Adolescent sex offenders with autism spectrum conditions: currently used treatment approaches and their impact

Aims: Offending behaviour in adolescents with autism spectrum conditions (ASC) is rare. However, some theoretical links have been drawn between sexual offending and autism-typical deficits. Although research in this area is scarce, case-studies have begun to evaluate the impact of treatments for juvenile sexual offenders with ASC. This review aimed to summarise the available treatments for this group and their impact on young people (YP).

Methods: A systematic literature review was conducted. Six online data-bases were searched for studies detailing interventions with adolescent sexual offenders with ASC.

Results: Six case-studies were reviewed. Interventions consisted of detailed assessments, staff training, peer support, medication, and adapted cognitive- behavioural therapy. One case-study used narrative techniques. Only two studies reported on objective and measurable treatment effects whilst the remainder relied solely on anecdotal evidence. Studies presenting quantitative data found a decrease in sexual arousal, absconding, sexually harmful/inappropriate behaviour, and masturbation to deviant fantasies. Anecdotal evidence pointed to increased insight, flexibility, ability to open-up, and reintegration. The overall quality of studies was low with one exception. Research and clinical implications are discussed.

Conclusions: Whilst some benefitted from the currently used treatment options, results cannot be generalised due to methodological flaws.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Andrews, D. A., & Bonta, J. (2006). The psychology of criminal conduct (4th ed.) Cincinnati, OH: Anderson.
Attwood, T. (2006). The complete guide to Asperger's Syndrome London and Philadelphia: Jessica Kingsley Publishers.
Baron-Cohen, S. (1995). Mindblindness: An essay on autism and theory of mind London: MIT.
Baxter, A. J., Brugha, T. S., Erskine, H. E., Scheurer, R. W., Vos, T., & Scott, J. G. (2015). The epidemiology and global burden of autism spectrum disorders. Psychol Med, 45(3), pp. 601-613. doi:10.1017/S003329171400172X
Beech, A. R., Parrett, N., Ward, T., & Fisher, D. (2009). Assessing female sexual offenders’ motivations and cognitions: An exploratory study. Psychology, Crime & Law, 15(2-3), pp. 201-216. doi:10.1080/10683160802190921
Belton, E., Barnard, M., & Cotmore, R. (2014). Turn the page: Learning from a manualised approach to treating harmful sexual behaviour London: NSPCC Impact and Evidence Series.
Boer, D., Haaven, J., Lambrick, F., Lindsay, W., McVilly, K., Sakdalan, J., & Frize, M. (2012). Assessment of risk manageability for individuals with developmental and intellectual limitations who offend (ARMIDILO).
Bogdashina, O. (2003). Sensory Perceptual Issues in Autism and Asperger Syndrome : Different Sensory Experiences - Different Perceptual Worlds: Jessica Kingsley.
Borduin, C. M., & Dopp, A. R. (2015). Economic impact of multisystemic therapy with juvenile sexual offenders. Journal of Family Psychology, 29(5), p 687.
Borduin, C. M., Schaeffer, C. M., & Heiblum, N. (2009). A randomized clinical trial of multisystemic therapy with juvenile sexual offenders: effects on youth social ecology and criminal activity. Journal of Consulting and Clinical Psychology, 77(1), p 26.
Bourke, J., de Klerk, N., Smith, T., & Leonard, H. (2016). Population-based prevalence of intellectual disability and autism spectrum disorders in Western Australia: A comparison with previous estimates. Medicine, 95(21), pp. e3737-e3737. doi:10.1097/MD.0000000000003737
Brown-Lavoie, S. M., Viecili, M. A., & Weiss, J. A. (2014). Sexual knowledge and victimization in adults with autism spectrum disorders. Journal of autism and developmental disorders, 44(9), pp. 2185-2196. doi:10.1007/s10803-014-2093-y
Browning, A., & Caulfield, L. (2011). The prevalence and treatment of people with Asperger’s Syndrome in the criminal justice system. Criminology & Criminal Justice, 11(2), pp. 165-180. doi:10.1177/1748895811398455
Bryson, S. E., Bradley, E. A., Thompson, A., & Wainwright, A. (2008). Prevalence of autism among adolescents with intellectual disabilities. The Canadian Journal of Psychiatry, 53(7), pp. 449-459. doi:10.1177/070674370805300710 Retrieved from https://doi.org/10.1177/070674370805300710
Cohen, G., & Harvey, J. (2016). The use of psychological interventions for adult male sex offenders with a learning disability: A systematic review. Journal of Sexual Aggression, 22(2), pp. 206-223. doi:10.1080/13552600.2015.1077279 Retrieved from https://doi.org/10.1080/13552600.2015.1077279
Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.) Upper Saddle River, NJ: Pearson/Merrill-Prentice Hall.
de la Cuesta, G. (2010). A selective review of offending behaviour in individuals with autism spectrum disorders. Journal of Learning Disabilities and Offending Behaviour, 1(2), pp. 47-58. doi:http://dx.doi.org/10.5042/jldob.2010.0419
DeHart, G. B., Cooper, R. G., & Sroufe, L. A. (2004). Child Development: Its nature and Course (5th ed.) New York: McGraw-Hill.
Dewinter, J., Vermeiren, R., Vanwesenbeeck, I., Lobbestael, J., & Van Nieuwenhuizen, C. (2015). Sexuality in adolescent boys with autism spectrum disorder: Self-reported behaviours and attitudes. Journal of autism and developmental disorders, 45(3), pp. 731-741. doi:10.1007/s10803-014-2226-3
Dopp, A. R., Borduin, C. M., & Brown, C. E. (2015). Evidence-based treatments for juvenile sexual offenders: Review and recommendations. Journal of aggression, conflict and peace research, 7(4), pp. 223-236. doi:https://doi.org/10.1108/JACPR-01-2015-0155
Endrass, J., Rossegger, A., & Braunschweig, M. (2012). Wirksamkeit von Behandlungsprogrammen. In J. Endrass, A. Rossegger, F. Urbaniok & B. Borchard (Eds.), Interventionen bei Gewalt- und Sexualstraftätern. Berlin: Medizinisch Wissenschaftliche Verlagsgesellschaft.
Erikson, E. H. (1968). Indentity: Youth and Crisis New York: Norton.
Fosdick, C., & Mohiuddin, S. (2016). Case report: Resolution of severe sexual aggression in a developmentally disabled adolescent during leuprolide acetate ase. Journal of autism and developmental disorders, 46(6), pp. 2267-2269. doi:10.1007/s10803-016-2739-z
Griffin-Shelley, E. (2010). An Asperger's adolescent sex addict, sex offender: A Case Study. Sexual Addiction & Compulsivity, 17(1), pp. 46-64. doi:10.1080/10720161003646450
Hanson, R. K., Gordon, A., Harris, A. J. R., Marques, J. K., Murphy, W., Quinsey, V. L., & Seto, M. C. (2002). First report of the collaborative outcome data project on the effectiveness of psychological treatment for sex offenders. Sexual abuse: A journal of research and treatment, 14(2), p 169. doi:10.1023/A:1014624315814
Heaton, K. M., & Murphy, G. H. (2013). Men with intellectual disabilities who have attended sex offender treatment groups: A follow-up. Journal of Applied Research in Intellectual Disabilities, 26(5), pp. 489-500. doi:doi:10.1111/jar.12038 Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/jar.12038
Hénault, I. (2006). Asperger's syndrome and Sexuality: From Adolescence Through Adulthood London and Philadelphia: Jessica Kingsley Publishers.
Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (2009). Multisystemic therapy for antisocial behavior in children and adolescents Guildford: Guilford Press.
Higgs, T., & Carter, A. J. (2015). Autism spectrum disorder and sexual offending: Responsivity in forensic interventions. Aggression and Violent Behavior, 22, pp. 112-119. doi:10.1016/j.avb.2015.04.003
Kenny, L., Hattersley, C., Molins, B., Buckley, C., Povey, C., & Pellicano, E. (2016). Which terms should be used to describe autism? Perspectives from the UK autism community. Autism, 20(4), pp. 442-462. doi:10.1177/1362361315588200 Retrieved from http://journals.sagepub.com/doi/abs/10.1177/1362361315588200
Kohn, Y., Fahum, T., Ratzoni, G., & Apter, A. (1998). Aggression and sexual offense in Asperger's syndrome. The Israel journal of psychiatry and related sciences, 35(4), pp. 293-299.
Kumagami, T., & Matsuura, N. (2009). Prevalence of pervasive developmental disorder in juvenile court cases in Japan. Journal of Forensic Psychiatry and Psychology, 20(6), pp. 974-987. doi:10.1080/14789940903174170
Lindsay, W. R. (2002). Integration of recent reviews on offenders with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 15(2), pp. 111-119. doi:doi:10.1046/j.1468-3148.2002.00112.x Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1468-3148.2002.001...
Longo, R. E., & Groth, A. N. (1983). Juvenile sexual offenses in the histories of adult rapists and child molesters. International journal of offender therapy and comparative criminology, 27(2), pp. 150-155. doi:10.1177/0306624X8302700207
Mandell, D. S., Walrath, C. M., Manteuffel, B., Sgro, G., & Pinto-Martin, J. A. (2005). The prevalence and correlates of abuse among children with autism served in comprehensive community-based mental health settings. Child abuse & neglect, 29(12), pp. 1359-1372. doi:https://doi.org/10.1016/j.chiabu.2005.06.006
McCrory, E. (2011). A treatment manual for adolescents displaying harmful sexual behaviour: Change for good London: Jessica Kingsley Publishers.
Melvin, C. L., Langdon, P. E., & Murphy, G. H. (2017). Treatment effectiveness for offenders with autism spectrum conditions: A systematic review Psychology, Crime & Law, 23(8), pp. 748-776. doi:10.1080/1068316X.2017.1324027 Retrieved from https://doi.org/10.1080/1068316X.2017.1324027
Mental Health Act. (2007). c. 9. Retrieved from http://www.legislation.gov.uk/ukpga/2007/12/contents
Mouridsen, S. E. (2012). Current status of research on autism spectrum disorders and offending. Research in Autism Spectrum Disorders, 6, pp. 79-86. doi:10.1016/j.rasd.2011.09.003
Murphy, D. (2010). Extreme violence in a man with an autistic spectrum disorder: Assessment and treatment within high-security psychiatric care. The Journal of Forensic Psychiatry & Psychology, 21(3), pp. 462-477. doi:10.1080/14789940903426885 Retrieved from https://doi.org/10.1080/14789940903426885
Murphy, G., Powell, S., Guzman, A.-M., & Hays, S.-J. (2007). Cognitive-behavioural treatment for men with intellectual disabilities and sexually abusive behaviour: A pilot study. Journal of Intellectual Disability Research, 51(11), pp. 902-912. doi:doi:10.1111/j.1365-2788.2007.00990.x Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2788.2007.009...
National Institute for Health and Care Excellence. (2016). Harmful sexual behaviour among children and young people. Retrieved from https://www.nice.org.uk/guidance/NG55
Perry, G. P., & Orchard, J. (1992). Adolescent Sex Offender Risk Check List Sarasota: Professional Resource Press.
Prentky, R., & Righthand, S. (2003). Juvenile Sexual Offender Assessment Protocol-II (J-SOAP-II) manual.
Pritchard, D., Graham, N., Penney, H., Owen, G., Peters, S., & Mace, F. C. (2016). Multi-component behavioural intervention reduces harmful sexual behaviour in a 17-year-old male with autism spectrum disorder: A case study. Journal of Sexual Aggression, 22(3), pp. 368-378. doi:10.1080/13552600.2015.1130269
Ray, F., Marks, C., & Bray-Garretson, H. (2004). Challenges to treating adolescents with Asperger's syndrome who are sexually abusive. Sexual Addiction & Compulsivity, 11(4), pp. 265-285. doi:10.1080/10720160490900614
Rutten, A., Vermeiren, R., & Nieuwenhuizen, C. (2017). Autism in adult and juvenile delinquents: a literature review. Child and adolescent psychiatry and mental health, 11(1), p 45. doi:10.1186/s13034-017-0181-4
Ryan, G., Leversee, T. F., & Lane, S. (2011). Juvenile sexual offending: Causes, consequences, and correction Hoboken: John Wiley & Sons.
Sevlever, M., Roth, M. E., & Gillis, J. M. (2013). Sexual abuse and offending in autism spectrum disorders. Sexuality and Disability, 31(2), pp. 189-200. doi:https://doi.org/10.1007/s11195-013-9286-8
Shenk, C., & Brown, A. (2007). Cognitive-behavioral treatment of an adolescent sexual offender with an intellectual disability. Clinical Case Studies, 6(4), pp. 307-324. doi:10.1177/1534650106288235
Sparrow, S. S., Balla, D., & Cicchetti, D. V. (1984). Vineland Adaptive Behavior Scales (Extended Form) Circle Pines: American Guidance Service.
Timms, S., & Goreczny, A. J. (2002). Adolescent sex offenders with mental retardation: Literature review and assessment considerations. Aggression and Violent Behavior, 7(1), pp. 1-19. doi:https://doi.org/10.1016/S1359-1789(00)00031-8
Tolman, D. L., & McClelland, S. I. (2011). Normative sexuality development in adolescence: A decade in review, 2000–2009. Journal of Research on Adolescence, 21(1), pp. 242-255. doi:10.1111/j.1532-7795.2010.00726.x
Veneziano, C., & Veneziano, L. (2002). Adolescent sex offenders: A review of the literature. Trauma, Violence, & Abuse, 3(4), pp. 247-260. doi:10.1177/1524838002237329
Visser, K., Greaves-Lord, K., Tick, N. T., Verhulst, F. C., Maras, A., & van Der Vegt, E. J. M. (2017). An exploration of the judgement of sexual situations by adolescents with autism spectrum disorders versus typically developing adolescents. Research in Autism Spectrum Disorders, 36, pp. 35-43. doi:10.1016/j.rasd.2017.01.004
Vollmer, T. R., Reyes, J. R., & Walker, S. F. (2012). Behavioral assessment and intervention for sexual offenders with intellectual and developmental disabilities. In J. Luiselli (Ed.), The Handbook of High-Risk Challenging Behaviors: Assessment and Intervention (pp. 121-144). Baltimore: Paul H. Brookes.
Wechsler, D., Kaplan, E., Fein, D., Kramer, J., Morris, R., Delis, D., & Maelender, A. (2004). Wechsler intelligence scale for children: Fourth UK edition (WISC-IV) Cambridge: Pearson.
White, M., & Epston, D. (1990). Narrative Means to Therapeutic Ends New York: Norton.
White, S. W., & Roberson-Nay, R. (2009). Anxiety, social deficits, and loneliness in youth with autism spectrum disorders. Journal of autism and developmental disorders, 39(7), pp. 1006-1013. doi:https://doi.org/10.1007/s10803-009-0713-8
Wylie, L. A., & Griffin, H. L. (2013). G-map's application of the Good Lives Model to adolescent males who sexually harm: A case study. Journal of Sexual Aggression, 19(3), pp. 345-356. doi:10.1080/13552600.2011.650715 Retrieved from https://doi.org/10.1080/13552600.2011.650715
Yates, P., & Ward, T. (2008). Good lives, self-regulation, and risk management: An integrated model of sexual offender assessment and treatment. Sexual Abuse in Australia and New Zealand, 1(1), pp. 2-19.
Yin, R. K. (2014). Case Study Research: Design and Methods (5th ed.) Thousand Oaks, California: Sage.