Vol. XXIX, No. 2
Spring 2017
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Sexual deviance or social deviance: What MRI research reveals about pedophilia
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Assessing the Risk of Child Pornography Offenders:
Development of the Child Pornography Offender Risk Tool (CPORT)
Moral Reasoning in Juveniles Who Sexually Offend
HMP Whatton: working with diverse groups in prison
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Do paraphilic sexual interests increase the risk for sexually coercive behavior? A population-based twin study
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Deliberate Practice for Psychotherapists: A Guide to Improving Clinical Effectiveness
Ethical Porn for Dicks: A Man’s Guide to Responsible Viewing Pleasure
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Moral Reasoning in Juveniles Who Sexually Offend
by Norbert Ralph
   Private Practice
   San Leandro, CA

The establishment of a juvenile justice system, and Supreme Court decisions eliminating the death penalty, or life imprisonment for juveniles, is related to a view that adolescents are different in their thinking, motivations, and prognosis than adults regarding criminal behaviors (Steinberg, 2014). Developmental psychology and related research from brain development provide useful empirically grounded theories to understand the changes that occur in prosocial or moral reasoning during adolescence that have influenced the juvenile justice system. These developmental theories are as basic to understanding adolescence as the parallel biological changes regarding physical and sexual development. They are part of the universal biology of adolescence and basic to any work with this age group. As the body is changing physically and sexually, the youth's drives, interests, behaviors, and reasoning about life and relationships, including sexual issues, is developing. Just as we wouldn't want to treat medical problems of an adolescent without knowledge of adolescent diseases, anatomy, physiology, and growth, we are wise to be similarly informed regarding the best scientific evidence regarding developmental changes in prosocial reasoning and related areas in dealing with juvenile sexual offending. As described in this article, the developmental perspective provides useful and practical assessment methods for this population.

Youth on probation, including those who sexually offend, have engaged in some law violation which may be the result of deficits in prosocial reasoning. Therefore, tools to assess those deficits, and likewise interventions to promote prosocial reasoning skills would be beneficial to the field. The instruments to measure prosocial reasoning are closely related to clinical experience, provide objective measurement, and can be used to evaluate treatment outcomes. This contrasts with a style of clinical writing where developmental concepts are used as principles to organize clinical impressions and interventions, but without reference to the empirical measurement used to evaluate treatment outcomes.

A term used in this article, which may need clarification, is prosocial reasoning. Equivalent terms would be moral reasoning or social problem solving. Prosocial is the antonym of antisocial and refers to thinking and associated behaviors that promote desirable outcomes for the individual and others while following relevant laws and social norms. While the term antisocial usually describes "win/lose" interactions, prosocial refers to "win/win" interactions, where both parties benefit. To behave prosocially means the person is simultaneously tracking their own needs, while being aware of the needs and rights of others, and while being aware of the short and long-term consequences of behaviors, formal and informal customs, as well as rules and laws. Prosocial interactions with others which are mutually beneficial, in business or life, are usually the most advantageous, because they create the basis for future such relationships, without conflicts or adverse side effects. Also the term "juveniles who sexually offend" (JwSO) as used here describes behavior, not the person. Terms and words matter. The term “sex offender” implies a chronic behavioral pattern inconsistent with our understanding of these youth, especially given Caldwell's (2016) finding of a sexual recidivism rate of 2.75%. Finally, the research described below relates primarily to males, for a variety of reasons, including the lower prevalence of sexual offending among females, and far less scientific literature available.

This article will review relevant assessment tools for moral and prosocial reasoning, their utility with justice involved youth in general, and their application to JwSO specifically. Many issues are important to address with JwSO, such as the multiple consequences at home, school, family, and their life in general regarding their being on probation, and the stigma of their offense. Important areas may also include any prior victimization, school achievement problems, delinquent peer group issues, neighborhood and environmental factors, family dysfunction, substance abuse, and comorbid psychiatric issues. Prosocial or moral reasoning is proposed here as an additional factor to be considered as a focus of assessment and treatment with JwSO.  

While bodies grow and develop from ages 10 to 25, so do the brains of adolescents, but in not so obvious ways. Although the size and major topography of the brain is largely complete at 10 years old, the interconnections and pathways of the brain continue to undergo major changes that continue past age 25. In the book,The Teenage Brain Jensen (2015) describes adolescent neuropsychological development. Major changes occur in pruning of neural pathways and myelination, while some brain regions continue to develop. There is a decline in gray matter and unmyelinated cells, with a concurrent increase in white matter. Jensen notes that the teen brain is only about 80% mature, and the outstanding 20% is the difference between adolescence and prosocial adulthood. Steinberg (2014) notes brain structure and functioning changes in adolescence are related to behavioral changes, and increased drive levels, and reward seeking generally, not limited to sexual interests. This is reflected in many ways, and one example is the predictable increase in all cultures of accidents in adolescence. This "accident spike" is complemented by a dramatic increase in sexual offending, with the highest incidence at age 14 (Steinberg, 2014). This is complemented by the increase in testosterone particularly in males during this period as well. Adolescents dramatically increase in size and strength, and after puberty have adult sexual capabilities regarding reproduction and function. Sexual drive is also increasing dramatically during this period. Typically the "eyes on" direct supervision for the average 12-year-old is far greater than for the 16-year-old. While impulse and drive, freedom, and abilities are increasing, judgment is still developing. If-then and cost-benefit thinking is a major area of growth during adolescence that is essential for the transition from adolescent to adult problem solving. Bonner (2012) describes early adolescence as a transitory developmental period, when youth are at high risk for committing illegal sexual behaviors that in no way reflect lifelong incurable sexual disorders.

With the rise of neuropsychology in the past 30 years, developmental theories related to prosocial reasoning have begun to be linked with brain functioning (Watson, 2002). Probably the best-known developmental theory with assessment tools related to prosocial or moral behavior is Kohlberg's theory of moral development (Kohlberg, 1984). Based on Piaget's work, moral development occurs in universal fixed stages where each stage represents a greater level of moral reasoning and complexity. Each stage defines the person's moral perspective and associated rules they use to govern one’s behaviour. Kohlberg's theory describes six stages which can be grouped into three levels of two stages each: pre-conventional, conventional and post-conventional. The three levels and six stages are shown below and are adapted from Kohlberg (1984).

Kohlberg's Model of Moral Development

  • Level 1 (Pre-Conventional)
    • Stage 1. Obedience and punishment orientation
      • (How can I avoid punishment?)

    • Stage 2. Self-interest orientation
      • (What's in it for me?)
      • (Paying for a benefit)

  • Level 2 (Conventional)
    • Stage 3. Interpersonal accord and conformity
      • (Social norms)
      • (The good boy/girl attitude)

    • Stage 4. Authority and social-order maintaining orientation
      • (Law and order morality)

  • Level 3 (Post-Conventional)
    • Stage 5. Social contract orientation

    • Stage 6. Universal ethical principles
      • (Principled conscience)

A central dilemma in moral reasoning for any individual is how to get one’s needs met, and accomplish individual objectives, without violating the rights of others, and associated social rules and laws. Without an internalized moral compass individuals are at risk for antisocial behavior. In the Kohlberg view, violating the law and others' rights is more likely to occur at the Preconventional Level. The person at these stages does not yet have an internalized view of social rules and laws as something that need to be followed, while simultaneously getting his/her own needs met. At the Conventional level, the individual is motivated by these internalized rules and Stage 3 and Stage 4 describe sequential steps in moral development. Older adolescents, and particularly adults who don't develop at a Stage 3 level, because of their increased size, strength, and decreased supervision by others, are at greater risk for antisocial behaviors. In what follows, the focus will be on the use of selected instruments of moral reasoning and relevant theories with juvenile populations. Their use with the general juvenile probation population will be discussed first, and then their use with JwSO.

The Kohlberg levels can be assessed using the Moral Judgment Interview (MJI; Kohlberg, 1984). This tool elicits answers to various moral dilemmas, which can then be reliably coded and classified according to the Kohlberg stages. While well researched, the Kohlberg MJI instrument takes significant time to complete, and uses examples unfamiliar to many youth. To address this, alternative measures were developed using the Kohlberg framework. One measure is the Sociomoral Reflection Objective Measure (SROM-SF; Basinger & Gibbs, 1987). The SROM-SF has two moral dilemmas and 12 questions. Respondents indicate which options reflect their own thinking, which are then scored according to the moral reasoning stages. Another measure is the Sociomoral Reflection Measure-Short Form (SRM-SF; Gibbs, Basinger, & Fuller, 1992). The SRM-SF contains 11 items which ask the respondent to evaluate and justify the importance of sociomoral values, including such concepts as contracts, truth, affiliation, life, law, property, and justice. Introductory statements are followed by questions, which require respondents to generate their own answers. Another instrument assessing the Kohlberg model is the Defining Issues Test (DIT) (Rest, Narvaez, Thoma, & Bebeau, 2000), which is a well-researched instrument for assessing moral reasoning. This approach examines what types of moral schemas are activated when individuals are presented with certain types of problems or dilemmas.

Other measures of moral reasoning are available. The How I Think Questionnaire (How I Think Questionnaire, n.d.) has been used to show positive outcomes in the EQUIP Program, designed to promote moral reasoning and decrease cognitive distortions in delinquent youth (Brugman & Bink, 2011). The Prosocial Moral Reasoning (PROM) is another instrument with a significant body of research that has been used to assess prosocial and moral reasoning in adolescents (Carlo, Eisenberg, & Knight, 1992; Siu, Shek, & Lai, 2012). An overall score provides an indicator of the developmental level of the respondent's prosocial reasoning. The Moral Judgment Test (MJT) (Feitosa, et al., 2013; Lind, 2015) assesses moral reasoning by examining how the subject deals with counterarguments to their views on difficult problems. The respondent rates statements regarding the story on a scale from acceptable to unacceptable on a nine-point scale.

Another instrument, not from the Kohlberg tradition, has been used to study moral or prosocial reasoning in youth on probation. The Roberts Apperception Test for Children-2 (Roberts 2; Roberts, 2005) involves showing pictures and asking the youth to make up a story that has several elements, including what was going on before, what are people thinking and feeling now, and what is the outcome. Its theory is developed from careful examination of responses of youth on this test and develops a conceptual framework to describe the changes that occur in thinking over time. It has well-documented and appropriate psychometric qualities. Responses can be interpreted as increasing levels of prosocial thinking and reasoning, which increased with age. Two scales especially relevant for assessing prosocial reasoning are problem identification and resolution. The Problem Identification scale measures the ability to identify problem situations, feelings and behaviors, prior circumstances, and internal processes. The Resolution scale similarly measures increasing levels of constructive problem resolution, which include the steps involved in solutions, and how relevant feelings are addressed in addition to the practical situation.

Similar to the developmental theories of Piaget and Kohlberg, successive levels of development in the Roberts 2 are characterized by increasing complexity and differentiation in responses. The Roberts 2 adds an important perspective to understanding moral or prosocial development during the teen years. In a previous publication (Ralph, 2012), I described how research identified that a difference between adults and adolescents is the use of "if-then" thinking regarding the "cost-benefit" calculation of situations. Regarding a hypothetical situation, such as riding a bike down stairs, compared to adolescents, adults are able to think through the upside versus the downside of such behaviors, and quickly make a decision. Adolescents have to think through the options, and use different parts of their brain compared to adults. Prosocial reasoning is not just a rule to be used, it's the ability to better understand the situation, its antecedents, people's motives, behavioral alternatives, and the likely consequences of behaviors.

Unpublished research was done by the author with the Roberts 2 using probation and normative samples (Ralph, 2007). The samples were matched for age and ethnicity, with 66 youth on probation and 68 youth from a nonclinical sample. The summary of the Problem Identification and Resolution scales was used as a measure to see if youth on probation could be differentiated from the normative sample, and indeed the AUCs were impressive for Problem Identification (0.92) and Resolution (0.88). In a separate publication, similar materials were used as part of a stimulus for a clinical intervention with youth on probation, to help elicit and enhance their social problem solving skills (Ralph, 2016b).

The research review up to now has been on youth on probation and prosocial reasoning. I will now review some of my research on JwSO youth specifically. The Washington University Sentence Completion Test (WUSCT) is a projective type instrument, which uses a sentence completion to assess the youth's level of ego functioning (Hy & Loevinger, 1996). This model and its stages very closely mirror's Kohlberg's levels of moral reasoning. This instrument's focus is on the individual's view of self, social relations, rules and values. It is a broader concept than the Kohlberg model of moral reasoning, but also includes it. It was hypothesized that this broader perspective more accurately reflected prosocial development in adolescence. The underlying hypothesis, generated from the Roberts 2 data, was that prosocial reasoning involves seeing the self, roles, and relationships in more complex ways captured by this instrument. The consequences of more complex development is the capacity for more prosocial behavior.   Respondents can be assigned to one of eight levels of interpersonal maturity. Data is available for the WUSCT with JwSO from several male samples described in a previous publication (Ralph, 2015a). The first sample included 14 youth in a residential program for the treatment of sexual offenses. The second sample included 37 youth from outpatient and residential programs for sexual offenses. The samples were compared with a non-clinical group of 46 14-year-old males (Westenberg & Gjerde, 1999).  Of the JwSO group, 92.5% were either classified as either Impulsive or Self-Protective (relatively lower levels of ego functioning), compared to 43% of the non-clinical sample. This finding is consistent with the research above indicating lower ego or moral reasoning levels among youth on probation. Although promising, there are a number of methodological limitations. The sample sizes are modest, and potential confounding variables such as SES, and verbal IQ, were not controlled in the comparisons. Replications with other samples with improved methodology would need to be done to have greater confidence in the results.

A newly developed instrument, the Prosocial Reasoning Outcomes (PRO), has been used with JwSO populations as well (Ralph, 2016b). The statistical analyses summarized here are described in greater detail in that publication. The PRO was influenced by both the Roberts 2, and the WUSCT regarding its general approach and theory regarding assessing youth on probation. It incorporates their approach of looking at the complexity of youth's view of social situations, and steps towards problem analysis and resolution as part of prosocial development. It is also more focused on prosocial reasoning specifically, which is easier to learn, test, and score. An assumption supported by existing research described above, is that youth on probation generally, and JwSO youth specifically, have delays in prosocial reasoning/ego functioning which may contribute to offending. Having adult type sexual abilities and drive, but with delays in reasoning compared to age-mates, in addition to other factors, may make these youth at greater risk for offending behaviors.

The PRO uses five vignettes and six follow up questions. There are a total of 30 responses, and each is scored as falling into one of three levels, shown below. Each successive level is seen as more complex than the one it proceeded, similar to the Roberts 2.

Level 1  Concrete: Simplistic or concrete description of feelings, rules, motives, outcomes, or consequences. Simplistic resolution of problems or feelings (e.g., "He is happy", "OK now"). Gratification of impulses is prominent, and also being overwhelmed, or helpless.

Level 2  Normative: Provides some context, contingencies, complexity, or alternatives. Perceiving and acting based on conventional rules, roles, and expectations of general society that are more than peer group values.

Level 3  Principled: Clear description of ambivalence, and alternatives, regarding feelings, rules, motives, outcomes, or consequences. Articulates concepts and/or steps regarding prosocial resolutions of problems and/or feelings.

Answers provide an indication of the level of prosocial reasoning of adolescents (ages 12 to 18). Research described elsewhere (Ralph, 2016a) uses the PRO to compare JwSO and non-probation samples. Two JwSO samples were used, all males, participating in either a High Level or a Medium Level program, based on risk level. In addition, a private high school population was used as a comparison group, 53% of which were males.


The Prosocial Reasoning Outcomes showed that there was a statistically significant ranking between the various samples with respect to PRO scores (PHS>Med>Hi), as well as an age effect, in that older youth scored higher than younger youth, (F (1,70) = 4.81, p = .03) There was also an equivalent to a six-year difference between the Medium Level JwSO program, and the Private High School program.

A partial replication of the above study was conducted using a short version of the PRO, the PRO-S. It used the first vignette only. While the full version had 30 responses to score, the brief version uses six. A sample of JwSO from a treatment validation study was used, and this is described more extensively elsewhere (Ralph, in press). The sample consisted of 37 JwSO males in either outpatient or residential treatment programs, all of whom were on probation. The other sample used was the private high school sample (Normative) described above (n = 30). The average scores on the PRO-S for the JwSO and Normative groups respectively, were 2.28 and 2.83 (F(1,68) = 15.72, p = .0002). The difference between the two populations, similar to the findings with the full version of the PRO, may be due to other characteristics that differentiate the samples, including age, educational achievement, and SES factors. Replication of the findings would be necessary to have greater confidence in these results.

Stams et al. (2006), in a meta-analysis, summarize studies regarding juvenile delinquency and moral reasoning. It complements the research described above with JwSO. Stams et al. completed a meta-analysis of 50 studies using assessment measures of moral reasoning, including some discussed above, and found lower levels of moral judgment in delinquent youth than nondelinquent youth, with a large effect size (d=.76). They concluded that developmentally delayed moral judgment was strongly associated with juvenile delinquency, even after controlling for socioeconomic status, gender, age and intelligence. They also distinguished between production and recognition measures and found that production measures produced a larger difference between delinquent and non-delinquent populations. They attribute this difference to the fact that the respondent is required to generate a moral reasoning response, rather than just recognize the right answer or desirable response. The Roberts 2, the WUSCT, the PRO, and PRO-S, described above would be classified as production measures.

In summary, there is significant evidence that prosocial or moral reasoning distinguishes youth on probation from non-clinical samples. There is also reasonable evidence that JwSO, similar to youth on probation, show differences compared to non-clinical youth. However, more research is needed to replicate and address methodological issues surrounding moral reasoning for JwSO. Specifically longitudinal designs may be useful as they allow researchers to measure moral reasoning along developmental gradients.

If moral or prosocial reasoning can help understand general and also sexual offenses, might it be modifiable and treatable? Aggression Replacement Training (ART) and Moral Reconation Therapy (MRT) are treatment methods for juveniles on probation that use a Kohlberg model of moral development. The effectiveness of ART with youth on probation is documented in a number of studies (e.g. Goldstein, Nensén, Daleflod, & Kalt, 2005). Amendola and Oliver (2010) reviewed ART evidence favorably, and noted that it is classified as a "Model Program" for the United States Office of Juvenile Justice and Delinquency Prevention, and the United Kingdom Home Office. Regarding MRT, Ferguson and Wormith (2013) reviewed 33 studies which showed a significant positive treatment effect size for adult and juvenile subjects. It is also listed as a Substance Abuse and Mental Health Services Administration evidence-based practice. Both ART and MRT are listed as beneficial practices for youth on probation by the Washington State Institute for Public Policy in their meta-analytic review (2016). Although there is emerging evidence to suggest ART is effective for JwSO (Ralph, 2012; Ralph, 2015a; Ralph, 2015b), additional and more rigorous evaluations are needed.  To this end, it would be important to assess youth in various types of treatment settings, and across risk level. Likewise age, ethnicity, and other factors such as socioeconomic status, intellectual disability, or verbal IQ might be factors that would impact treatment responsivity.

This article reviews instruments for assessing moral or prosocial reasoning in the general youth probation population. Additionally, research on instruments for assessing the same factors for JwSO is reviewed which suggests that this area may be relevant for this population as well. All the instruments reviewed for JwSO, that is the Roberts 2, WUSCT, the PRO, and the PRO-S, are either public domain or relatively inexpensive. However, it should be noted that the PRO and the PRO-S are still in development. The tools can readily be administered, and in the author's experience, these measures have adequate face validity, and appear to in fact assess moral and prosocial reasoning. Also the results closely match what is observable in counseling with these youth. This is important in clinical work where the assessment information should reflect and elucidate the youth's functioning in counseling, residential, and everyday situations.

References

Amendola, M., & Oliver, R. (2010). Aggression replacement training stands the test of time. Reclaiming Children and Youth, 19, 47-50.

Basinger, K. S., & Gibbs, J. C. (1987). Validation of the sociomoral reflection objective measure-short form. Psychological Reports, 61(1), 139–146.

Bonner, B. (2012, November 01). Don’t Shoot: We’re Your Children. What We Know about Children and Adolescents with Sexual Behavior Problems. Retrieved February 20, 2017, from Boy Scouts of America, http://www.scouting.org/filestore/nyps/presentations/Children-with-Sexual-Behavior-Problems-Bonner.ppt

Brugman, D., & Bink, M. D. (2011). Effects of the EQUIP peer intervention program on self-serving cognitive distortions and recidivism among delinquent male adolescents. Psychology, Crime & Law, 17(4), 345-358.

Caldwell, M. F. (2016). Quantifying the Decline in Juvenile Sexual Recidivism Rates. Psychology, Public Policy, and Law. Advance online publication. http://dx.doi.org/10.1037/law0000094

Carlo, G., Eisenberg, N., & Knight, G. P. (1992). An objective measure of adolescents' prosocial moral reasoning. Journal of Research on Adolescence, 2(4), 331-349.

Feitosa, H. N., Rego, S., Bataglia, P. U. R., Sancho, K. F. C. B., Rego, G., & Nunes, R. (2013). Moral judgment competence of medical students: a transcultural study. Advances in Health Sciences Education, 18(5), 1067-1085

Ferguson, L. M., & Wormith, J. S. (2013). A meta-analysis of moral reconation therapy. International Journal of Offender Therapy and Comparative Criminology, 57:1076-106.

Gibbs, J. C., Basinger, K. S., & Fuller, D. (1992). Moral maturity: measuring the development of sociomoral reflection. Hillsdale, NJ: Erlbaum.

HIT-How I Think Questionnaire. (n.d.). Retrieved December 16, 2015, from https://www.researchpress.com/books/937/hit-how-i-think-questionnaire.

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Westenberg, P. M., & Gjerde, P. F. (1999). Ego development during the transition from adolescence to young adulthood: A 9-year longitudinal study. Journal of Research in Personality, 33(2), 233-252.


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