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 has led to great consternation among those who viewed the Duggar family as a model of exemplary Christian living. The recent disclosure of a police report describing accusations made about Josh’s behavior led to his resignation from a prominent position with the Family Research Council, condemnation of Josh’s parents for steps they took in response to his behavior and vigorous discussion of how to deal with adults with a history of inappropriate sexual behavior in their childhood or teen years.
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?
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Church4EveryChild 
Thanks so much, Steve for stepping in to give your perspective! I was hoping you would do that! We say we believe in redemption and ultimate restoration. The question is: when stuff like this blazes across the news front and center – Do we remember and stand tall for truth?
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Ann…thanks for your encouragement. Sadly, in a broken world, kids in Christian families are also impacted by brokenness resulting from the misuse and distortion of sexuality.
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Thank you for a good article. Is there any research you know of which shows that the Patriarchal family structure like Josh lived in produces a higher incidence of child or adult offenders?
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jsf08…thanks for joining us!
There’s not a lot of research out there on the topic, and the research that exists is somewhat dated at this point…pre-1990. Here’s a link to one study from 1987 based on a survey of 586 female undergrad students suggesting an association between father-daughter incest and patriarchal family structure: http://www.ncbi.nlm.nih.gov/pubmed/3606380
One of my take-home points from the literature review was that kids who sexually abuse other kids are, more often than not, abuse victims themselves. Second, given the wide range of factors associated with kids offending other kids, even if there was data supporting an association with patriarchal families, blaming the behavior on the family structure would be a major reach.
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Steve, would it be fair to suggest, though, that in families with extreme patriarchal structures, women – including daughters – would be less enabled to seek help and support after an assault? In other words, patriarchy doesn’t necessarily lead to abuse and/or create offenders but after an offense occurs, I suspect that women in extreme patriarchal families could be less likely to seek help. (I know in this case they did tell their father but they didn’t tell outside of the family, according to the reports and statements available.) I’m going to be doing some research on this topic tonight, but I’d love to know if you’re aware of anything already.
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Shannon, I’ve requested a copy of this study that speaks to your question. I didn’t use it because the full text wasn’t readily available and the sample size was so small.
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Thanks for your reply.
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Reblogged this on Anchor Of Promise and commented:
A great article worth reading. There are many more Josh’s out in the world and we need to find a way to help them as well as respond in a positive way that will encourage healing for all the teens and children.
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Thanks Stacy! Hope God will use this to disrupt the cycle of brokenness impacting many families brought about by sexual abuse.
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Thanks, Steve, for this great article. Now, where’s that “Like Button”?!?! Oh, I know, I’ll share this article with others!!!!
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Joy…thanks for the kind words!
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Thank you for pulling together the research and providing links to additional information. Some facts are very helpful in contrast to all the hype.
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A comment about the 10-15% of people with ID/DD being offenders. We know that this population has an extraordinarily high level of victimization, thus your point that most offenders were victimized. This is a population that often receives no training around boundaries or or self protection. They often are viewed as being non sexual or over sexualized. Often when they are abused it goes unreported because a lack of communication skills. I worry that the take away from the stat here is that people with ID/DD are likely perpetrators.
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Hi Cathy,
Thanks for your comment…let me touch on the issue with kids with ID/DD in more detail.
The overall rate of sexually inappropriate behavior among “neurotypical” adolescent males is probably around 5%. Given the vulnerability for kids with autism spectrum disorders or ID/DD to become victims and the delays in language development and executive functioning many experience, the observation that sexual behavior would bring persons with autism/ID to the attention of the legal system probably isn’t a surprise. You may have misread my comment…I didn’t say that 10-15 % were offenders, I said they committed 10-15% of the offenses, which is slightly more than would be predicted, based upon their share of the population.
Here’s a link to an item from the American Psychological Association…I’ll quote excerpts here:
High-functioning teens with autism may be difficult to spot because they don’t display typical behaviors, such as rocking and hand waving, and their language skills may be adequate. Because the features of autism are less obvious among these youth, a disproportionate number land in juvenile detention for behaviors such as obsessive following or touching others
A clinical psychologist who works for the state of Pennsylvania, observed that 43 percent of the young people in a juvenile sex-offense unit met criteria for autism. After taking a closer look, the psychologists also found that these young people weren’t improving under traditional treatment approaches for sexual offenses. For example, the standard treatment for juvenile sex offenders places a strong emphasis on learning to empathize with the victim’s point of view, as well as on putting young people into group formats that aid their socialization.
Their motives are also different from those of typical sex-offending youth, says Hughes. For instance, they may come up to someone and smell and touch their shiny hair because of sensory-stimulation needs combined with poor social skills, “not because they’re lying in wait to commit an assault,” she says.
I certainly didn’t mean to imply (nor does the data suggest) that people with ID/DD are likely perpetrators. It is an issue that brings them to the attention of the legal system, and clearly the courts and social service personnel can benefit from better education and training around the factors contributing to inappropriate sexual behavior in this population.
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Thank you so much for using your platform to educate us- thank you for using facts (as opposed to opinion) and for being purposeful about not pushing blame or shame. The article you put together will go far in helping others understand how we can best support the Duggars and others that may cross our paths who have faced similar situations.
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Pastors should report this to authorities when they become knowledgeable of this taking place.
I think that to help prevent this that pastors could preach and teach on healthy family dynamics which include illustrations about healthy closeness which would involve talking about boundaries that a healthy family would have, avoiding things like emotional incest where the parent makes a child their emotional partner because of problems in the marriage, avoiding physical incest, what emotional blackmail is from a sibling or a parent, and what healthy self-differentiation looks like for each member of a family. This would take a whole series of sermons to cover or several sermons over a period of time. This would even be a good idea to cover in premarital counseling. It would be a good idea for pastors to read and add some books to their libraries on this painful subject.
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I really appreciate this article and our Kids Ministry team is reviewing it as we have many teens serving in our ministry for whom we cannot formally background check. Any suggestions on screening teens differently than we screen adults would be most helpful.
Also, any research that suggests that lack of early and often sex education/discussion from parents as a contributing factor to adolescent perpetration? I often wonder if the lack of willingness of many parents to talk with their children about their bodies, sex and related issues can leave kids to gain their only understanding from media and other kids.
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Thank you so much for this article! I’ve found all the discussion around the Duggars so very frustrating because of the lack of grace and hope for redemption shown. I’m currently going through a similar thing with my son and daughter and find I resent juvenile and adult offenders being lumped together – they simply aren’t the same thing at all! I have found it difficult to find appropriate services for the offender – there’s plenty out there for the victims, but it took me 10 months to find the right mental health provider for my son.
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Dr. Grcevich,
Thank you for the way you treated this topic and for the studies cited.
It is tragic what has happened to this family. God only knows what triggered this behavior in Josh. What goes into developing an addict? He said he was repentant, but now we hear that he’s cheated on his wife? Does he possess the ability to respect females? And if not, how is respect developed? Can an adult learn this or is it too late?
If we were capable of making good, moral decisions without years of instruction, we would have been designed to be self-sufficient by age 3, like so many creatures in the animal kingdom. But, Parents are short on time, short on presence and short on patience, so they disengage. However, those kids need instruction and protection 24/7, till they reach adulthood. And now more than ever, given the debased nature of our culture.
My family had some major issues. I think the following (listed below) allowed abuse to exist and continue. Apologies if this is too lengthy.
ABSENCE/NEGLECT:
One or both parents not being present
Not checking in during a play date
Allowing younger kids to interacted with teens, unsupervised, or at someone else’s house
Not supervising when an outsider came into the home (borrowed from a friend)
Allowing kids or teens to play/hangout behind closed doors
POWER STRUCTURE:
“Dad is King”; everyone else (including mom) is a subject
*don’t share your opinion
*don’t disagree
*emotional punishment for intervening
*expected subjects to mind read his needs
*kids are stupid/idiots/non-people till they reach age 15
BOUNDARIES:
Not teaching your children how to say “No!”, “Stop!”, or how to cry out for help
Not responding or intervening when one child is beating up or picking on another
Not teaching children what is inappropriate touching and what the child should do if this happens
Not teaching children self defense methods to be used against ANYONE harming them
Not teaching proper boundaries or respect of self and others
DISCIPLINE:
*Fear/terror based home
*Spanking when “correct this issue” would be more reasonable
*Spanking when a 30-minute / read this book / time out would have been more productive and effective
*Allowing anger to push a spanking over the edge, into abuse (verbal and physical)
*Charging all with guilt, rather than trying to figure out the cause of the ruckus, calming down, and handling each situation with respect, patience, and dignity
PORN:
Bringing porn into the home
BODY IMAGE:
Freaking out over any talk about the body
Acting ashamed when helping us get dressed
ENGAGEMENT:
Not talking to the children
Insults
Sharing too much personal information with your children
Always angry, critical, irritated
Never kind, approachable, warm, happy
Too much family time glued to the TV
LACK OF EQUALITY:
Setting up a double standard with the chores (boys worked 1 hour a week, girls worked 10 hours)
MEDIA:
Allowing Hollywood to reprogram the kids
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Hi Anonymous,
Thanks for sharing from your experience. It would be inappropriate for me to speculate as to the specifics of why Josh developed the propensity for inappropriate sexual behavior. Here’s an article from Albert Mohler on the impact of pornography on the male brain.
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