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SAI-Juvenile

7. People say I spend too much time with children


much younger than myself.

Instructions
The statements in this booklet are personal. Your
answers will be kept confidential. Mark your
answers on your answer sheet.
Read each
statement carefully and choose the answer that
applies to you now. Answer each statement
truthfully. Do not give false information. Your
records may be reviewed. Any dishonesty will
likely be detected.

9. There are times when I think about exposing


my sex organs (genitals) to strangers.

There may be some statements that do not apply to


you because you do not engage in that behavior or
activity. For example, "I am sexually aroused by
dressing in the clothing of the opposite sex"
(wearing female clothing, if a male). If you have
done this and were aroused, you would answer
true. But, if you did not do this, or you did but you
were not aroused, you would answer false. Do not
read anything into these statements. There are no
trick questions.
Do not make any marks on this booklet. Mark your
answers on the answer sheet.
Starting with
statement one, answer every statement.
All statements must be answered.
Section 1
These statements must be answered True or False. If
a statement is true, put an X under T for True on your
answer sheet. If a statement is false, put an X under F
for False.
1. There are times when I worry about what
people think or say about me.

8. There have been times when I drank (beer,


wine or liquor) more than I should.

10. I have been very unhappy and depressed this


last year.
11. I have used drugs more than I should.
12. I am curious about sex.
13. I have a short temper and get angry quickly.
14. I consider my sexual behavior to be normal.
15. I usually do not like to take the time to plan
things in advance.
16. I have been sexually abused.
17. To be honest, I seem to lack gratitude,
sympathy and trust.
18. I like having fun and fooling around with
young sexy children.
19. I am concerned about my drinking.
20. I often daydream or fantasize about exposing
my sex organs (genitals) to unsuspecting
strangers.
21. I smoke marijuana (pot).
22. I often feel shaky, jittery and trembling inside.

2. I am often angry and resentful of others.

23. There are times when I am really down,


depressed and discouraged.

3. My sex life is normal and satisfying.

24. I have sexual interests and drives.

4. I make decisions quickly.

25. When somebody hurts or insults me I usually


try to get even.

5. There are times when I worry about what my


sex life will be like in the future.

26. I get frustrated quickly.

6. People tell me I am a cold, selfish and


ungrateful person.

27. I am disturbed by my intense and recurrent


sexual urges.

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28. People say I am antisocial because they think


many of my ideas would be harmful to others.

48. I often think about revenge and how I can get


even.

29. Even though I drink, I often deny drinking or


say I drink less than I really do.

49. I like to watch physically attractive and sexy


people.

30. I am attracted to and sexually aroused by


children younger than me.

50. I often act suddenly, without a lot of thought.

31. I frequently feel friendless, left out and alone.


32. I have strong urges to expose my sex organs to
strangers.

51. I have forced someone to have sex with me.


52. I enjoy child pornography.
53. When I drink my personality changes and I
seem like a different person.

33. I only do drugs when I want to relax and feel


good.

54. Just thinking of exposing my genitals to


unsuspecting strangers arouses me sexually.

34. There are times when I daydream or fantasize


about sex.

36. It bothers me when I am overlooked or ignored


by people I know.

55. Two or more of the following apply to me


(answer true or false on your answer sheet):
a. Cold or indifferent
b. Lying or manipulative
c. Unsympathetic or uncaring
d. Lack of remorse or regret
e. Unreliable or untrustworthy

37. To be honest, I am worried about my sex life.

56. I am often very lonely and unhappy.

38. People often say I am impulsive and do things


on the spur-of-the-moment.

57. There have been times when I have felt guilty


about using drugs.

39. I have obtained sexual pleasure from an


unwilling partner.

58. Fantasies and masturbation are my major


sexual release.

40. Most people in authority irritate and annoy me.

59. Two or more of the following apply to me


(answer true or false on your answer sheet):
a. Violent or dangerous
b. Fighting or argumentative
c. Explosive or blow-up
d. Lose control or uncontrollable
e. Vengeful or carry a grudge

35. I have a lot of anger, resentment and hostility


toward others.

41. Sometimes seductive children excite me and


lead me on sexually.
42. I know I drink more than I should.
43. I often think of peoples reactions when I show
them my sex organs.

60. To be honest, sex is important to me.

44. I am dissatisfied and unhappy with my life.

61. I like to do things quickly.

45. Even though I use drugs, I usually deny using


drugs, or say I use less than I really do.

62. I have done things when upset or angry that I


wish I had not done.

46. I have been offended and hurt by what


someone said about me.

63. I get angry and sometimes violent when my


sexual partner refuses to have sex with me.

47. There is something wrong with my sex life.

64. I resent authority and people telling me what I


can and cannot do.

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65. I am attracted to and sexually aroused by some


children.

83. To be honest, I often do things impulsively


without really thinking them through.

66. My drinking has caused family and social


problems for me.

84. There are times when I worry about my use of


drugs.

67. I have intentionally exposed my genitals (sex


organs) to an unsuspecting stranger.

85. My sexual urges have led to rough, ungentle


and forceful sex.

68. Two or more of the following apply to me


(answer true or false on your answer sheet):
a. Hurt, pain and suffering
b. Guilt, shame and humiliation
c. Remorse, worry and regret
d. Feeling worthless and unworthy
e. Constant stress, pressure and tension

86. Two or more of the following apply to me


(answer true or false on your answer sheet):
a. Evasive or secretive
b. Lying or deceiving
c. Cheating or stealing
d. Alcohol or drug abuse
e. Juvenile authority problems

69. I have felt strong sexual attractions toward


others.

87. I have had sexual contact with a child younger


than me.

70. I use and sometimes abuse drugs.

88. Sometimes I mix beer with wine or liquor so I


can get high (drunk) faster.

71. There are times I get so angry that I cannot


control myself.
72. I am often frustrated with my sex life.
73. There are times when I get very discouraged.
74. I have forcibly had sex with a person who did
not want to have sex with me.
75. I have sexual urges and fantasies involving sex
with young boys or girls.

89. I feel like no one really cares about me


anymore.
90. I have experimented with sex.
91. When offered drugs, I may or may not use
them. It depends on how I feel at the time.
92. There have been times when I have had the
urge to force someone to have sex with me.

76. When I drink I often get drunk.

93. There are times when I worry about my


responsibilities and happiness.

77. I have masturbated while fantasizing about


exposing my genitals to strangers.

94. I do a lot of impulsive and unexpected things.

78. I am often discouraged and feel left out or


alone.

95. To be honest, I am often hostile or angry and


sometimes can be violent.

79. Drug use is a problem for me.

96. I am in sex therapy, counseling or treatment.

80. There have been times when I have been


jealous of other peoples success.

97. I enjoy looking at naked children on the


internet.

81. I engage in unusual sexual behavior that is


considered by many as socially unacceptable
and wrong.

98. I have allowed a child younger than me to


touch or fondle my sex organs.

82. I often think about sex.

99. This last year drinking has been a problem for


me.

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100. I often feel friendless, left out and emotionally


isolated or alone.
101. My family is worried that I may have a drug
problem.
102. I like seeing strangers reactions when I expose
my genitals to them.

118. Two or more of the following apply to me


(answer true or false on your answer sheet):
a. Sudden and quick
b. Careless and reckless
c. Impatient and hurried
d. Unplanned and spontaneous
e. Not thought through and impulsive

103. Sometimes I get really frustrated and angry.

119. I have used force, or the threat of force, to have


sex over the objections of my sexual partner.

104. I can be dangerous when frustrated, insulted or


angered.

120. People often think my ideas are against society


or could be harmful to others.

105. I have been told I have a sex problem.

121. I enjoy looking at, touching and fondling


young children.

106. I fantasize or imagine my sexual partner when I


masturbate.

122. I have been told I have a drug problem.

107. I often talk before I think about what I am


going to say.

123. I have posted nude photos of myself on the


internet.

108. I have hurt or otherwise made a sexual partner


suffer.

124. I have a drinking problem.

109. I am a loner. People respect this and leave me


alone.

125. I know I am unhappy, depressed and need help.


126. I frequently think and fantasize about sex.

110. I have sexually touched or fondled a childs sex


organs.

127. I have many problems and conflicts with


others.

111. My drinking is more than just a little or minor


problem.

128. When my sexual partner says no or sexually


frustrates me, I sometimes get forceful, rough
and proceed anyway.

112. After intentionally exposing my genitals to a


stranger I leave with no attempt to have further
sexual activity with them.

129. There are times when I am very discouraged


and unhappy.

113. I do not have a support group or anybody I can


really talk to.

130. I am required to be in sexual counseling or


sexual treatment.

114. My use of drugs has threatened my happiness


and success in life.

131. I do a lot of unnecessary lying and conning


of others.

115. There have been times when I have worried


about my sexual performance.

132. I have had sex with a child under twelve (12)


years of age.

116. I have only occasionally or infrequently acted


upon my exhibitionistic (showing my genitals)
urges or fantasies.

133. There are times when it is difficult for me to


control my urges to expose my genitals to
strangers.

117. There are times when I worry about myself, my


friends and my popularity.

134. There have been times when I have been


sexually frustrated.

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135. My drug use is more than a little or minor


problem.

151. I am overwhelmed by the pain, misery and


suffering in my life.

136. When I think about some of the mistakes I


have made I get embarrassed and even upset.

152. I attend Narcotics Anonymous (NA) or


Cocaine Anonymous (CA) meetings for my
drug problem.

137. I have acted upon my sexual urges and


fantasies involving young children.
138. Two or more of the following apply to me
(answer true or false on your answer sheet):
a. Unsociable or antisocial
b. Reckless disregard of others rights
c. Opposed to societies rules and laws
d. Lie, misrepresent and con others
e. Indifferent to others welfare (health,
wealth and happiness)

153. Sex is an important part of my life.


154. I have an explosive and violent temper.
155. There are times when I really worry about
myself and my happiness.
156. People say I am hasty, careless and reckless.
157. It is difficult for me to keep close, warm and
lasting relationships.

139. I attend Alcoholics Anonymous (AA) or


Alateen meetings for my drinking problem.

158. I have forced a child to have sex with me.

140. I am alone and friendless.

159. My drinking is a serious problem.

141. I have a drug problem.

160. I often feel like I want to give up on


everything.

142. There have been times when I have been very


concerned about disapproval from others.
143. People tell me I have a quick temper and a bad
attitude.
144. I have raped or sexually assaulted someone.
145. There have been times when I have been
jealous and resentful of others.
146. I like to carefully think things through before
making decisions.
147. Over the last three months or longer I have had
recurrent, intense and sexually arousing
fantasies about exposing my sex organs to
strangers.

161. I have gone to someone for help regarding my


drug problem.
162. Two or more of the following apply to me
(answer true or false on your answer sheet):
a. Rowdy and disruptive
b. Unruly and uncooperative
c. Disrespectful and insulting
d. Vengeful and carry a grudge
e. Argumentative and quarrelsome
163. I am ashamed of some of the things I have said
or done.
164. I have been arrested for sexual assault or rape.
165. People tell me I am antisocial because I choose
not to fit in or socialize with most people.

148. I usually get upset when others criticize me.

166. To be honest, I am a child molester.

149. I am more angry, hostile and violent than most


people my age.

167. I have had two or more memory losses


(blackouts) after heavy drinking.

150. I am strongly opposed to many of my school


and community rules, policies and laws. I
disregard or ignore them whenever I can.

168. I feel strongly about my opinions and beliefs,


even though others call them antisocial.

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169. I am (or have been) an exhibitionist because


I purposely showed my sex organs to a
stranger.

187. I have never deliberately exposed my genitals


to a stranger.

170. I suffer from distressing anxiety, apprehension


and fear.

189. My sexual adjustment is disappointing and


unsatisfying.

171. Most of my problems with school


administrators and juvenile authorities have
been drug-related.

190. I never daydream or fantasize about sex


anymore.

188. I have never forced anyone to have sex with me.

191. I have a quick temper and get angry quickly.


172. I have had sex with a member of my family
(grandparent, parent, brother or sister).
173. There are times when I am concerned about my
sex life.
174. I am at my best when I shoot-from-the-hip and
do things spontaneously.
175. I often think about death, dying and suicide.
176. I am an impulsive person.
177. Drinking has interfered with my happiness and
success in life.
178. I need help to overcome the hurt, pain, worry
and suffering in my life.
179. I worry about being labeled or called a sex
offender.
180. Two or more of the following apply to me
(answer true or false on your answer sheet):
a. History of conduct disorders
b. Deceit and manipulation
c. Substance (alcohol or drugs) abuse
d. School problems or dropped out
e. Repeated problems with the law
181. I rarely think or talk about sex.

192. I put a lot of thought into decisions I need to


make.
193. There are times at home when I get really
frustrated and angry.
194. I need help to overcome my drinking problem.
195. Two or more of the following apply to me
(answer true or false on your answer sheet):
a. Vulgar or swearing
b. Forceful or threatening
c. Explosive or blow-up
d. Violent or dangerous
e. Substance (alcohol or drugs) abuse
196. I have said and done things when I was angry
or mad that I regret.
197. People say many of my ideas would be harmful
to our society. I dont agree.
198. To be honest, I am antisocial, but I still
consider myself to be a good neighbor and a
patriot.
199. Sex is not important to me.
200. People say I am a reckless, careless and
impulsive person.
201. I have never raped anyone.

182. I am a violent person.


183. I often say things I later regret.
184. I have never sexually molested a child.
185. At times I get angry and upset at myself.
186. I am concerned about being called antisocial.

202. Two or more of the following apply to me


(answer true or false on your answer sheet):
a. Hasty, unplanned or spontaneous
b. Instinctive, intuitive or untaught acts
c. Act abruptly without forethought
d. Act suddenly without deliberation
e. Act with little consideration of
consequences

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Section 2
The statements in this section have four answers. Put
an X under the number (1, 2, 3 or 4) on your answer
sheet that represents your answer.
203. During my childhood I was:
1. Sexually abused
2. Sexually assaulted or raped
3. Both 1 and 2
4. None of the above
204. How would you describe your sexual
adjustment?
1. A serious problem
2. A moderate problem
3. A slight or minor problem
4. None of the above
205. Rate your sexual adjustment on a scale from 1 to
10. One represents a good sexual adjustment
and ten represents a very bad sexual adjustment.
1. Rating 1 or 2 (good sexual adjustment)
2. Rating 3 to 5 (moderate adjustment)
3. Rating 6 to 8 (poor sexual adjustment)
4. Rating 9 or 10 (very bad sexual adjustment)

210. I have threatened or forced an unwilling


partner to have sex with me:
1. Once
2. Two or three times
3. Four or more times
4. None of the above
211. I have been convicted of:
1. Rape
2. Sexual Assault
3. Both 1 and 2
4. None of the above
212. I practice safe sex (contraceptive, condom,
rubber, etc):
1. All the time
2. Sometimes
3. Never
4. None of the above

206. I expose my sex organs to strangers in order to:


1. Shock or upset them
2. To sexually arouse them
3. So I can get relief
4. None of the above

213. Rate your exhibitionism (showing your genitals


to strangers) on a scale from 1 to 10. One
represents no exhibitionistic urges or acts
and ten represents extreme exhibitionistic
urges and acts.
1. Rating 1 or 2 (no urges and acts)
2. Rating 3 to 5 (some exhibitionistic urges)
3. Rating 6 to 8 (problem urges or acts)
4. Rating 9 or 10 (extreme urges or acts)

207. I have intentionally exposed my genitals (sex


organs) to strangers:
1. Once or twice
2. Three or four times
3. Five or more times
4. None of above

214. How would you describe your exhibitionism


(showing your genitals to strangers)?
1. A serious problem
2. A moderate problem
3. A slight or minor problem
4. None of the above

208. I have been arrested for:


1. Having sex with a minor
2. Child molestation
3. Both 1 and 2
4. None of the above

215. The total time I have been in sexual counseling


or treatment is:
1. Less than one year
2. One to three years
3. More than three years
4. None of the above

209. I have had sex with a member of my family:


1. Parent or grandparent
2. Sibling (brother or sister)
3. Close family relative
4. None of the above

216. Describe your desire to get (or continue in )


sexual counseling or treatment:
1. I want sexual counseling/treatment
2. I may need sexual counseling/treatment
3. I am not sure
4. None of the above

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217. How would you describe your temper?


1. A serious problem
2. A moderate problem
3. A slight or minor problem
4. None of the above
218. How would you describe your explosiveness or
violence proneness?
1. A serious problem
2. A moderate problem
3. A slight or minor problem
4. None of the above
219. During the last six months I have been:
1. Dangerous to others (Homicidal)
2. Dangerous to myself (Suicidal)
3. Both Suicidal and Homicidal
4. None of the above
220. How would you describe your antisocial
thoughts and feelings?
1. A serious problem
2. A moderate problem
3. A slight or minor problem
4. None of the above
221. Rate your antisocial thoughts on a scale from
1 to 10. One represents no antisocial
thoughts and ten represents extreme antisocial thoughts.
1. Rating 1 or 2 (no antisocial thoughts)
2. Rating 3 to 5 (some antisocial thoughts)
3. Rating 6 to 8 (problematic antisocial
thoughts)
4. Rating 9 or 10 (extreme antisocial
thoughts)
222. How would you describe your drinking?
1. A serious problem
2. A moderate problem
3. A slight or minor problem
4. None of the above
223. How would you describe your desire to get (or
continue) alcohol treatment or help?
1. I want help
2. I may need help
3. I am not sure
4. None of the above

224. Recovering means having an alcohol or drug


problem, but not drinking or using drugs
anymore. I am a recovering:
1. Alcoholic
2. Drug Abuser
3. Both 1 and 2
4. None of the above
225. How would you describe your drug use?
1. A serious problem
2. A moderate problem
3. A slight or minor problem
4. None of the above
226. How would you describe your desire to get (or
continue) drug treatment or help?
1. I want help
2. I may need help
3. I am not sure
4. None of the above
227. During the last three months I have been very:
1. Unhappy and depressed
2. Anxious and apprehensive
3. Both 1 and 2
4. None of the above
228. How would you describe your distress?
1. A serious problem
2. A moderate problem
3. A slight or minor problem
4. None of the above
229. Rate your distress on a scale from 1 to 10. One
represents no distress and ten represents
severe distress.
1. Rating 1 or 2 (no distress)
2. Rating 3 to 5 (some distress)
3. Rating 6 to 8 (problematic)
4. Rating 9 or 10 (severe distress)
230. Rate your level of impulsiveness on a scale
from 1 to 10. One represents not impulsive
and ten represents very impulsive.
1. Rating 1 or 2 (not impulsive)
2. Rating 3 to 5 (somewhat impulsive)
3. Rating 6 to 8 (impulsive)
4. Rating 9 or 10 (very impulsive)
v100209

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SAI-Juvenile
Name:_______________________________________
Last Name:___________________________________
Middle Initial:_________________________________
Last Four Digits of Your SSN:____________________
Age:________________

Sex:_________________

Date of Birth: _______ / _______ / _______


Ethnicity (race):_______________________________
Education (highest grade completed):______________
Todays Date: _______ / _______ / _______
Number (#) refers to the total number in your lifetime.
1. Age at first sex-related arrest: . . . . . . . . . . . . . . __
2. Number of times arrested: . . . . . . . . . . . _______
3. # of violence-related (non-sexual) arrests: ______
4. # of sex-related arrests: . . . . . . . . . . . . . _______
5. # of sexual assault arrests: . . . . . . . . . . . _______
6. # of child molestation arrests: . . . . . . . . _______
7. # of exhibitionism arrests: . . . . . . . . . . . _______
8. # of incest-related arrests: . . . . . . . . . . . _______
9. # of alcohol-related arrests: . . . . . . . . . . _______
10. # of drug-related arrests: . . . . . . . . . . . . _______
11. I am a registered sex offender:
True
False
12. I am required to be in sex counseling or treatment:
True
False

Section 1
If a statement is True make a X under T for True.
If a statement is False make an X under F for
False.
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Section 1, Continued
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172.
173.
174.
175.
176.
177.
178.
179.
180.
181.
182.
183.
184.
185.
186.
187.
188.
189.
190.
191.
192.
193.
194.
195.
196.
197.
198.
199.
200.
201.
202.

T
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F
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Section 2
The statements in this section have four answers. Put an X under the number (1, 2, 3 or 4) on your answer
sheet that represents your answer.
1
2
3
4
1
2
3
4
1
2
3
4
203. ____ ____ ____ ____ 213. ____ ____ ____ ____ 222. ____ ____ ____ ____
204. ____ ____ ____ ____ 214. ____ ____ ____ ____ 223. ____ ____ ____ ____
205. ____ ____ ____ ____ 215. ____ ____ ____ ____ 224. ____ ____ ____ ____
206. ____ ____ ____ ____ 216. ____ ____ ____ ____ 225. ____ ____ ____ ____
207. ____ ____ ____ ____ 217. ____ ____ ____ ____ 226. ____ ____ ____ ____
208. ____ ____ ____ ____ 218. ____ ____ ____ ____ 227. ____ ____ ____ ____
209. ____ ____ ____ ____ 219. ____ ____ ____ ____ 228. ____ ____ ____ ____
210. ____ ____ ____ ____ 220. ____ ____ ____ ____ 229. ____ ____ ____ ____
211. ____ ____ ____ ____ 221. ____ ____ ____ ____ 230. ____ ____ ____ ____
212. ____ ____ ____ ____
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