “hands-on” sexualized behavior noted that 66.7% had been diagnosed with ADHD, 55.6% were diagnosed with PTSD, 49% were identified with a mood disorder, approximately ¼ had used drugs and 1/5 had used alcohol in association with their sexual offenses.
Delinquency: One meta-analysis of 59 studies comparing 13,000 male adolescents with histories of sexual offenses to male adolescents with non-sexual offenses found the adolescents who committed sexual offenses had much less extensive criminal histories, fewer antisocial peers, and fewer substance abuse problems compared with nonsexual offenders. Additional factors associated with sexual offending included sexual abuse history, exposure to sexual violence, other abuse or neglect, social isolation, early exposure to sex or pornography, atypical sexual interests, anxiety, and low self-esteem.
Autism/Developmental Disabilities: 10-15% of all sexual offenses are committed by persons with intellectual disabilities. Sex offenses are the second most common crimes for which persons with intellectual disabilities are arrested and the most crime for which persons with intellectual disability are incarcerated. Here’s a link to a resource page from the ARC on the subject.
Pornography: We don’t yet have good research on the role exposure to pornography plays in increasing the propensity of children/teens to offend. Anecdotally, I’ve had several patients with either OCD or autism spectrum disorders who have struggled with inappropriate sexual behavior following exposure to online pornography. I’d speculate that online pornography might be more traumatizing to kids with conditions contributing to perseveration on troubling thoughts or images.
Who do teens victimize? Adolescents who offend prepubescent children were found in one study to…
- Manifested greater deficits in psychosocial functioning
- Used less aggression in their sexual offending
- Were more likely to offend against relatives
- Were more likely to meet criteria for clinical intervention for depression and anxiety
Adolescents who offended adolescent or adult females were…
- More likely to use force in the commission of their sexual offense
- More likely to use a weapon
- More likely to be under the influence of alcohol or drugs at the time of the offense
- Less likely to be related to their victim
- Less likely to commit the offense in the victim’s home or in their own residence
- More likely to have a prior arrest history for a nonsexual crime
- Manifest less anxiety or depression
- Experience less pronounced social skill or self-esteem deficits
Benefits of treatment: Here’s a link to an excellent summary article from the U.S. Department of Justice summarizing the research evaluating the effectiveness of treatment for juveniles with sexually offending behavior. I’ll summarize some key observations…
- Treatment outcomes are far more positive among child and adolescent offenders when compared to adult offenders. In general, recidivism (reoffending) rates in long-term follow up studies of up to 20 years duration run between 5-12%. The research suggests a majority of children and teens who commit sexual offenses will not reoffend as adults.
- Multisystemic Therapy (MST) appears to be an effective treatment approach for youth with sexually offending behavior. Additional approaches shown to be helpful include cognitive-behavioral therapy (CBT) and parent behavior management training.
- Therapeutic services delivered in natural environments (home, school, community) may enhance the effectiveness of treatment.
The Justice Department made the following statement in their report…
Treatment approaches that are developmentally appropriate; that take motivational and behavioral diversity into account; and that focus on family, peer, and other contextual correlates of sexually abusive behavior in youth, rather than focusing on individual psychological deficits alone, are likely to be most effective.
Here are some thoughts for our friends involved with children’s ministry, student ministry, family ministry, disability ministry, adoption ministry and others who read our blog, based upon my review of the literature and clinical experience…
- Most children and teens who perpetrate sexually offending behavior are themselves victims of sexual trauma or abuse.
- A high percentage of kids who engage in sexually offending behavior are experiencing symptoms of a mental health condition necessitating effective treatment. Others may have more poorly developed language and social skills or struggle with impulse control and/or emotional self-regulation.
- As more and more families seek to adopt or serve as foster parents to children who are victims of sexual trauma or struggling with attachment issues, the church needs to be prepared to minister with them (as well as families in the church in general) in the event their kids engage in sexually inappropriate behavior. We need to be careful not to judge parents and caregivers, especially when they seek appropriate help for their kids.
- Given the statistics on sexually offending behavior among juveniles, churches need to pay special attention to teens serving as volunteers in children’s ministry under their protection policies because information about sexual offenses may not appear in background checks.
- Clergy and church staff typically have the same legal duty to report suspicion of sexual abuse (as well as physical abuse or neglect) of a minor as physicians and mental health professionals. In 27 states, the law includes clergy as mandated reporters (including Arkansas, where the Duggar incidents occurred). In 18 other states, any person aware of child abuse or neglect is a mandated reporter by law, with three of those states specifically listing clergy as mandated reporters in their statutes. Here’s a guide to reporting requirements on a state by state basis.
- Parents and families of kids involved with sexually offending behavior should be encouraged to seek help from mental health professionals with appropriate training and experience in treating kids with severe emotional or behavioral disturbances. While many professionals (including pediatricians and primary care physicians) may feel ill-equipped to help youth with inappropriate sexual behavior, they can help direct families to more appropriate treatment resources in their area.
- The Christian community needs to stop putting other Christians up on pedestals because they’ll fall off or get knocked off. The only man worthy of worship is the One who was able to raise himself from the dead by his own power. The rest of us are sinners who fall short of the glory of God.
Finally, I’d ask whether we as a society believe in redemption? Given what we know about the differences between kids and adults from a neurodevelopment perspective in their capacity for impulse control, emotional self-regulation, social skills, susceptibility to peer pressure, capacity for moral reasoning, judgment, propensity for risky behavior and persistence of sexually inappropriate behavior, is it appropriate for society to identify kids as young as age 14 as sexual offenders for life?