Juvenile Sex Offenders

Juvenile Sex Offenders is a handbook written by three leading practitioners in the fields of child and adolescent psychiatry, forensic psychiatry and psychology, and sexual offending. The book emphasizes practicality and utility and is geared toward psychiatrists, psychologists, and other mental health professionals who are already skilled in the evaluation, diagnosis, and treatment of children and adolescents but are new to the areas of forensic evaluation and sexual offending. Each of the book's nine well-organized chapters contains a preface and separately captioned sections that make it easily readable. Most chapters start with an overview of the topic and end with a summary and a list of references.

The introductory chapter, “Changing Perceptions of Juvenile Sexual Offending in Society and the Legal System,” takes note of the increased attention that sexual offending has recently received. It summarizes the basic epidemiological data on adult and juvenile sexual offending, defines the terminology, and outlines the legal and political changes that have marked the approach to sexual offending over the past several decades. Several observations that are discussed in subsequent chapters are articulated in this introductory one. These include the heterogeneity of the juvenile offending population and the fact that juvenile sex offenders, as a whole, are far more similar to generally delinquent youths than to adult sex offenders. They are noted to be more amenable to treatment than adult sex offenders. Most juveniles who molest children do not develop pedophilia and do not continue sexual offending into adulthood. The relevance of sexually violent predator laws and related court decisions to the juvenile sex-offending population is briefly discussed.

The book contains an overview of the (somewhat limited) literature on normative sexual behavior in children and adolescents. In children, common childhood sexual behavior (typically forms of self-stimulation) is contrasted with sexual behavior toward others that usually indicates a history of sexual victimization. Data on the age of the first intercourse and on other sexual behaviors in adolescents are presented, as well as regional and ethnic differences in these activities.

Data regarding sexually problematic behavior in youths are presented separately for prepubescent children, adolescent females, and adolescent males. A typology of offending behaviors is suggested, and external and internal risk factors are summarized. The book contains case vignettes that illustrate the psychiatric comorbidity of sexually offending behavior. The authors describe the interaction between various psychiatric conditions and offending behavior and discuss the extent to which psychiatric disorders can explain such behavior in a particular individual.

The authors delineate the differences between forensic and clinical evaluations and highlight the potential pitfalls a clinician who is not forensically trained may fall into when asked to provide a forensic opinion about a patient. Elements of a forensic psychiatric evaluation, including guidelines for interviewing, evaluating, and conducting risk assessments of sexually offending youth; report-writing; and testimony are outlined.

Psychological assessment instruments used in the evaluation of juvenile sex offenders are described. The authors note that, in contrast to the assessment of adult offenders, there is no generally applicable tool that aids in providing initial risk estimates for the sexual reoffense of juveniles. There is a detailed discussion of the structured instruments for assessing juveniles, including the Juvenile Sex Offender Assessment Protocol-II (J-SOAP-II) and the Estimate of Risk of Adolescent Sex Offender Recidivism (ERASOR). Data on the Psychopathy Checklist: Youth Version (PCL:YV), an adult assessment modified for use in the juvenile population, are presented and discussed.

The last two chapters of the book are devoted to the management and treatment of juvenile sex offenders. The authors discuss available treatment venues (levels of care), examine the core areas of therapeutic focus, and describe two model community treatment programs (the Wraparound Milwaukee and Norfolk (VA) Juvenile Court). The shortage of youth treatment outcomes studies impedes our ability to identify the most effective rehabilitation options for these youths. There is up-to-date information about the biological and pharmacologic treatments of sexually aberrant behavior. Given the dearth of scientific literature on biological treatment of juvenile sex offenders, most of the literature reviewed in this chapter involves studies of adult offenders. Principles of pediatric pharmacology are reviewed, and general principles of biological and psychopharmacologic treatment of children and adolescents are outlined. The chapter also includes a brief review of the biological and hormonal mechanisms involved in the control of sexual behavior.

Overall, the book provides a condensed, yet clear, comprehensive, and very useful overview of the field of juvenile sex offender evaluation and treatment. The relevant research is presented in an objective and dispassionate way. As a forensic psychiatrist who often evaluates adult sex offenders, some of whom have only offended as juveniles, I found the book a valuable source that helped me to supplement my knowledge of the adult-sex-offender–related literature.

• © 2014 American Academy of Psychiatry and the Law