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Introduction During the early part of this decade, an increasing number of researchers, practitioners, and clinicians, within the field of assessing and treating sexually abusive and sexually aggressive behavior, among others, have begun to address the impact of trauma on the brain, especially in young people with sexual behavior problems, Teicher (2007), Creeden, (2006), Bengis & Cunningam (2006). This information and knowledge also has direct application to those young people who also have histories of abuse and/or neglect, Ziegler, (2005), Ogden, Minton, & Pain, (2006). In particular the professionals listed above and others have addressed the impact on youth with sexual behavior problems and those who have been sexually abused. This is important because many young people with sexual behavior problems have a history of abuse and neglect. Teicher, (2008), notes that exposure to childhood abuse, particularly childhood sexual abuse, is a risk factor for development of impulse control disorders, and can lead to a cycle of violence and perpetration. Exposure to early stress can exert enduring effects on brain development that may underlie many of the consequences of exposure to sexual abuse. Research indicates there are negative effects of childhood sexual abuse on development of the hippocampus, corpus callosum, prefrontal cortex and visual cortex. Martin Kafka, MD, Clinical Associate Professor of Psychiatry at Harvard Medical School notes, that the following are risk factors for sexual recidivism in adult males: negative mood states, mood disorder, ADHD combined subtype, PTSD, Conduct Disorder, and BiPolar Dysthymic Disorder. Kafka notes that 10-15% of males with anxiety and/or depression had sexual risk taking behaviors; and that "mood and anxiety disorders may be so common among sexual offenders, that these conditions and their associated effects are not distinctly identified as correlated with recidivism." Trauma and Its Impact on the Brain Trauma resulting from early childhood abuse and neglect impacts the brain in a variety of ways. The Training & Research Institute, Inc. in Albuquerque, NM (2004) notes that childhood physical, emotional, sexual abuse and neglect can cause antisocial behavior by over-excitation of the limbic system; the primitive midbrain region that regulates memory and emotion, and the prefrontal cortex; which is associated with judgment, consequential thinking, and moral reasoning. They note, for example: 1) The left hemisphere is responsible for regulation and oversight of logical responses to a situation; and control and mediation of emotional responses generated by the right hemisphere. The impact of childhood abuse or neglect results in diminished control of emotional response, resulting in poor or inappropriate reactions to emotional situations, angry outbursts, selfdestructive or suicidal impulses, paranoia, psychosis, and a tendency to pursue intense ultimately unstable relationships. 2) The prefrontal cortex is the internal editor of emotional states, consequential thinking, moral reasoning, and reactions to emotional crisis. The impact of childhood abuse or neglect results in increased potential for depression and delinquent and criminal behavior. 3) The corpus collosum creates communication between the right and left hemispheres. The impact of childhood abuse or neglect results in a significantly smaller corpus collosum, causing nonintegrated, inappropriate responses to everyday situations. 4) The temporal lobes regulate emotions and verbal memory. The impact of childhood abuse or neglect results in poor modulation of emotions, and an increased chance for temporal lobe epilepsy. 5) The hippocampus (part of the limbic system) is responsible for the formulation and retrieval of verbal and emotional memories. …

This article promotes the use of experiential exercises in treating adolescents with sexual behavior problems. Even when exploring compulsive, impulsive, and addictive behaviors, experiential and expressive therapies can open up thinking and emotions in ways that may not occur with traditional talk therapies. Adolescents have a variety of learning styles, and some may not be easily engaged in treatment through traditional sit down, talk therapy. The use of experiential exercises in treating adolescents with sexual behavior problems provides the clinician with an opportunity to use a variety of learning styles in doing meaningful clinical work. The use of experiential exercises, takes into account that (a) adolescents are resilient, (b) adolescents learn in a variety of ways, (c) adolescents can be motivated to explore personal issues when they are engaged in experiential exercises, and (d) the use of experiential treatments can have a positive and profound impact in treating adolescents with sexual behavi...

SUMMARY This article promotes the use of an integrated (holistic) approach to treating juvenile sexual offenders. An integrated model takes into account the fact that: (a) youth are resilient, (b) youth progress through various stages of development, (c) these stages are often arrested as a result of trauma, child abuse and neglect, and attachment disorders, (d) humanistic approaches and the therapeutic relationship are essential to the healing and recovery process, (e) youth learn and work with a variety of learning styles and multiple intelligences, (f) many traditional assessment and treatment approaches can be modified and blended with an integrated approach, and (g) the use of experiential treatments can have a positive and profound impact in treating youth with sexual behavior problems.

Although a mainstay of most juvenile and adult sexual offender treatment programmes today, relapse prevention originated nearly two decades ago as a treatment for substance abuse (Brownell et al., 1986; Marlatt and George, 1984). The model, as conceived by Marlatt and colleagues, reflected an attempt to explain the acquisition and reoccurrence of addictive behaviours. While Marlatt’s original model has been criticised for its lack of theoretical consistency, it is generally based on the tenants of social learning theory and an understanding of the influence of attributions on motivational processes (Hudson and Ward, 1996).

Children and adolescents with sexual behavior problems are a growing national concern. While the field continues to make advances, we have much more work to do. We are working in a difficult and trying period for juvenile justice. It is a time when many are willing to give up on adolescents or punish them as we do adults. We have reached a point where many in our society do not know about, or care to understand, the complex issues that are the roots of violence and sexual violence in youth. Certainly their faith in the resiliency of youth has been tarnished. Nine critical areas that need to be taken into account when working with youth with sexual behavior problems are addressed. These areas include the unfortunate but continued trickle-down and use of adult-based treatment models to treat youth with sexual behavior problems, changes in juvenile law that have an impact on our ability to treat these youths effectively, the need for continued research in developing typologies for youths with sexual behavior problems and valid and reliable risk assessment scales, continued work with understanding and developing dynamic risk factors for sexually abusive youth, the need to develop better treatments for special populations of youth with sexual behavior problems, the need for a continuum of care, what constitutes best practice in treating youths with sexual behavior problems, the need for developing and refining standards of care, and the need for continued public education that supports prevention efforts to reduce sexual abuse by youth.

A sample of 231 sexual offenders was studied with respect to the progression of their offenses from non-contact sexual crimes (such as exhibitionism and voyeurism) as juveniles, to the more serious sex assaults of rape and child molestation as adults. The results of this study reveal that a significant number of offenders manifest a history of sexually inappropriate behaviors beginning in early adolescence. It appears from the study that many offenders begin to act out sexually at an early age and if left untreated may escalate to more serious sexual assaults.

Although recidivism among dangerous sexual offenders is generally reported to be low, clinical experience suggests otherwise. In order to assess the actual recidivism rate of offenders who commit sexual as saults, we administered to a sample of eighty-three convicted rapists and fifty-four convicted child molesters an anonymous questionnaire in which they were asked a series of questions pertaining to their his tory of sexual offenses. The results indicate that the majority of the offenders had been convicted more than once for a sexual assault. Furthermore, on average, they admitted to having committed two to five times as many sex crimes for which they were not apprehended. This study suggests that dangerous sex offenders usually commit their first sexual assault during adolescence, and that they persist in this criminal behavior, but that the offense has low visibility. For this reason recidivism, as judged by rearrests, is not a dependable measure of rehabilitation of the sexual offender.