The Effective Treatment of Juveniles Who Sexually Offend: An Ethical Imperative

Abstract

This article raises serious concerns regarding the widespread use of unproven interventions with juveniles who sexually offend and suggests innovative methods for addressing these concerns. Dominant interventions (i.e., cognitive-behavioral group treatments with an emphasis on relapse prevention) typically fail to address the multiple determinants of juvenile sexual offending and could result in iatrogenic outcomes. Methodologically sophisticated research studies (i.e., randomized clinical trials) are needed to examine the clinical and cost-effectiveness of cognitive-behavioral group interventions, especially those delivered in residential settings. The moral and ethical mandate for such research is evident when considering the alternative, in which clinicians and society are willing to live in ignorance regarding the etiology and treatment of juvenile sexual offending and to consign offending youths to the potential harm of untested interventions. Encouraging signs of a changing ethical climate include recent federal funding of a randomized clinical trial examining treatment effectiveness with sexually offending youths and the introduction of separate (i.e., developmentally informed) clinical and legal interventions for juvenile vs. adult sexual offenders.

Introduction to this issue: adolescent sexual offending

“…They conclude, perhaps not surprisingly, that therapeutic engagement needs to be improved in the interest of treatment effectiveness. Their study illustrates the importance of identifying specific issues that are relevant to improving the overall therapy provided to adolescent sexual offenders and is consistent with an emerging body of literature (Letourneau & Borduin, 2008) that stresses the need for specialized treatments with demonstrated effectiveness rather than more general treatments.…”

“…Future research should focus on evaluating effective treatment components for adolescent sex offenders and pinpointing specific aspects of treatment most responsible for decreasing the risk of sexual recidivism. This could provide an antidote to the caution of Letourneau and Borduin (2008), who noted that too many unproven treatments are routinely administered with adolescent sexual offenders. The issue is one of effectiveness and clinical ethics: it is unfair to administer an unproven treatment to adolescent sex offenders and conclude that treatment is ineffective in reducing sex offender risk, thereby providing support to a punitive case disposition.…”

Assessing risk in adolescent sexual offenders: recommendations for clinical practice

“…Moreover, this treatment is fiscally responsible, as it can be administered in a cost effective manner (Farrell & O'Brien, 1988; see also Borduin & Kleitz, 2003;Caldwell, Vitacco, & Van Rybroek, 2006). 4 One concern outlined by Letourneau and Borduin (2008) is that unproven interventions are routinely administered in treatment settings. They recommended using interventions that have shown promise in controlled treatment studies of adolescent sex offenders.…”

Service Approaches for Youths Who Commit Sexual Crimes: A Call for Family-Oriented Models

“…The service sector has also commonly used unsound approaches to reducing youth sex offending (Lobanov-Rostovsky, 2010). The widespread application of under-studied services suggests the field is endorsing an unethical, archaic, and often times punitive approach to addressing youth sex offending behavior (Letourneau & Borduin, 2008).…”

“…Services argued to be appropriate for symptom reduction operate under the assumption that juveniles will have similar re-offending trajectories as adults, punitive approaches will prevent future offenses, and deviant behaviors are unchangeable (Letourneau & Miner, 2005;Caldwell, 2007). Despite the popular philosophy that youths and adults ought to be treated similarly, evidence supporting this claim is lacking Metzner, Humphreys, & Ryan, 2009;Ryan, Leversee, & Lane, 2010b;Hunter & Longo, 2004), as randomized clinical trials have yet to test the overall effectiveness of adult-based approaches for juveniles (Hunter & Becker, 1999;Letourneau & Borduin, 2008).…”