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This woman is trying to stop juvenile sex offenders — by helping them

Elizabeth Letourneau is one of the country's leading experts on sex crime — why it happens and whether there are better ways to stop it. She focuses in particular on juvenile sex offenders: people who commit a sex crime before they turn 18. This is an important group to understand in the fight against child sex abuse. Juvenile sex offenders perpetrate approximately one-third of sexual offenses against minors. They are also are more likely than adult offenders to commit crimes against younger victims. That's why it's so important to figure out the most effective ways to treat them. Understanding what makes them offend and intervening in innovative ways can protect other kids.

As the director of the Moore Center for the Prevention of Child Sexual Abuse at Johns Hopkins University, Letourneau has devoted her career to trying to do just that. Letourneau and I spoke recently about why adolescents commit sex crimes, and how to stop sex abuse before it happens.

"How do we prevent child sex abuse in the first place?"

Sarah Kliff: You run a center that focuses on preventing child abuse, and most of your research looks at sex offenders, why they offend, and how to treat them. How did you get into this line of research?

Elizabeth Letourneau: I got into the field in graduate school. I’m a clinical psychologist by training and I started doing some research with a faculty member about adult sex offenders. And at a very early stage I got a lot of reinforcement from the Association for the Treatment of Sexual Abusers. I won their graduate student award, and they worked really hard to retain people like me who were doing research in this field. I could have gone down another path, but I stayed because of the warmth of this community. At first my research focused on trying to identify treatment options, recognizing that most abusers do return to their communities. But then it became more about, "How do we prevent child sex abuse in the first place?" Much of the work that happens is trying to get little kids to keep themselves safe, but that’s really assigning six-year-olds a lot of responsibility.

Sarah Kliff: What does the public misunderstand about juvenile sexual offenders?

Elizabeth Letourneau: When it comes to kids perpetrating harm is we stop seeing them as kids. We start seeing them as monsters or pedophiles or adults. When kids engage in sexual inappropriate behavior, I think we sort of reactively start to think of them as more mature because the behavior involves sex. That’s one real mistake that we make, is we automatically start to view them as adults.

When you read about the kids, the victims are referred to as children, but often the offenders are referred to as adults or young men or young adults. We take them out of childhood the minute they commit these offenses. In some states, even at very young ages, sexual offenders will be tried automatically as adults because the offenses are sexual in nature. Treating them like adults means they're treated more harshly at each stage of the process.

In most states, kids who commit sexual offenses are the only kids subjected to post-probation controls. Many have to register as sex offenders and that's then tied to housing and employment restrictions and all sorts of other things. And it can be lengthy. In South Carolina, youth have to register for life.

All of this ties back to another misunderstanding, which is that these kids are likely to re-offend. I hold my field accountable for some pretty significant missteps back in the 1980s and 1990s. Back then, there was an idea that we needed long-term residential care for these offenders because there was believed to be a high risk of recidivism. But it turns out these youth, on a whole, are not at risk for recidivism. The typical rate is about zero to five percent. Most of these kids who are caught are not going to re-engage.

Kids need clear boundaries around how to treat each other

Sarah Kliff: What do we know about recidivism among juvenile sex offenders? Why are recidivism rates pretty low?

Elizabeth Letourneau: The idea that these kids are engaging in sexual offending because they are sexually attracted or desire those things is not correct. There’s a small percent of kids who are attracted to young children. We don’t know what the percent is, but the best estimate of adult attraction to prepubescent children is one to three percent of the population. For kids, there are lots of avenues for heading towards a sex-offending path. Some of our treatment has brought this to light. We see kids who were unmonitored, engaging in a lot of delinquent behavior, kids left in developmentally inappropriate, long-term baby sitting; children who share bedrooms who span different age ranges or developmental levels; kids who are bored, impulsive. And of course across all of that is lack of knowledge of what’s appropriate.

One problem is we don't give boys or girls direct information on what you are allowed to do, and there's actually a lot of low-hanging fruit there. Younger adolescents account for a large percentage of child abuse. It's not because they're pedophiles or psychopathic monsters. They just don't know the rules. Telling 12-year-old boys, for example, "Do not touch the penises of younger kids," would be simple information that they don't get even though we let them babysit. We never say before babysitting, "Don't touch his penis." And the kid would be shocked and the parents horrified if that happened. But that's the level of information that we could start with, some pretty basic stuff that could hold great potential.

Teaching pedophiles to stop being attracted to minors generally doesn't work

Sarah Kliff: I came across your work when I listened to the This American Life podcast, where they talk about this support group you work with of mostly adolescents who are attracted to prepubescent children who want help not acting on their attraction. One of the issues that came up in that story is, among that small group, what is the best way to not offend. It seemed like there was a bit of a split among researchers about whether this is an attraction that could be changed, or if it's a permanent attraction that has to be managed.

Elizabeth Letourneau: I would say that no one in the present day would recommend reconditioning approaches [therapy that tries to re-orient an individual's sexual desires, which has previously been used in gay conversion therapy, a practice that the psychology community rejects]. Those were done with the 1980s with adults and then they were extended to juveniles. They were practiced with some well-regarded people, who I regard as mentors, but these days I would say I think most of us would view that kind of intervention with grave concern. The best case scenario is you'd only get a short-term change in arousal patterns.

So the question is, if you're sexually attracted to pre-pubescent children can you change that? There are sexologists who say that a person's so-called erotic age preference can't change. It may be like one's gender preference, which most people are born with and where there is very little wiggle room.

But with erotic age preference, there are some people who have reached out to me who have described their preferences changing. I think we haven't done enough research to know if there are subgroups, and if there really are some who might change over time. Right now, the interventions are generally premised on teaching a child and hopefully his family members how to accept themselves, feel good about themselves, and not view themselves as completely defined by this atypical sexual attraction. And then it's figuring out ways to continue to not offend against children or stop offending immediately, and maintain that for the rest of their life.

Sarah Kliff: So right now, the idea is that we can't cure pedophilia, but there's ways to work to manage it?

Elizabeth Letourneau: It's safe to say for many it will be a lifelong management issue. And that circles back to what I was saying earlier about destigmatizing help-seeking behaviors and making it okay to ask for help. It's important to get a cadre of professionals who can provide help and develop good online resources so that when people do go looking for help, they get help. They don't just get doors slammed in their faces, which is what tends to happen now.

Sarah Kliff: It was such a unique story and different perspective about pedophilia, and what it's like to struggle with that. What kind of response have you gotten since that show aired?

Elizabeth Letourneau: I get at least five emails a week since April, which for me would qualify as being inundated. I've lost count of how many people have reached out — I think its about 100 — and there doesn't seem to be any let-up. About half are from people living with this kind of sexual attraction. But many are from other walks of life. There have been several victims, parents of victims, sisters, wives of non-offending men who are success stories. I've heard from a lot of therapists and then there are citziens who just want to help, and who had never thought of people attracted to children in this light. I've been interviewed often in my 20-year career, but I've never seen something that evoked so much hope and empathy.

It's not easy to get funding to study juvenile sex offenders

Sarah Kliff: What's it like to try to apply for funding on projects about juvenile sex offenders? Is this something that groups want to spend money on?

Elizabeth Letourneau: One of my mentors told me, when I was getting started, that he didn't think I'd be able to get support. He was trying to be protective of me and get me into other kinds of more fundable work. But I've managed to string together funding for this type of work since about 2002.

A lot of my funding is in the context of a one-off grant. When the NIH was relatively fat, in the early 2000s, they funded our randomized, controlled treatment trial. They didn't fund any follow-up studies though even though it was highly successful. We went back to them but as their funding declined what they were willing to fund sex crime research went down too. We saw the same thing with the CDC, which is very interested in prevention science, and they funded one early registry study but also didn't fund any secondary research.

Where I’ve been successful is getting multiple grants the Office of Juvenile Justice, Delinquency and Prevention. The Department of Justice has a vested interest in trying to figure out what makes kids delinquent. We've been contacted by some private foundations, too, since the This American Life story. None have ponied up any money, but there's at least some interest on their part.

"Anything that improves the lives of children will probably help" prevent child sexual abuse

Sarah Kliff: What do you think a sexual offense prevention curriculum would look like?

Elizabeth Letourneau: It depends on the focus, but really anything that improves the lives of children will probably help. The risk factors for child sexual abuse are similar to those for peer victimization. So improving the outcomes of disadvantaged youths and young families would be important.

On a more targeted level, I think one place to focus is to give parents the tools and skills and language they need for addressing the sexual behavior of children from birth. They need the skills to comfortably talk with their kids using correct language about penises and vaginas even when they are very young and then adding more to the conversation as their children age into older childhood and adolescence, to talk about sex, both the great parts and the areas of concern. That includes rules about what is okay or is not okay to do at this age. Parents also need to feel comfortable talking with other adults about their concerns, including adults who provide any care taking of their children.

Those are things that families have to stumble through right now. I would also advocate for parents to ask their children, from an early age, if anyone has tried to touch their penis or vagina or asked the child to touch theirs. Kids don't show up with a sign that says "someone tried to touch my penis today" and if we don't ask every now and again, we'll miss opportunities to prevent or intervene early.

We started asking our boys these questions and others, like about bullying, as soon as people besides ourselves started providing care for them. And, 10 years later, we get a lot of eye-rolling by our sons but they are not surprised or upset by these questions. We use the same tone of voice as "How was your day at school?" which also engenders a lot of eye-rolling too.

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