Assessing Sexual Interest in Adolescents Who Have Sexually Offended.

Adolescents who have sexually offended have unique treatment needs. For mental health professionals to adequately address these unique needs, further research is necessary. To that end, we explored the assessment of sexual interest (which may play an integral role in understanding potential for sexual reoffending) in a sample of 103 male adolescents who have sexually offended. We compared results from a physiological assessment (MONARCH 21 penile plethysmography [PPG]) and an actuarial assessment (Screening Scale for Pedophilic Interest [SSPI]), plus data from an unobstrusive assessment (Affinity, a viewing time measure) in a smaller subsample of 16 male adolescents. One finding that has particular relevance for clinical assessment is that the SSPI may have limited utility with adolescents. We also found evidence for some overlap between data from PPG and viewing time assessments, although whether or not PPG data are ipsatized may affect relationships with other assessment modalities.

Leuprolide acetate suppresses pedophilic urges and arousability.

Cognitive-behavioral psychotherapy was compared with cognitive-behavioral psychotherapy augmented by leuprolide acetate (LA) for suppression of pedophilic behavior. Five male pedophiles (M age, 50 years; range, 36-58) were administered LA by Depo injection for 12 months, followed by saline placebo for 12 months. Testosterone levels, sexual interest preference by visual reaction time (Abel Assessment), penile tumescence (Monarch Penile Plethysmography, PPG), as well as strong sexual urges toward children and masturbatory frequency involving thoughts of children (polygraph), were measured every 3 months. On LA, testosterone decreased to castrate levels. Penile tumescence was significantly suppressed compared with baseline, but sufficient response remained to detect pedophilic interest. Pedophilic interest was also detected by visual reaction times. When asked about having pedophilic urges and masturbating to thoughts of children, all subjects self-reported a decrease. Polygraph responses indicated subjects were not deceptive. On placebo, testosterone and physiologic arousal eventually rose to baseline. As noted by polygraph, at baseline and on placebo, subjects were deceptive regarding increased pedophilic urges and masturbatory frequency. Interest preference, as measured by Abel Assessment and Monarch PPG, was generally unchanged throughout the study. Cognitive-behavioral psychotherapy augmented with LA significantly reduced pedophilic fantasies, urges, and masturbation; however, pedophilic interest did not change during 1 year of therapy. Deceptive responses by polygraph suggested that self-report was unreliable. Follow-up utilizing objective measures is essential for monitoring efficacy of treatment in pedophilia. Our study supports the premise that suppression of pedophilic behavior is possible. LA may augment cognitive-behavioral psychotherapy and help break the sequence leading to a re-offense.