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Boys = 667; Girls = 155. Adverse Early Life Experiences

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Title: Boys = 667; Girls = 155. Adverse Early Life Experiences


1
Juvenile Sexual Offenders Analysis Management
of Risk
The Field Center for Childrens Policy, Practice
Research University of Pennsylvania 05 December
2006
  • Robert Prentky
  • Research Department
  • Justice Resource Institute
  • Bridgewater, MA
  • rprentky_at_jri.org

2
K.R.U.
3
When Things Go (really) Awry
4
Immanuel Kant, 250 years earlier
  • From the crooked timber of humanity,
  • No straight thing can be made

5
Invisible, Insidious, Incurable
  • Out of a benign sense of obligation to prevent
    the worst of the worst from
    re-occurring, we may, unwittingly, unleash demons
    from which no straight thing can be made
  • Twin Curses
  • Protracted severe abuse neglect
  • Emotional Detachment

6
Affective Risk Factors
  • Emotional disconnectedness / loneliness
  • Low self-esteem vulnerability to feeling
  • humiliated
  • Absence of empathy
  • Inability to express positive feelings
  • Inability to manage strong negative feelings

7
Emotional Detachment
8
Perry, Pollard, Blakley, Baker, Vigilante
(1995)
  • The child who has been emotionally neglected
    early in life will exhibit profound attachment
    problems which are extremely insensitive to any
    replacement experiences later, including therapy.
    Examples of this include feral children,
    children in orphanages and, often, the
    remorseless, violent child, (p. 276-277).

9
Amid the extraordinary diversity and
heterogeneity of expressions of sexually coercive
behavior, there appears to be only 1 least common
denominator the relative inability to develop
and sustain healthy attachments with peers
10
Disordered Attachment (Levy Orlans, 1999)
  • Behavior Oppositional defiant, impulsive
    destructive, hyperactive, self-destructive
  • Emotions Intense anger and/or depression,
    fearful anxious
  • Thoughts Negative core beliefs about ones self
    and ones relationship with others,
    attention
  • learning problems
  • Relationships Untrusting manipulative, unable
    to give
  • or receive
    genuine affection, poor

  • perspective-taking
  • Moral Lack of empathy compassion, little
  • capacity for
    remorse, asocial or antisocial
  • values.

11
Critical Outcomes of Disordered Attachment
  • Impulsive (inability to regulate or control
    emotions)
  • Intense emotions (anger, depression or anxiety)
  • Profound lack of trust
  • Incapacity for empathy perspective-taking
  • Incapacity for reciprocal love
  • Relationships are superficial and loveless

12
What is the Magnitude of this Problem?
13
Lyons-Ruth, 1996
  • Of the 1 million substantiated cases of serious
    abuse and neglect in the United States each year,
    about 800,000 of those children have severe
    attachment disorder

14
Gallup, Moore, Schussel, 1995
  • The actual number of cases of serious abuse and
    neglect may be 10-16 times higher (8 million -
    12.8 million), increasing the number of children
    with severe attachment disorder to 6,400,000 -
    10,240,000

15
The Nexus of Caregiver Instability Sexual
Abuse (Prentky, Knight, Sims-Knight, Straus,
Rokous, Cerce, 1989)
  • A study of 82 adult sex offenders
  • File Coded Variables
    Self-Report
  • Physical Abuse longest
    time spent with caregivers
  • Neglect
    total of caregivers
  • Sexual Abuse total
    of changes in caregivers
  • Sexual Deviation in Family total time
    with bio mother

  • total time with bio father

  • total time spent with caregivers

  • longest time spent in institutions

  • total of changes in institutions

16
Outcome Variables
  • Severity of sexual aggression
  • Severity of nonsexual aggression
  • Total of sexual offenses
  • Total of nonsexual, victim-Inv. offenses

17
ß0.31
Caregiver Inconstancy
Sexual Aggression
ß0.43
Institutional History
General Aggression
ß0.24
Physical Abuse Neglect
Total Offenses Sexual
ß0.-0.26
ß0.32
Sexual Deviation Abuse in Family
Total Offenses Non-Sexual
plt .05, p lt.005, p lt.001
18
Prediction of Sexual Aggression (Using CI SDA)
19
Mother Violence ß.29
Caregiver Instability
Father Violence ß.18
Emotional Abuse ß.30
Physical Abuse ß.22
Sexual Abuse ß.09
20
Health ß.77
School Problems ß.40
Caregiver Instability
Aggression ß.77
Depression ß.59
Juv. Antisocial Behavior ß.83
Ineptness ß.26
Anxiety ß.30
21
Research Project Assessment for Safe and
Appropriate Placement (ASAP)
Mission The Massachusetts ASAP Program evaluates
children and juveniles who engage in firesetting
and sexually abusive behaviors. The mandate
Rosenberg Law is to improve the management and
care of these children by the Department of
Social Services (DSS) and to reduce victimization
of other children.
22
ASAP Research Project (Prentky, 2006)
  • Only youth with a history of sexual behavior
    problems
  • Supported by DSS and NIJ
  • Study Timeline
  • February, 1998 (ASAP Evaluations Began)
  • July, 2001 (Began Data Collection)
  • June, 2003 (Phase 1 Completed N250)
  • November, 2004 (Phase 2 Completed N720)
  • November, 2005 (Phase 3 Completed Stopped
    Data Collection)
  • Final sample N 822
  • Boys 667 Girls 155

23
Adverse Early Life Experiences Short-Term
Outcome
24
Child Abuse Sexual Behaviors Legend
SA Severity of Sexual Abuse PA
Severity of Physical Abuse SA PA Severity
of Sexual and Physical Abuse LS Number of
changes in Living Situations LS SA
Living Situation and Severity of Sexual Abuse
LS, SA, PA Living Situation, Severity of
Sexual Abuse, and Severity of Physical
Abuse
25
Child Abuse Sexual Aggression (yellow p lt
.01, .005, or .001)
26
Child Abuse Sexual Aggression (yellow p lt
.01, .005, or .001)
27
Child Abuse Paraphilias (yellow p lt .01,
.005, or .001)
28
Take Home Message
  • Sexual abuse and physical abuse, either
    alone or in combination, were not
    significantly correlated with different types of
    sexual abuse.
  • However, when changes in living situation was
    added to either or both of the above very
    significant relationships were noted.

29
So Whats the Story with Sexual Abuse ???
30
  • A youths history of having been a victim
    of sexual abuse / assault is generally NOT
    predictive of sexual re-offense
  • (e.g., Hagan Cho, 1996 Langstrom, 2002
    Rasmussen, 1999 Worling Curwen, 2001)

31
Studies finding sex abuse history predictive of
sexual re-offense in juveniles
32
Studies finding sex abuse history predictive of
sexual re-offense in juveniles
33
Worling Langstrom, 2003
  • all of the available data indicate that
    adolescents who have offended sexually and also
    acknowledge a history of child sexual abuse are
    at no greater risk of sexual assault recidivism,
    p.355

34
The Silver Bullet is Tarnished
  • Recapitulation Ho of the 1980s
  • cycle-of-abuse
  • vampire syndrome

35
Abuse-Specific Considerations Morbidity
Factors (Burton, 2000 2003 Prentky, 1999)
  • Sexual abuse becomes critical under certain
    conditions or in the presence of other factors
    (Kaufman Zigler, 1987)
  • 1. Age of onset
  • 2. Duration
  • 3. Severity
  • 4. Relationship to
    offender

36
Abuse-Specific Victim Age
  • Ho juveniles who victimize children are more
    likely to have been sexually abused than those
    who victimize peers
  • Awad Saunders, 1991 (20 vs. 4)
  • OBrien, 1991 (40 vs. 29)

37
Abuse-Specific Victim Gender
  • Ho juveniles who victimize males are more
    likely to have been sexually abused than
    those who victimize females
  • Becker Stein (32 male vs. 18 female)
  • Worling, 1995 (75 male vs. 25 female)

38
Victim Age / Gender Confound
  • Assaults against peers or adults female victims
  • Assaults against children roughly 2/3 include
    male victims

39
Treatment Confound?
  • Juvenile offenders with known histories of
    sexual abuse more likely to be treated? And thus
    at reduced risk?

40
Developmental Constitutional Considerations
  • self-esteem,
  • resilience,
  • ego strength,
  • capacity for
    introspection
  • (Friedrich, 1998)

41
Child Sexual Abuse A Kaleidoscopic Risk Predictor
  • whereas, Delinquency, reflects an invariant,
    stable pattern of behavior.
  • Child Sexual Abuse, reflects idiosyncratic
    patterns of abusive experiences that interact
    with other concurrent life experiences, some
    mitigating and some aggravating, producing highly
    variable degrees of risk

42
To Further Complicate Matters Neurobiology of
Child Abuse
43
Effects of Child Abuse on the Developing Brain
  • A wide range of replicated experiments have
    demonstrated that child abuse can cause permanent
    damage to the neural structure and function of
    the developing brain.

44
Abuse-induced Stress
  • Persistently high levels of stress trauma
    induced hormones during childhood may permanently
    alter brain development,
  • especially the hippocampus

45
Why the Hippocampus?
  • It develops slowly.
  • It is one of the few brain regions that continues
    to develop after birth.
  • It has a higher density of cortisol receptors
    than almost any other area of the brain.

46
How does stress damage the new
brain?
  • Prolonged or excessive exposure to cortisol can
    significantly change the shape of the largest
    neurons in the hippocampus, and can kill them.
  • Cortisol can suppress production of new granule
    cells (small neurons), that normally continue to
    develop after birth.

47
Severe, Prolonged Abuse in Childhood
  • Damage to limbic structures, associated with
    physiological effects (hyporeactivity) that may
    impair
  • Socialization
    Capacity
    for identifying with others
    Internalization of values
    (i.e., conditionability)

48
De Bellis Colleagues, 1999 (Univ. Of
Pittsburgh Medical Center)
  • 44 children adolescents with PTSD and 61
    matched controls
  • brain volume robustly and positively correlated
    with age of onset of PTSD and negatively
    correlated with duration of abuse
  • symptoms of intrusive thoughts, avoidance,
    hyperarousal or dissociation correlated
    negatively with brain volume

49
Teicher, 2002
  • Human brains evolved to be molded by
    experience, and early difficulties were routine
    during our ancestral development. Is it plausible
    that the developing brain never evolved to cope
    with exposure to maltreatment and so is damaged
    in a nonadaptive manner?

50
Teicher This seems most unlikely
  • The logical alternative is that exposure
    to early stress generates molecular and
    neurobiological effects that alter neural
    development in an adaptive way that prepares the
    adult brain to survive reproduce in a dangerous
    world.

51
Teicher (2002) concluded that
  • Society reaps what it sows in the way it
    nurtures its children. Stress sculpts the brain
    to exhibit various antisocial, though adaptive,
    behaviors. stress can set off a ripple of
    hormonal changes that permanently wire a childs
    brain to cope with a malevolent world.

52
Risk Assessment / Prediction
53
Why Do We Care?
  • In the Dispositional Planning Unit of Family
    Court
  • By a probation officer prior to adjudication
  • In court during the adjudicatory process
  • By Dept Human Services (DSS, CPS) caseworkers
    responding to reports of sexually acting out kids
  • By clinicians considering discharging kids from
    residential placement
  • By clinicians receiving postadjudication
    referrals for treatment

54
Two common demands of clinicians that work with
sexually abusive youth
  • 1. gathering, assimilating, and interpreting
  • data for the purpose of evaluating a
    client
  • (i.e., assessment)
  • 2. using the data to make judgments about
  • the likelihood of specific outcomes
  • (i.e., prediction)

55
Although we may do assessments of offenders for
many reasons, generally speaking, there are 3
broad areas
  • 1. Clinical (or Needs) Assessment
  • 2. Risk Prediction
  • 3. Risk Reduction

56
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57
Focus will be on last 2 points
  • A Priori Risk Assessment or Risk Prediction
  • (goal predicting violent behavior).
  • Risk Management or Risk Reduction
  • (goal determining what aggravates (increases)
    or mitigates (reduces) an existing or preexisting
    condition of risk).

58
  • Risk Prediction relies on Static factors
    (historical information about past behavior
    that, for the most part, is unchangeable or
    fixed).
  • Risk Reduction relies on Dynamic factors
    (current information about existing behavior
    problems, life events, situational events or
    recent interventions that are all subject to
    change.

59
To begin with What ARE Risk Predictors?
60
Risk Factors Defined
  • Personal characteristics or environmental
    conditions that predict the onset, continuity, or
    escalation of violence

61
What is a Dynamic Risk Factor? (Rice, 2000)
  • The factor precedes is associated with outcome
  • The factor changes or can be changed
  • Manipulating the factor changes outcome
  • True Dynamic Factor

62
Are Risk Factors Causes?
  • ONLY when it has been empirically demonstrated
    that changing the risk factor produces changes in
    the onset or rate of violence

63
Assessing Risk in Children Juveniles The Top
10 Problems
64
  • Developmental Flux
  • Situational Flux
  • Boundaries of Normative Sexual Behavior
  • Developmentally-Sensitive Risk Predictors
  • Low Base Rate Non-Predictors
  • High Base Rate Non-Predictors
  • Child Sexual Abuse
  • Sexual Preference
  • Hormones and Sex Drive
  • Sexual Recidivism Low Base Rates?

65
The MAJOR risk-relevant difference between adults
and juveniles Age!
66
2,300 Years ago, Aristotle observed
Youth are heated by Nature as drunken men by
wine
67
400 years ago, Shakespeare quipped
I would that there were no age between 10 and
23, for theres nothing in between but getting
wenches with child, wrongdoing the ancientry,
stealing, fighting
(The Winters Tale, Act III)
68
100 years ago, the great Granville Stanley Hall
wrote of
the heightened storm and stress of adolescence
69
Under normal conditions,
  • Adolescence is characterized by pervasive
    developmental maturational change
  • The stability that we assume when assessing risk
    in adults can NOT be assumed with adolescents

70
Hallmarks of normal adolescent development
  • RISK-TAKING
  • risk-adversity increases with age the
    hedonic motive in adolescence overshadows
    rational recognition of adverse outcomes
  • Dr. Steinberg (2004) increased risk taking
    in adolescence is normative, biologically-driven,
    and inevitable.
  • cf., Levin Hart, 2003 Reyna, 1996 Reyna
    Farley, 2006 Rice, 1995

71
  • EMOTIONAL INTENSITY LABILITY
  • associated with changes in reproductive and
    stress hormones
  • IMPULSIVITY
  • associated with CNS immaturity - frontal lobe
    continues to mature into the mid-20s
  • (Dahl Spear, 2004)

72
Juveniles are not fully cooked
  • Research on
  • Physical Development
  • Buchanan, Eccles, Becker, 1992
  • Psychosocial Development
  • Cauffman Steinberg, 2000 Steinberg
    Cauffman,
  • 1996
  • Brain Development
  • Baird et al., 1999 Giedd et al., 1999 Sowell
    et al., 1999

73
Metaphor for Assessing Risk with Adolescents
74
Relationship of Instability to Age
Inverse under normal conditions i.e.,
instability tends to decrease with age
75
Developmentally-Sensitive Risk Predictors
76
Selected Effect Sizes of Risk Factors
  • Early Onset Juvenile
    Onset
  • (6-11) (12-14)
  • Aggression .21 .19
  • Low IQ .12 .11
  • Broken Home .09 .10
  • Substance Abuse .30 .06
  • Low Family SES .24 .10
  • Being Male .26 .19
  • Antisocial Parents .23 .16
  • Weak Social Ties .15 .39
  • Antisocial Peers .04 .37
  • Gang Memberships - .31
  • Large ES r gt .30
  • Moderate ES r .20-.29
  • Small ES r lt .20

77
  • Low Incidence Non-Predictors

78
Condition 1 for Risk Factors to Predict
  • Present among a relatively large proportion of
    those who re-offend sexually
  • Violation?
  • deviant sexual arousal ?

79
Deviant Sexual Arousal A Low Incidence Risk
Factor ?
Non-Reoffenders
Re-offenders
Wrong 80 of the time!
80
High Incidence Non-Predictors
81
Condition 2 for Risk Factors to
Predict
  • Present among a higher proportion of those who
    re-offend than those who dont re-offend
  • Violations?
  • dysfunction chaos in the home poor social
    skills, substance abuse, denial of problems,
    child abuse?

82
Substance Abuse A High Incidence Risk Factor?
Non-Reoffenders
Re-offenders
Wrong 60 of the time!
83
Substance Abuse (Bonta et al., 1998)
(NR Not Reported)
84
Low Incidence of Re-offense
85
JUVENILE RECIDIVISM
86
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87
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88
Overview Incidence
  • Most studies, sexual recidivism rates 5-14
  • Higher rates in some older, more aggressive
    offenders
  • Higher rates in residential samples
  • Higher rates of nonsexual offending
  • True incidence is unknown

89
DSS / NIJ Follow-up Study
  • Supported by DSS and NIJ
  • Study Timeline
  • November, 2005 (Phase 3 Completed stop data
    collection)
  • Final sample N 822
  • Boys 667 Girls 155

90
Sources of Follow-Up Data
  • Department of Social Service Records (DSS)
  • Phone Conversations w/Social Workers (SW)
  • Criminal History Systems Board (CHSB)
  • Sex Offender Registry Board (SORB)

91
Followup Time
  • Minimum 6 Months
  • Maximum 7 years

Age Range (ASAP Age)
  • 1998 3 years old to 20 years old
  • 2005 10 years old to 27 years

92
Group Assignments
  • Group 1 DSS Sexual Reoffend
  • Youth who sexually reoffend and the reoffense was
    only reported in the DSS record and/or DSS SW
  • Group 2 CJ Sexual Reoffend
  • Youth whose sexual reoffense was known to the
    criminal justice system and resulted in a
    criminal sanction
  • Group 3 CJ Non-Sexual Reoffend
  • Youth who reoffended non-sexually and was known
    to the criminal justice system and resulted in a
    criminal sanction
  • Group 4 No Reoffense
  • Youth who had no sexual reoffense and no
    non-sexual reoffense, per CJ DSS records

93
Survival Analysis
a test of equality, df 1 p lt .001
94
JSOAP Static1, Dynamic2, Total2 Scores by
Groups (boys only)
1 df 3, 648 2 df 3, 205 abc reflects SNK
group difference (plt.05)
95
ROC curve for Pre-Adolescent Boys (J-SOAP-II
Total Score)
96
ROC Pre-adolescent Boys (optimum probability
levels for classification)
97
ROC curve for Adolescent Boys (J-SOAP-II Total
Score)
98
ROC Adolescent Boys (optimum probability levels
for classification)
99
ROC AUC Comparison of Adolescent
Pre-adolescent Boys
100
Empirical Risk Factors for Juvenile Sex Offenders
  • Prior sexual offenses
  • Impulsive antisocial behavior, delinquency,
    Conduct Disorder, ADHD, truancy, fighting
  • Marked deficits in social skills
  • Severe abuse / maltreatment
  • Sexual preoccupation / paraphilias
  • Deviant sexual arousal

101
Weak and/or Inconsistent Risk Predictors
  • Victim Sex
  • Substance Abuse
  • Psychiatric Problems
  • Denial of Problems
  • Poor Social Interpersonal Skills
  • Dysfunction Chaos in the Home
  • Domestic Violence
  • Recent Failures or Disappointments
  • Failure to Comply with Probation
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