Executive Dysfunction Predicts Delinquency But Not Characteristics of Sexual Aggression Among Adolescent Sexual Offenders

Abstract

Our aim in this study was to evaluate executive function and its relationship to delinquency and sexual crime in adolescents incarcerated for sexual crimes. Based on self-report data, 196 male adolescent sexual offenders from a Midwest state reported high rates of executive dysfunction. Although such deficits did not relate to the number of victims of sexual abuse, severity, or degree of force used in commission of the sexual crimes, poor executive function was significantly predictive of both general delinquency and felony theft. In both measures of delinquent conduct, behavioral regulation dysfunction was predictive of the frequency of commission of the crimes, whereas metacognition was not. Research and treatment implications are offered.

Keywords

Behavior Rating Inventory executive function

Literature Review

Executive functioning is the ability to react in an adaptive way, to conceptualize and modify plans, to monitor interpersonal interactions, to self-regulate emotions, and to inhibit automatic cognition and behavior, and is seen as a requirement for appropriate navigation of human interactions (Hoaken, Allaby, & Earle, 2007; White et al., 1994). Unsurprisingly, across age groups, deficits in these skill areas are highly correlated with many conduct disorders, with associated cognitive and behavioral impulsivity, and with antisocial tendencies (Brower & Price, 2001; Craig, Browne, Beech, & Stringer, 2004; Villemarette-Pittman, Stanford, & Greve, 2002; White et al., 1994). Deficits in executive functioning have also been correlated to delinquency, criminality, and violent offenses, although many findings are from preliminary or pilot studies, and researchers appropriately hesitate to report a direct causal relationship (Hoaken et al., 2007; White et al., 1994).

Executive dysfunction has been measured via neurophysiological exam, performance-based evaluations, and self-report data in adult male incarcerated criminals (Hoaken et al., 2007), severely delinquent male children (White et al., 1994), adult male sexual offenders (Craig et al., 2004; Stinson, Becker, & Tromp, 2005), and adolescent male sexual offenders (Craig et al., 2004; Fago, 2003; Kelly, Richardson, Hunter, & Knapp, 2002). Although researchers have measured executive dysfunction differently in these discrete groups using the above-mentioned methodologies, their results indicate discernible, common, and often overlapping executive functioning deficits across these groups, supporting the validity of executive dysfunction as at least co-occurring with both nonsexual and sexual criminality. Several specific explanations hypothesizing why executive dysfunction is related to or may, in part, cause delinquent and criminal behavior for some youth appear thematically across the studies, including inability to control impulse (Craig et al., 2004; Kelly et al., 2002; Stinson et al., 2005; White et al., 1994), inability to regulate and gauge emotion (Hoaken et al., 2007; Stinson et al., 2005), inability to correctly interpret social cues (Hoaken et al., 2007; Kelly et al., 2002; White et al., 1994), and inability to process interactions quickly enough to illicit an appropriate behavioral and emotional response (Kelly et al., 2002). Obviously, not all youth with such difficulties commit criminal behavior, and other factors may influence such behavior including genetics (Moffitt & Caspi, 2007) and other issues.

The examination of the linkage between impulsivity and criminality, aggression and violence, is relevant for understanding the dynamic between violent and nonviolent criminality, and the application of these differences to treatment and prevention initiatives (Fago, 2003; Hoaken et al., 2007; Villemarette-Pittman et al., 2002). For example, one set of researchers found that adult offenders incarcerated for criminal behavior had significantly greater executive dysfunction than the general population (Hoaken et al., 2007). Those incarcerated for violent crime perform very poorly on executive function measures of planning, cognitive flexibility, and impulsiveness, but even more so than those incarcerated for nonviolent crime (Hoaken et al., 2007). This suggests that severity of executive dysfunction may escalate violent behavior, illuminating at least one pathway linking executive function to characteristics of criminality.

Researchers have hypothesized executive dysfunction as a causal antecedent to adolescent criminality, delinquency, and youth conduct disorders (Fago, 2003; Kelly et al., 2002; White et al., 1994). For example, in examining this possible relationship in delinquent and criminal sample groups, deficient impulse control has been shown to interfere with a youth’s ability to factor impending consequences into decision making (Fago, 2003; White et al., 1994) while incorrect cognitive or behavioral shift due to slowed informational processing has been shown to result in disinhibited behavior (Fago, 2003; Kelly et al., 2002). The correlation between the criminal actions of these youth and their disregard for consequences and incorrect processing of social cues might be explained by heightened impulsivity and deficiency in cognitive and behavioral control; both characteristic markers of poor executive function (Kelly et al., 2002; White et al., 1994). Like adult male criminals, male youth may also be more prone to aggression and delinquency than less disinhibited controls because of significant executive dysfunction, but this link requires more research and understanding (Hoaken et al., 2007; Villemarette-Pittman et al., 2002; White et al., 1994).

Compared with research on violent offense or delinquent youth, the findings on adult males who sexually offend are unfortunately few and far between, and much less conclusive. It has been theorized that the shallow affect, lack of remorse and empathy, impulsivity, and sensation-seeking behaviors characteristic of psychopathy and antisocial behavior (Stinson et al., 2005), as well as depressive symptomatology (Craig et al., 2004; Stinson et al., 2005), may stem from a deeper inability to utilize emotional control and cognitive inhibition, both key components of executive function (Stinson et al., 2005). Despite this hypothesis, measures of psychopathy and depression failed to predict sexual re-offense in a group of adult sexual and nonsexual offenders (Stinson et al., 2005). Interestingly, and in agreement with conclusions about the link between executive dysfunction and general criminality (Hoaken et al., 2007), poor performance on measures of impulsivity correlate with both nonsexual violent and nonsexual nonviolent re-conviction (Craig et al., 2004). The lack of conclusive findings by Stinson et al. (2005) and Craig et al. (2004) does not suggest that sexual offenders, versus nonsexual violent and nonviolent offenders, possess elevated impulse, emotional, or cognitive control (in fact, results support the opposite), but rather that executive dysfunction, or perhaps available models and measurements of executive dysfunction, does not consistently predict a sexual offender or sexual re-offender profile (Craig et al., 2004; Stinson et al., 2005). More research is needed to confirm a relationship between sexual offense and poor executive function for adult offenders.

However, and similar to adult male sexual offenders, adolescent male sexual offenders have been shown to perform poorly on measures of executive function, exhibiting decreased cognitive and behavioral control (Kelly et al., 2002). And like nonsexual delinquents (White et al., 1994), this suggests that adolescent sexual offenders also experience deficient impulse control and a failure to appropriately process information, resulting in risk taking, and often criminal behavior (Fago, 2003; Kelly et al., 2002). Adolescent sexual offenders have been reported as having marked deficits in adaptability, high behavioral impulsivity, and antisocial behavior (Fago, 2003; Kelly et al., 2002), which also characterize adolescent nonsexual criminals, predicted by executive dysfunction (White et al., 1994). Therefore, deficits in executive function may explain or offer a predictive insight into sexual aggression and sexual criminality (Fago, 2003). Currently, no study to date has investigated how executive dysfunction in adolescent sex offenders may cause or predict sexual crime. By understanding the role that executive functioning plays in antisocial or criminal behaviors, clinicians and researchers can more effectively target deficit areas that may mediate criminal actions and behaviors. As such, the primary aim of this study is to add to the literature with a description of executive functioning in adolescent sex offenders and to, for this sample, examine the relationship between executive functioning and sexual and nonsexual criminal behaviors.

Method

Sample Characteristics

The youth were on average 17.15 years of age (SD = 1.73 years) and in the 10th grade (SD = 1.65 grades). As is not uncommon in adolescent male sexual offender samples (Burton & Meezan, 2004), the largest racial group was Caucasian (48.5%), followed by African American (26.5%), Hispanic/Latino (5.1%), and Native American (4.1%); 7.1% were other, including Asian Pacific Islander. A number of the youth did not offer their race (8.7%).

A previously developed scale of severity of perpetration of sexual aggression using a 14-point rank order scale, which runs from 1 = exposure to 14 = penetration, oral sex, exposure, and fondling, was used to get a sense of sexual crime level (Burton, Miller, & Shill, 2002). Youth were asked about every sexual crime they have committed and this measure combines the various acts into one score. The average perpetration severity level across the sample was 8.17 (SD = 4.95 levels). A score of 8 = penetration (vaginal or anal) and exposure. More than 69% of the sample reported committing some form of penetration (including oral sex) and close to 50% committing some form of vaginal or anal penetration. The sample (n = 165) reported a total of 340 victims (some did not fill in the question) with an average of 2.06 victims each.

Measures

For the purposes of this study, a detailed demographic and history form was used, previously used in earlier studies (Burton, 2003; Burton et al., 2002), which has questions on life history and sexual aggression. From this measure, a number of behavioral scales were derived, including a scale of severity of sexual aggression using a 14-point rank order scale, which runs from 1 = exhibitionism or voyeurism to 14 = penetration, fondling, and exhibitionism or voyeurism, and number of victims. Reliability testing for this entire instrument yielded an alpha of .86, with an 8-week test–retest agreement of 79% (Burton & Fleming, 1998) for a subsample.

The Self Report Sexual Aggression Scale (SERSAS) is a multi-item inventory used in prior studies (Burton, 2003; Burton et al., 2002). The scale measures sexually aggressive behaviors over the life span. Questions about several sexual acts are all prefaced with “Have you ever conned or forced someone to . . . ?” This instrument is essentially a checklist of relationships and acts with an 8-week test–retest agreement, for a small sample of 96% (Burton & Fleming, 1998). The aforementioned 14-point rank order scale that measures severity of perpetration of sexual aggression is derived from this measure.

Elliot, Huizinga, and Ageton’s (1985) Self-Reported Delinquency (SRD) Measure was used to assess delinquency. The scale has 32 questions using a 7-point frequency scale from 0 (never) to 6 (2 to 3 times per day) on questions ranging from drug use to aggression. Inter-term reliability was sound for most of the subscales of this measure with General Delinquency (sans the question on sexual aggression as we measured this in other ways) α = .65, Property Damage α = .72, Felony Theft α = .86, Public Disorderly α = .68, Alcohol Use α = .82, Drug Use α = .31 (not used in further analyses), Robbery (only one item), Felony Assault α = .77, and Drug Sales α = .70.

The Behavior Rating Inventory of Executive Function (BRIEF) is a tool commonly used in diagnosing Attention Deficit Hyperactivity Disorder (ADHD) and Pervasive Developmental Disorder (Autism Spectrum Disorder) among children aged 5 to 18 years (Giola, Isquith, & Kenworthy, 2000). The cross validity of the BRIEF has been demonstrated with several instruments (Guy, Isquith, & Gioia, 2004). Comparative research using the BRIEF and the Child Behavioral Checklist–Youth Self-Report (CBCL/YSR) have shown significant correlation between all BRIEF scales and scores of attentional problems, aggression, and delinquent behavior on the CBCL/YSR (Achenbach, 1991a, 1991b). Analysis of the Behavioral Assessment System for Children–Self-Report of Personality (BASC- SRP) has also shown that the BRIEF Inhibit, Shift, and Emotional Control scales are consistently correlated with self-reported sensation-seeking behavior as well as anxiety, depression, social stress, and lack of self-esteem on the BASC (Reynolds & Kamphaus, 1992). Finally, self-report ratings of children with chronic illness as measured by the Child Health Questionnaire (CHQ) demonstrate significant and differentiated correlation to the BRIEF scales where behavior ratings on the CHQ correlate negatively to behavioral dysfunction as measured by the BRIEF, and emotional health and perceptions of general health functioning ratings on the CHQ correlate to the metacognitive problems as indicated by the BRIEF scores (Landgraf, Abetz, & Ware, 1996).

The BRIEF-SR (Self-Report) accurately measures abilities of inhibition, attentional shift, emotional control, working memory, planning, organizing materials, and self-monitoring, all aspects of executive function studied in both violent and delinquent behavior, and adult and adolescent sexual offense. The instrument has evidence of content, convergence, and divergent validity (Walker & D’Amato, 2006). Through factor analysis, a behavioral factor (the Behavioral Regulation Index or BRI) and a cognitive factor (the Metacognition Index or MI) are used on the BRIEF. The BRI includes the Inhibit, Shift, and Emotional Control scales, while the MI includes the Initiate, Working Memory, Plan/Organize, Organization of Materials, and Monitor scales. The Shift scale includes the total of two subscales: Behavioral Shift and Cognitive Shift. The BRI and MI are combined in the overall Global Executive Composite (GEC), designating a relative score for general executive function. Cronbach’s alphas for the BRIEF scales in the current study were acceptable, with Inhibit α = .87, Behavioral Shift α = .76, Cognitive Shift α = .72, Total Shift α = .83, Emotional Control α = .83, Monitor α = .66, Working Memory α = .88, Plan/Organize α = .85, Organization of Materials α = .75, Task Completion α = .87, BRI α = .94, MI α = .95, and GEC α = .97.

Procedure

After Human Subjects Review Board approval from the state department of youth services in a Midwestern state, data were collected in 2009 from 196 youth in six residential medium or high security delinquency facilities in Midwestern state. Surveys as described below were administered in small groups of 8 to 10 adolescents. Youth were organized so that they could not see each other’s responses.

Compensation was not provided to individuals who participated in the study. For those participants who struggled with reading (n = 4, 2%), the surveys were privately read aloud by trained graduate research assistants while the individual privately marked their answers. All youth in each facility were asked to participate via oral presentation by the researcher team. Approximately 82% of the potential respondents agreed to fill out the surveys. No data were obtained on nonresponders. Data were entered in SPSS Version 15 and analyses with SPSS Version 16.

Results

The BRIEF scores for this sample were very high (see Table 1) with the sample’s average on every scale being above the manual’s suggested clinically significant level (i.e., ≥65, above the 90th percentile of the norm sample) indicating a great amount of dysfunction in each area for the majority of the youth.

Table 1.

BRIEF Scales.

Scale	Description	M (SD) (n = )	Percentage over 60/65
Inhibit	Controls impulses and behavior; appropriately stops and modulates own behavior at the proper time or in the proper context.	77.1 (8.2)	3.7% 60-64 95.5% ≥ 65
Behavioral Shift	Adjusts behaviorally to changes in environment or schedule.	76.0 (10.2)	7.9% 60-64 87.1% ≥ 65
Cognitive Shift	Solves problems flexibly.	77.0 (12.3)	10.0% 60-64 83.6% ≥ 65
Total Shift	Moves freely from one situation, activity, or aspect of a problem to another as the situation demands; makes transitions; solves problems flexibly.	80.2 (12.3)	4.3% 60-64 90.7% ≥ 65
Emotional Control	Modulates emotional responses appropriately to situational demand or context.	79.3 (8.0)	5.2% 60-64 94.8% ≥ 65
Monitor	Aware of strengths and weaknesses; aware of own behavior and its impact on others.	72.8 (9.8)	7.7% 60-64 85.9% ≥ 65
Working Memory	Holds information in mind of the purpose of completing a task or making the appropriate response.	78.1 (9.2)	9.0% 60-64 89.5% ≥ 65
Plan/Organize	Anticipates future events or consequences; uses goals or instructions to guide behavior in context; develops or implements appropriate steps ahead of time to carry out an associated task or action.	74.3 (7.8)	13.4% 60-64 84.3% ≥ 65
Organization of Materials	Keeps work and school materials organized; able to organize environment such as backpack and bedroom.	68.3 (9.5)	7.9% 60-64 73.4% ≥ 65
Task Completion	Completes schoolwork or chores in timely fashion; finishes tests within time limits; works at a satisfactory pace.	75.4 (10.4)	6.5% 60-64 89.8% ≥ 65
Behavioral Regulation Index (BRI)	Ability to maintain appropriate regulatory control of behavior and emotional responses, including appropriate inhibition of thoughts and actions, flexibility in shifting problem-solving set, modulation of emotional response, and monitoring one’s actions.	82.9 (11.9)	0% 60-64 97.1% ≥ 65
Metacognition Index (MI)	Ability to systematically solve problems via planning and organization while sustaining task completion efforts in active working memory.	78.2 (8.4)	6.0% 60-64 94.0% ≥ 65
Global Executive Composite (GEC)	Includes all scales; an accurate reflection of level of executive dysfunction.	82.1 (11.4)	0.0% 60-64 97.8% ≥ 65

Note. BRIEF = Behavior Rating Inventory of Executive Function.

The sample also scored relatively highly on the SRD scores (see Table 2), indicating a high frequency of many nonsexual criminal behaviors including but not limited to alcohol and drug use, theft, assault, and so on.

Table 2.

SRD Scores (Sorted by Mean).

Scale	Description	M ^a	SD
General Delinquency	(carried a hidden weapon, stole or tried to steal things worth $1,200 or less, paid someone for sex, stole money or other things from family, hit or threatened to hit parents and hit or threatened to hit supervisor or employee—the sexual aggression question was taken out)	4.66	5.45
Felony Theft	(stole or tried to steal a motor vehicle such as a car or motorcycle or something worth more than $100, knowingly bought, sold, or held stolen goods—or tried to, broke, or tried to break into a building or vehicle to steal something or just look around)	3.34	5.37
Drug Use	(used inhalants such as glue, used pot/hash/weed/marijuana, used cocaine, coke, or crack, used other types of drugs)	2.97	4.33
Alcohol Use	(used alcohol or other liquor, was drunk in a public place)	2.40	3.39
Selling Drugs	(sold marijuana/pot/weed/hash, sold hard drugs such as heroin, cocaine, and Lysergic acid diethylamide [LSD])	2.06	3.57
Property Damage	(purposely damaged or destroyed property belonging to my parents or other family members, purposely damaged or destroyed other property damage that did not belong to me—not counting family or work property, purposely set fire to a building, a car, or other property—or tried to)	2.00	3.42
Felony Assault	(attacked someone with the idea of seriously hurting or killing that person, was involved in gang fights)	1.65	2.98
Robbery	(used force or strong-arm methods to get money or things from people)	0.64	1.49
Public Disorderly	(begged for money or things from strangers, used or tried to use credit cards without the owner’s permission, made obscene telephone calls—such as calling someone and saying dirty things)	0.62	1.89
SRD total	(Total of all subscales)	23.67	25.70

Note. SRD = Self-Reported Delinquency Measure.

The scale goes from 0 (never) to 6 (2 to 3 times per day).

In an effort to assess the relationship between executive functioning and criminal behaviors, the executive functioning scales were correlated with the criminality scales. In no case were any of the 13 executive functioning scales significantly related to the characteristics of sexual crimes, including total number of victims (Pearson r values ran from .023 [Planning and Organizing] to .071 [Emotional Control]), the perpetration severity score (r values ran from .002 [Metacognition] to .081 [Total Shift]), and the amount of force used in sexual crimes (r values ran from .008 [Task Completion] to .113 [Total Shift]). Next, we attempted to assess the relationship between executive functioning and nonsexual criminality (see Table 3) and some moderate and small relationships were found.

Table 3.

Pearson Correlation of SRD to BRIEF Subscales and Composite Scales.

	SRD total	General Delinquency (sans sexual aggression)	General Delinquency	Property Damage	Felony Theft	Public Disorderly	Felony Assault
Inhibit^a	.206*	.267**	.274**	.249**	.245**	.169	.106
Behavioral Shift	.168*	.229*	.242**	.158	.236**	.093	.148
Cognitive Shift	.084	.188*	.192*	.148	.196*	.059	.097
Total Shift	.156	.228*	.238**	.165	.237**	.124	.138
Emotional Control	.234**	.268**	.293**	.282**	.296**	.217*	.170
Monitor	.145	.204*	.225*	.218*	.235*	.057	.202*
Working Memory	.091	.186*	.219*	.167	.193*	.166	.020
Plan/Organize	.013	.07	.147	.134	.165	.086	−.039
Organization of Materials	−.001	.103	.143	.090	.111	.037	.021
Task Completion	.095	.174	.205*	.109	.200*	.047	.037
BRI	.171*	.228**	.246**	.149	.254**	.132	.104
MI	.072	.164	.217*	.188*	.203*	.110	.026
GEC	.111	.1958	.191*	.137	.207*	.097	.053

Note. SRD = Self-Reported Delinquency Measure; BRIEF = Behavior Rating Inventory of Executive Function; BRI = Behavioral Regulation Index; MI = Metacognition Index; GEC = Global Executive Composite.

BRIEF Scales presented as scored in the instrument.

p < .05. **p < .01. ***p < .001.

Based on the correlations in Table 3, most of the BRIEF scales are correlated to General Delinquency and Felony Theft. Using linear regression, the two BRIEF indexes, the BRI (a total of the Inhibit, Shift, and Emotional Control subscales) and the MI (a total of the Initiate, Working memory, Planning/Organizing Organization of Materials, and Monitor subscales; the subscales were not used due to potential multicollinearity) were regressed onto the General Delinquency scale, F(2) = 6.64, p = .002. Only the BRI was a significant predictor of General Delinquency, accounting for 10.3% of the variance in the frequency of General Delinquency. Similarly, a regression was used with Felony Theft, with somewhat similar results, F(2) = 7.53, p = .001, with the BRI Scale a significant predictor and the MI Scale not a significant predictor of Felony Theft. This equation accounted for 11.2% of the variance in the Felony Theft scale.

Discussion

Congruent with prior research with different—but related—samples and diverse measures (violent and nonviolent adult criminals, Hoaken et al., 2007; delinquent and sexually aggressive youth, Fago, 2003; adolescent sexual offenders, Kelly, Richardson, Hunter & Knapp, 2002), this sample had poor executive functioning. It seems that in nearly every study we reviewed, executive dysfunction was extent in the researched samples. While there may be article acceptance bias (i.e., articles with significant findings are more easily accepted), these findings are clear. In fact, in our sample (similar to the others), there are very few subjects who did not score poorly on the test of executive functioning.

The relatively high rates of poor executive functioning may partially be explained by the corresponding elevated rates of trauma, victimization, or environmental stressors among samples of youthful offenders and sexual perpetrators (Veneziano, Veneziano, LeGrand, & Richards, 2004), suggesting that critical events deemed especially traumatic may relate to impairments in information processing, impulse control, or neuropsychological development (Lee & Hoaken, 2007; Zou et al., 2013). In fact, executive dysfunction has been found to mediate the relationship between trauma and aggression (Lee & Hoaken, 2007). The complexities of these relationships require ongoing investigation, and future research using multivariate models with multiple comparison groups with sexually abused youth ought to elucidate trauma as a conceivable explanation.

These poor scores may hold significant implications for treatment approaches and cannot be overlooked. In fact, the scores are in the worst 1% to 3% of samples of youth with ADHD as reported in the BRIEF manual (Giola et al., 2000). In this sample, the BRI Scale score strongly predicted the frequency of General Delinquency and Felony Theft than the MI Scale. As the BRI Scale includes behavioral themes such as self-inhibition and problem-solving skills, this finding is congruent with prior researchers’ findings on the link between behavioral disinhibition and criminal behavior (Hoaken et al., 2007; White et al., 1994). However, despite previous research supporting the comorbidity of neurodevelopmental disorder and sexually aggressive behavior (Fago, 2003; Kelly et al., 2002; Stinson et al., 2005) as well as nonsexual criminality (Hoaken et al., 2007), little has been done to integrate targeted therapy techniques for executive function deficits into adolescent sexual offender treatment approaches (Fago, 2003).

Other features of the therapeutic process may be negatively affected when adolescents demonstrate poor executive function skills; indeed, deficits in attentional focus and self-regulation may significantly decrease a child’s or adolescent’s ability to learn (Blair & Diamond, 2008), seriously deteriorating the effectiveness of psychoeducational practice and cognitive restructuring. In addition, although our results do not suggest that poor executive functioning skills predict recidivism, a treatment focus on diminishing behavioral and cognitive impulsivity, and emotional dyscontrol, may reduce both sexual and nonsexual re-offense by targeting an underlying lack of control (Stinson et al., 2005). Fago (2003) went as far as suggesting that the focus on altering cognitive distortions in treatment may be misguided because lack of cognitive skill to make change, rather than cognitive errors, characterizes adolescent sexual offenders who demonstrate neurodevelopmental problems. The implication is that these adolescents must be taught to think, before they can be taught to think differently.

It is therefore important to take into account the effects of deficits in executive function on treatment process and outcome, and possibly re-evaluate or amend treatment procedures to include explicit emphasis on improvement of executive function. For example, incorporating family-oriented approaches has been found particularly promising for youth with executive functioning deficits (Yap, Allen, & Ladouceur, 2008). Specifically, if a client has ADHD, shortening treatment group time may make sense. If a client demonstrates impulsive tendencies, treatment using pharmacotherapy or cognitive-behavioral methods may facilitate more effective treatment outcomes (see Table 4 for other examples—all of which need to be considered case-by-case). The underlying mechanism (or mechanisms) that causes executive dysfunction is (are) not specifically known for the sexual offender population, and more research is needed to determine whether clear environmental, personal characteristics or environmental histories demonstrate significant causative effect.

Table 4.

Potential Treatments by BRIEF Scale.

Scale	With further assessment, potential treatments may include the following:
Inhibit	Treatment for Attention Deficit/Hyperactivity Disorder (ADHD), cognitive behavioral, and or pharmacotherapy.
Behavioral Shift	Practice making transitions (e.g., learning to note when classes may change or when treatment group is over, beginning with 5 min notice from facilitator/teacher). Treat Anxiety.
Cognitive Shift	Problem-solving skills, increased use of creative in vivo problem solving.
Total Shift	Anxiety reduction, therapeutic activities that increased flexibility in thinking and behavior.
Emotional Control	Mindfulness, counting strategies to increase emotional regulation, anger management.
Monitor	Increasing awareness of others’ reactions to their behavior, empathy building skills.
Working Memory	Memory building skills, anxiety reduction, teaching the benefits of goals and focus.
Plan/Organize	Vocational activities, help with planning for the day and for school, lists and the use of electronic lists and schedules.
Organization of Materials	Teaching orderliness, cleaning, structuring of work spaces.
Task Completion	Focus, goals, working one step at a time, organizing work so it does not become overwhelming, helping see the benefit of completion.

Note. BRIEF = Behavior Rating Inventory of Executive Function.

Also relevant to treatment, researchers quantifying the most beneficial features of psychotherapeutic treatment of sexual offenders have posited therapeutic relationship as the core of effective therapy, accounting in some cases for as much as twice the positive outcome of treatment than therapeutic technique alone (Marshall & Burton, 2010). In individual therapy, whereas skilled therapists may embody the essential qualities of warmth, genuineness, and empathy key to building an effective therapeutic relationship (Marshall & Burton, 2010; Rich, 2011), adolescents with severe deficits in executive function—characterized by lack of self-perspective and perspective-taking skills, and lack of empathy (Stinson et al., 2005), emotional dysregulation (Stinson et al., 2005), poor encoding skills (Hoaken et al., 2007), misattribution in ambiguous circumstances (Fernandez-Duque, Baird, & Posner, 2000), and cognitive inflexibility (Hoaken et al., 2007)—may fail to recognize or may misinterpret some or all of the intentions of the therapeutic alliance, partially or wholly undermining an otherwise beneficial practice. In group therapy, these same concerns, when unaddressed, may negatively alter outcome and inter-group environment (Dishion, McCord, & Poulin, 1999).

Research Implications

Further research with improved functional measures of executive functioning may be useful in examining the relationship of impulsivity to other psychological and behavioral variables. There are many components of executive functioning (see Table 4 for those in our study) and many measures. Defining the concept of executive functioning more clearly and using additional standardized measures aside from the BRIEF with youthful offenders could replicate findings from this study and reveal differences or similarities among delinquent youth and sexually abusive youth. There are multiple computerized response measures available including the Tasks of Executive Control (TEC; Isquith, Roth, & Gioia, 2010) measuring memory and inhibitory control, Conner’s Continuous Performance Test II (Conners, 2004) measuring learning and attention disorders, or Wisconsin Card Sort 64 (Berg, 1948) measuring attention, working memory, and visual processing. The use of such computerized assessment tools may help identify other unknown facets of executive functioning among youthful offenders.

Additional inquiry is needed into diverse parts of executive functioning, as they relate to certain psychological symptoms associated with sex offending behavior, such as psychopathy. Some linkages have been identified between callous, unemotional, or antisocial characteristics and sexual criminality (Fago, 2003; Kelly et al., 2002) and general delinquency (Morrell & Burton, 2014). Research with youthful nonsexual offenders has disentangled the role of such interpersonal styles in relation to deficits in executive functioning with elevated aggression or exposure to violence (Kimonis, Frick, Munoz, & Aucoin, 2008). Research with sexually abusive youth has begun to explore similar relationships, and has found contrary to what was previously conjectured, psychopathic traits are not related to sexual crimes; rather, they are closely associated with sexually abusive youth committing delinquent crimes (Morrell & Burton, 2014). Further research is needed to accurately delineate the influence of psychopathy to expose potential typologies of sexually abusive youth.

Perhaps the most interesting finding in the study is the lack of relationship of executive function to sexual crime characteristics, and the simultaneous solid relationship of executive dysfunction to nonsexual crimes. Several hypotheses can be developed and tested including the following: (a) Are these two behaviors (sexual and nonsexual crimes), within an individual, perhaps driven in part by different neurological paths? (b) Do those individuals who only commit sexual crimes have better executive function abilities than youth who commit sexual and nonsexual crimes? (c) How is the pattern of a specialist crime path (youth who commit only one or primarily one type of crime are specialists) related to neurological differences? Perhaps as suggested by Blanchard, Cantor, and Robichaud (2006), deficits among adolescent sexual offenders may be quite broad and therefore not specifically related to sexual crime.

Given that this study and others (Brown & Burton, 2010; Ford & Linney, 1995) have reported many nonsexual crimes committed by sexual offenders, and that nonsexual crimes (as opposed to sexual crimes) are about 4 to 5 times as likely to be re-offense crimes, we must examine the commission, characteristics, and treatment of nonsexual criminality more closely. In future, research separating youth who are solely sexual offenders and those who are “sex offender plus” (Butler & Seto, 2002) may be very useful.

Limitations

The self-report nature of executive dysfunction and delinquency in this study raises questions of validity of perceived deficits in youth compared with functional measures of executive functioning and delinquency. Although the sample size is not small, diversification and sample size increase could provide clearer or more conclusive results. The BRIEF has not been found in much research on topics of criminality, both sexual and nonsexual, regardless of population of interest, offering little comparison. Furthermore, authors of the SRD note the difficulties in assessing the reliability and validity of self-report measures of delinquency such that issues of underreporting, content validity, and degree of reliability are common (Huizinga & Elliott, 1986). Finally, as discussed previously, control and comparison groups are needed in further research.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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