Abstract
Prolonged exposure (PE) was used to treat chronic PTSD secondary to severe developmental trauma in two adolescent male sex offenders referred for residential sex offender treatment. Both youth were treatment resistant prior to initiation of PE and showed evidence of long-standing irritability and depression/anxiety. Clinical observation and treatment outcome data suggest that marked progress was made in reducing PTSD symptoms and improving the youth’s overall mood after 16–19 PE sessions. Abatement of PTSD appeared to have a parallel effect on improving the youth’s overall investment in his sex offender treatment and his relationship with his therapists. Results suggest that PE is feasible for treating PTSD in juvenile sex offenders, highlight the potential relevance of PTSD intervention in these youth, and help to emphasize the need to conduct more rigorous evaluations (e.g. randomized designs) of the effect of PE in improving sex offender treatment outcomes of trauma exposed youth.
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References
Abram, K. M., Teplin, L. A., Charles, D. R., Longworth, S. L., McClelland, G. M., & Dulcan, M. K. (2004). Posttraumatic stress disorder and trauma in youth in juvenile detention. Archives of General Psychiatry, 61(4), 403–410.
Abrantes, A. M., Hoffmann, N. G., Anton, R. P., & Estroff, T. W. (2004). Identifying co-occurring disorders in Juvenile Justice populations. Youth Violence and Juvenile Justice, 2(4), 329–341.
Achenbach, T. (2001). Youth self-report for ages 11–18. University of Vermont: ASEBA.
Becker, J. V., Hunter, J. A., Stein, R., & Kaplan, M. (1989). Factors associated with erection in adolescent sex offenders. Journal of Psychopathology and Behavioral Assessment, 2(4), 353–362.
Burton, D. (2003). Male adolescents: Sexual victimization and subsequent sexual abuse. Child and Adolescent Social Work Journal, 20(4), 277–296.
Cauffman, E., Feldman, S., Waterman, J., & Steiner, H. (1998). Posttraumatic stress disorder among female juvenile offenders. Journal of the American Academy of Child & Adolescent Psychiatry., 37(11), 1209–1216.
Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 393–402.
Deblinger, E., & Heflin, A. (1996). Treating sexually abused children and their nonoffending parents: A cognitive- behavioral approach. Interpersonal violence: The practice series (vol 16). Thousand Oaks, CA: Sage Publications.
Douglas, E. M., & Finkelhor, D. (2005). Childhood sexual abuse fact sheet. http://www.unh.edu/ccrc/factsheet/pdf/CSA-FS20.pdf.
Evans, W., Albers, E., Macari, D., & Mason, A. (1996). Suicide ideation, attempts and abuse among incarcerated gang and non-gang delinquents. Child and Adolescent Social Work Journal, 13(2), 115–126.
Feeny, N. C., Foa, E. B., Treadwell, K. R. H., & March, J. (2004). Posttraumatic stress disorder in youth: A critical review of the cognitive behavioral treatment outcome literature. Professional Psychology: Research and Practice, 35(5), 466–476.
Finkelhor, D., & Browne, A. (1985). The traumatic impact of child sexual abuse: A conceptualization. American Journal of Orthopsychiatry, 55(4), 530–541.
Foa, E. B., Chrestman, K. R., & Gilboa-Schechtman, E. (2009). Prolonged exposure therapy for adolescents with PTSD: Emotional processing of traumatic experiences (Therapist’s Guide). New York: Oxford.
Foa, E. B., Dancu, C. V., Hembree, E. A., Jaycox, L. H., Meadows, E. A., & Street, G. P. (1999). A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. Journal of Consulting and Clinical Psychology, 67, 194–200.
Foa, E. B., Johnson, K. M., Feeny, N. C., & Treadwell, K. R. H. (2001). The Child PTSD Symptom Scale: A preliminary examination of its psychometric properties. Journal of Clinical Child Psychology, 30(3), 376–384.
Foa, E. B., & Kozak, M. J. (1985). Treatment of anxiety disorders: Implications for psychopathology. In A. H. Tuma & J. D. Maser (Eds.), Anxiety and the anxiety disorders (pp. 421–452). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35.
Foa, E. B., & Meadows, E. A. (1997). Psychosocial treatments for post-traumatic stress disorder: A critical review. In J. Spence, J. M. Darley, & D. J. Foss (Eds.), Annual review of psychology (pp. 449–480), Vol. 48. Palo Alto, CA: Annual Reviews Inc.
Foa, E. B., Riggs, D. S., Dancu, C. V., & Rothbaum, B. O. (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress, 6, 459–473.
Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. New York: The Guilford Press.
Foa, E. B., Rothbaum, B. O., Riggs, D., & Murdock, T. (1991). Treatment of PTSD in rape victims: A comparison between cognitive-behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59, 715–723.
Friedrich, W. N., & Luecke, W. J. (1988). Young school-age sexually aggressive children. Professional Psychology: Research and Practice, 19(2), 155–164.
Hawke, J., Albert, D., & Ford, J. D. (2008). Trauma and post-traumatic stress disorder in adolescent substance use disorders. In Y. Kaminer & O. G. Bukstein (Eds.), Adolescent substance abuse: Psychiatric comorbidity and high-risk behaviors (pp. 291–321). New York: Routledge/Taylor and Francis Group.
Hunter, J. A., Figueredo, A. J., & Malamuth, N. M. (2009). Pathways into social and sexual deviance. Journal of Family Violence, doi:10.1007/s10896-009-9277-9.
Hunter, J. A., Figueredo, A. J., Malamuth, N. M., & Becker, J. V. (2003). Juvenile sex offenders: Toward the development of a typology. Sexual Abuse: Journal of Research and Treatment, 15(1), 27–48.
Keane, T. M., Fairbank, J. A., Caddell, J. M., & Zimering, R. T. (1989). Implosive (flooding) therapy reduces symptoms of PTSD in Vietnam combat veterans. Behavior Therapy, 20, 245–260.
Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993). Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113(1), 164–180.
Last, C. G., & Perrin, S. (1993). Anxiety disorders in African–American and white children. Journal of Abnormal Child Psychology, 21(2), 153–164.
Lederman, C. S., Dakof, G. A., Larrea, M. A., & Hua, L. (2004). Characteristics of adolescent females in juvenile detention. International Journal of Law and Psychiatry, 27, 321–337.
March, J., Amaya-Jackson, L., Murry, M., & Schulte, A. (1998). Cognitive-behavioral psychotherapy for children and adolescents with Post-Traumatic Stress Disorder following a single incident stressor. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 585–593.
Marks, I., Lovell, K., Noshirvani, H., Livanou, M., & Thrasher, S. (1998). Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring: A controlled study. Archives of General Psychiatry, 55, 317–325.
Mathews, R., Hunter, J. A., & Vuz, J. (1997). Juvenile female sexual offenders: Clinical characteristics and treatment issues. Sexual Abuse: A Journal of Research and Treatment, 9(3), 187–199.
McMacklin, R. A., Leisen, M. B., Cusack, J. F., & Litwin, P. (2002). The relationship of trauma exposure to sex offending behavior among male juvenile offenders. Journal of Child Sexual Abuse, 11(2), 25–40.
Mulvihill, D. (2005). The health impact of childhood trauma: An interdisciplinary review, 1997–2003. Issues in Comprehensive Pediatric Nursing., 28(2), 115–136.
Oddone, P. E., Genuis, M. L., & Violato, C. (2001). A meta-analysis of the published research on the effects of child sexual abuse. Journal of Psychology: Interdisciplinary and Applied, 135(1), 17–36.
Ovaert, L. B., Cashel, M. L., & Sewell, K. W. (2003). Structured group therapy for posttraumatic stress disorder in incarcerated male juveniles. American Journal of Orthopsychiatry, 73(3), 294–301.
Rauch, S., & Foa, E. (2006). Emotional processing theory (EPT) and exposure therapy for PTSD. Journal of Contemporary Psychotherapy, 36(2), 61–65.
Rubin, S., Spates, C. R., Johnson, D. A., & Jouppi, L. (2009). Dosed versus prolonged exposure in the treatment of fear: An experimental evaluation and review of behavioral mechanisms. Journal of Anxiety Disorders, 23(6), 806–812.
Shah, N., & Mudholkar, S. (2000). Clinical aspects of post-traumatic stress disorder in children and adolescents. In K. N. Dwivedi (Ed.), Post-traumatic stress disorder in children and adolescents (pp. 97–112). Philadelphia: Whurr.
Veneziano, C., Veneziano, L., & LeGrand, S. (2000). The relationship between adolescent sex offender behaviors and victim characteristics with prior victimization. Journal of Interpersonal Violence, 15(4), 363–374.
Wood, J., Foy, D. W., Goguen, C. A., Pynoos, R., & James, C. B. (2002). Violence exposure and PTSD among delinquent girls. Journal of Aggression, Maltreatment & Trauma, 6(1), 109–126.
Yule, W., Perrin, S., & Smith, P. (1999). Post-traumatic stress disorder in children and adolescents. In W. Yule (Ed.), Post-traumatic stress disorder: Concepts and therapy (pp. 25–50). New York: Wiley.
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Hunter, J.A. Prolonged Exposure Treatment of Chronic PTSD in Juvenile Sex Offenders: Promising Results from Two Case Studies. Child Youth Care Forum 39, 367–384 (2010). https://doi.org/10.1007/s10566-010-9108-4
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DOI: https://doi.org/10.1007/s10566-010-9108-4