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Sexual Addiction & Compulsivity, 17:4664, 2010

Copyright Taylor & Francis Group, LLC


ISSN: 1072-0162 print / 1532-5318 online
DOI: 10.1080/10720161003646450

An Aspergers Adolescent Sex Addict,


Sex Offender: A Case Study
ERIC GRIFFIN-SHELLEY
Private Practice, Lafayette Hill, Pennsylvania

Five years of treatment for an adolescent sex offender and sex addict, who was adjudicated at 14 and diagnosed with Aspergers
Syndrome, highlights many issues treatment providers have to address. The role of assessment, interfacing with the family and the
legal system, offender treatment, trauma and sexual compulsivity
treatment, residential and outpatient therapy, family and community safety are elements of a complex treatment process at various stages. Family treatment and appropriate support groups are
considerations that challenge existing models and knowledge. The
difficulties of cases like these suggest ways that sexual offending
and sexual addiction treatments can be integrated and provide for
community safety as well as personal recovery.
As with many complex, challenging cases, the simple response to a phone
call from a reliable referral source can open up a Pandoras box of concerns
and questions. The contact said that there was a problem with a 14 yearold boy who recently graduated from eighth grade. He had been caught
engaging in inappropriate sexual contact with an 11 year-old nephew and
a 9 year-old male family friend. While the teen had been in counseling
with a masters level counselor for a year and had seen a psychiatrist, who
had prescribed a common anti-depressant that had anti-anxiety properties,
an expert in sexual behaviors was sought. Immediately, these issues came
to mind: Is this a problem of delayed development? Is it normal sexual
exploration? Is it sexual offending or sexual addiction? Perhaps the clients
problems were some combination of these concerns.

The author gratefully acknowledges the comments of Susan Campling, PsyD, Steve Eichel,
Ph.D., Marie Wilson, MA, LPC, CSAT, Eric Dech, Ph.D., Michele Saffier, LMFT, CSAT and
Charles Samenow, M.D. on the manuscript draft.
Address correspondence to Eric Griffin-Shelley, 4079 Oak Lane, Lafayette Hill, PA, 19444.
E-mail: ericgs1@aol.com
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An extended initial assessment with the client and his family revealed
many important details. The teenager himself acted like a typical teen by
only revealing what was already known by the psychologist, but this guardedness is also typical of sex offenders and sex addicts. The family expressed
considerable anxiety and fear, while the client showed little emotion. The
age difference between the teenager and his victims was 2 years and 4 years
respectively, which raised the question of whether this was normal sex play
or sexual offending. Many legal statutes require a 4 or 5 year difference in age
for a sexual behavior to be considered a sexual offense or the use of coercion
or force if the age difference is less. The existence of a referring therapist
plus a psychiatrist suggested a history of problems as well as demonstrating
concern on the part of the family regarding the boys problems.
While the client was understandably defensive and anxious, his family
indicated that he had been weird for a long time. He was odd socially and
engaged in rituals like hair pulling, counting, nail biting, and writing with his
finger in the air. The family was particularly struck by his lack of empathy.
They reported that he usually didnt say that he was sorry. At the same time,
he got good grades. For most of his life, he had a serious problem with lying.
In addition, he engaged in rule breaking and arguing at home and could be
oppositional in school at times. They observed both gross and fine motor
difficulties, rocking and repetitive behaviors, as well as an over-involvement
in fantasy. There were some other somewhat inappropriate activities with
two younger female siblings. There were also two incidents of problematic
Internet sexual activity (viewing pornography) 1 year and 3 years ago.
The family, due to these problems, had sought therapy on numerous
occasions. He had therapy for a speech delay early on. He suffered from
night terrors. He had difficulty with vomiting and being ataxic which led to
a neurological exam. He was pronounced all right. Then, in fifth grade
(age 10), he received 6 months of counseling for anxiety. The next year,
in sixth grade he had behavior problems, which led to a Child Study Team
evaluation. Again, he was pronounced O.K., perhaps because he got good
grades. During the summer before seventh grade, he had social problems that
led him to see a psychiatrist for 6 months, but he was given no medication.
He was described as pseudo-mature with poor social boundaries. Again,
in the summer before eighth grade, he was inappropriate with his sister
when applying sun tan lotion (attempting to touch her breasts while he was
applying the lotion to her back) and exhibited more overt anxiety, which
resulted in the counseling with the therapist who eventually referred him to
the author and initiation of psychiatric medication (Zoloft).

COMPREHENSIVE, PSYCHOLOGICAL TESTING


Obviously, a number of professionals had evaluated and worked with this
boy and none of them had seen these sexual problems coming. His family

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did not expect this sort of problem either although they knew he was not
a normal child. Due to the lengthy history of unresolved problems and the
immediate crisis including legal charges, a comprehensive, psychological
evaluation by an independent psychologist was recommended to the family.
The resulting report was so eloquent that the author has chosen to include
these portions (Eichel, 2004):
Social and emotional development, however, were very unusual. His
parents reported a laundry list of troubled and troubling behaviors over
the years, including: persistent rule breaking, procrastination, immaturity,
distractibility, disorganization, obsessions and compulsions, anxiety, low
frustration tolerance, isolation and withdrawal, lack of physical coordination and tic-like behaviors, victimization by peers, rocking and other
repetitive motions, restlessness, and lack of coordination. The client also
has a history of over involvement in fantasy and with imaginary playmates, and a lack of emotion that contrasts sharply with his immature
moodiness when frustrated or disappointed. His parents also described
his peer relations as poor. When he interacts, it is often with children
who are younger and whom he in a sense directs. (p. 3).
The client immediately struck me as odd. Physically, he is slim and
perhaps a bit short, and he appears younger than his stated age. His
gait was subtly jerky and too quick, in a manner that can be mistaken
for anxiety but also seemed to me a bit robot-like. He related almost
immediately in an overly-friendly and overly-familiar manner, asking me
within minutes of our meetings questions about my personal life and
history. Although on the surface his behavior resembled openness and
friendliness, I felt as though he was mimicking social relatedness; once
again, there was a programmed or robot-like quality to these interactions.
This sense persisted through all four meetings I had with the client, and
was interrupted only when his relatedness became overtly strange or
occasionally superficially intrusive. There were many examples of this
strangeness, so I will briefly illustrate one. As part of administering the
projective tests and recording his responses, I wrote the RIT and TAT
plate (test card) numbers in my notes. After doing so for a few plates, he
took a pen and a small pad of Post-It notes I had on my desk and also
began to write down the plate numbers, thereby mimicking my actions.
I did not feel he was imitating me to mock me, but rather his behavior
was similar to what I imagine an alien from another planet might do
(as in Spielbergs film E.T. the Extra-Terrestrial for example) in attempt
to understand and learn about humans. Similarly, the client occasionally
asked me questions that felt very inappropriate and intrusive, but were
in fact poorly-timed, robot-like but genuine attempts to connect to me
and know something about me.
In other ways, he behaved in a manner that was highly consistent with
how his parents described him. He was cooperative and compliant,
yet occasionally distractible, agitated and impulsive. He intermittently
demonstrated tic-like and/or subtly compulsive physical actions. When

An Aspergers Adolescent Sex Addict, Sex Offender

answering questions about his sexual behaviors, he became overtly anxious and agitated; he breathed laboriously and clutched a pillow to him
as though for comfort and/or protection. Sometimes I felt he lacked an
appreciation of the weightiness of this evaluation; he behaved in a collegial, almost convivial manner as though we were jointly engaged in a
fascinating intellectual challenge. However, when asked he clearly understood the importance and gravity of what we were doing. The client
was clearly not psychotic; his thinking seemed fairly clear and organized,
there were no indications or reports of hallucinations or grossly delusional thinking, and he was oriented to time, place and person. Rather,
he seemed disconnected and perhaps even depersonalized, as though
there was a time-delay in how he processed reality because it was first
being filtered through and colored by his imagination or fantasy-life.
(p. 4) .
Projective Tests: The clients responses on three projective measures were
very illuminating. His H-T-P drawings were very immature; the faces on
the people resembled pumpkin heads while the drawing of a person in
the rain depicted a disheveled boy unable to protect himself adequately
from the rain. These drawings and his verbal responses to my projective
questions about them strongly suggested an unrealistic and narcissistic (mis)understanding of other people. His fantasy life permeates his
awareness of others at the risk of causing him to grossly misjudge their
feelings, motives and needs. His ability to effectively deal with common
problems deteriorates under mild stress. His responses to the Rorschach
Inkblot Test (RIT) underscored these findings. On the RIT, the client
demonstrated impaired reality testing and a significant lack of connection to and identification with others. His ability to plan and organize his
behavior is under-developed, he is highly impulsive and lacks an ageappropriate ability to delay gratification. His overall RIT profile was not
a psychotic or an antisocial one, but rather the kind associated with an
over-involvement with his own fantasy life and a profound disconnection with his interpersonal environment. His functioning on the RIT was
autistic-like. (pp. 78).
The client truly feels like a stranger in a strange land, and unlike
severely autistic children, however, he longs for some sense of interpersonal connectedness. He cannot understand why he is so odd and why
people react to him the way they do, and he feels frustrated because he
does not know how to change his situation. He sees people enjoying
their relationships, is old enough to have a vague sense of the pleasures
of intimacy and sex, and because he does not experience these himself
he also feels deep resentment and occasionally great hostility, even or
perhaps especially toward those who are most present in his life: his
immediate family (which includes the family friend that he victimized.
(p. 9)
There is little question that the allegations about the clients sexually
offending behaviors suggest compulsivity, but they do not constitute a
primary diagnosis of sexual compulsivity. It would be more accurate

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to see these alleged behaviors as a manifestation of a deeper, more


autistic compulsivity combined with a deep but primitive longing for
intimate physical contact. His behaviors might also be attempts to learn
more about himself and others; in essence they would be interpersonal
experiments conducted by a boy with a profound lack of understanding
of basic human needs, motives and feelings. His own sense of dread
and threat in the presence of his age-appropriate peers (whom he sees
as his psychological superiors and elders), coupled with a rudimentary
awareness of his own tendency to obey and comply with those who are
older and stronger, might motivate him to target his two male victims
(and his sisters) as the subjects of these experiments. (p. 9) . . .

In addition, the assessment report indicated that the client had a verbal
IQ of 121 and a performance IQ of 86, which is a significant difference, i.e.,
his verbal abilities are above average while his hands-on skills are poorer
although within the average range. He was given a formal diagnosis of
Aspergers Syndrome.
Aspergers Syndrome originated with a Viennese pediatrician, Hans Asperger, who, in 1944, wrote about a small number of cases of boys with
normal intelligence and language development, but serious difficulties with
social skills and communication. These boys were clumsy, lacked empathy,
had special interests, and problems with relationships similar to autism.
Lora Wing (1981, cited in Frith, 2004) introduced the term Aspergers Disorder for autistic children who are higher functioning and more intelligent
but had serious social difficulties. Pervasive Developmental Disorders (PDD)
include autism and Aspergers Syndrome is now considered a separate diagnosis and a sub-category of autistic spectrum disorders (Attwood, 1998;
Kutscher, 2004). As with autism, the etiology is not well understood although
there may be a genetic basis (Atwood, 2008).
In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (1994), the American Psychiatric Association added Aspergers Disorder
and identified the following diagnostic criteria:
A. Qualitative impairment in social interaction, as manifested by at least two
of the following:
1) marked impairment in the use of multiple nonverbal behaviors such
as eye-to-eye gaze, facial expression, body postures, and gestures to
regulate social interaction;
2) failure to develop peer relationships appropriate to developmental
level;
3) a lack of spontaneous seeking to share enjoyment, interests or achievements with other people (e.g.: by a lack of showing, bringing, or
pointing out objects of interest to other people);
4) lack of social or emotional reciprocity.

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B. Restricted repetitive and stereotyped patterns of behavior, interests, and


activities, as manifested by at least one of the following:
1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus;
2) apparently inflexible adherence to specific, nonfunctional routines or
rituals;
3) stereotyped and repetitive motor mannerisms (e.g.: hand or finger
flapping or twisting, or complex whole-body movements);
4) persistent preoccupation with parts of objects
C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
D. There is no clinically significant general delay in language (e.g., single
words used by age 2 years, communicative phrases used by age 3 years).
E. There is no clinically significant delay in cognitive development or in
the development of age-appropriate self-help skills, adaptive behavior
(other than social interaction), and curiosity about the environment in
childhood.
F. Criteria are not met for another specific Pervasive Developmental Disorder, or Schizophrenia.

The client exhibited impaired social interactions with poor eye contact,
a lack of peer relations, no spontaneous sharing, and little social reciprocity.
He also had repetitive and stereotypic patterns of behavior, interests and
activities, although he did not have hand flapping or complex body movements. His family and social life were impaired, but his school work was
not. He was isolated and did not have close friends in school, scouts, or the
neighborhood. There was no clinically significant delay in language and, in
fact, his verbal skills were strong. His cognitive, self-help, adaptive skills, and
curiosity about the environment were age appropriate and he showed no
signs of schizophrenia. He did not meet criteria for another specific Pervasive
Developmental Disorder.

INITIAL TREATMENT: UNCOVERING


As treatment began, building a relationship and uncovering personal history
were the early focus. There were some obvious traumas in the clients history.
After his arrest, he admitted to what he described as a mutual exchange of
oral sex with a male classmate in fourth grade (age 10). He did not perceive
this as abusive, although it suggested some early exposure to adult sexuality
for at least one of the boys. The boy moved the next year and sexual activity
ended. Access to pornography or the Internet could account for exposure to
oral sex, although my clients family seemed rather careful about protecting

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their children and were restrictive with regard to the Internet or other sources
of sexual stimulation.
A more obvious trauma, which the client had identified in earlier counseling and with his parents, was teasing and bullying by peers. He never
fit in socially, even in Boy Scouts, band or intramural sports, and reported
many humiliating experiences with children his own age. He said, Kids
take advantage of me. He did speak of a deep loneliness saying, No one
understands me. He developed a passive/aggressive style where he could
feel some form of power by lying and manipulating although he did this
mainly with family members.
An area that was obvious, but apparently not sufficiently explored, was
the impact of his parents divorce. Prior to their separation, as with many
divorcing couples, there were significant fights between his mother and his
father. The client felt frightened and confused by this conflict although he
tended to minimize its impact on him. It appeared that he did not want to
open this issue, especially with his parents, possibly due to his dependency
needs. They appeared to have an amicable co-parenting agreement now and
treatment professionals reported a high level of cooperation.
The question of sexual addiction came up in counseling. The assessing psychologist opined that he was not sexually compulsive. However, he
gave some indication of compulsive masturbation, e.g., telling the author
of masturbating more than once a day, while, at the same time, expressing
anger at an evaluating psychiatrist who doubted his assertion that he only
masturbated once in his lifetime. It was hard to judge how sexually obsessed
he was because he felt so much shame around sexuality. His father reported
that a teacher had found some pictures of women with inappropriate sexual
comments written on them within the last 6 months. The presence of a legal
case compounded his shame, so his guardedness about sexual issues was
not surprising.
After about 2 months of counseling, it emerged that there were additional victims, i.e., sibling incest. The family had suspicions about an incident
where the client was applying suntan lotion to his sister, who was 2 years
younger, and seemed inappropriate in his touching. This sister and the second (of four) reluctantly acknowledged some sexual contacts with their older
brother.
Clearly, the client had many issues. He was acting out sexually with
younger children, whom he had access to through his family. He lacked
empathy and perhaps even understanding of what harm he had done. As
with many adult sexual offenders, he perceived his victims as being willing
participants. He knew that the sexual behavior was wrong because he kept
it secret and told his victims to do the same. He was not very articulate about
the issues despite his verbal strengths. He continued to lie, which seemed
to come from a combination of fear and people pleasing. He was in denial
about having problems and wanted to be normal.

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There were other problem behaviors, such as sitting still. In sessions, he


could not accept no, nor could he respect behavioral limits. For example,
he ripped up stress balls that were beside the therapy chair and wrote on
coasters on the side table. He photocopied his hand. He did seem calmer
when we tossed a stress ball back and forth. He made comments like, I
have no feelings. He lied and was quite guarded. He appeared to act out
feelings because he cant express them. His response to a suggestion that
he write an apology letter to his aunt was superficial.
He seemed unemotional about the legal process, although an overnight
incarceration at a juvenile detention facility left him feeling humiliated.
He continued to withhold details. His family was shocked to discover at the
initial hearing that the police report indicated 15 incidents of oral sex with the
7 year old rather than the three that he initially stated. About 3 months later,
he was adjudicated a juvenile delinquent and sent to a long-term, residential
treatment program for adolescent, male sex offenders about 2 hours from
home.

RESIDENTIAL TREATMENT: EMPATHY BARRIER


The whole process of residential treatment was frustrating for all involved.
The client was able to learn what was expected of him, but, probably due
to his Aspergers Syndrome, he was unable to successfully meet treatment
expectations. Most obviously, he became stuck at the level that required
expression of empathy for his victims. Months of treatment slowly turned
into years.
In monthly visits, the client explained the treatment model for the program, i.e., he earned his way up a level system. According to the client, the
levels of treatment changed after the first year to five levels called, C.A.R.E.S.:
Change, Accountability, Respect, Empathy, and Support. He was required to
keep fantasy logs, identify grooming patterns for his victims, and engage in
appropriate arousal reconditioning. The clients learned the cycle of offense
(Way & Spiker, 1997) that starts the persons history and core beliefs, which
induce strong feelings related to a difficult situation, experience or memory.
These led to a sexual thought or desire for sex and power. The offender
chooses to dwell on the deviant thoughts and/or sexual feelings. Then, the
person convinces himself that it is all right to offend and begins to plan the
offense (groom himself). This leads to convincing himself that he will get
away with the sexual offense and the breakdown of barriers to offending.
Next, the offender sets the stage by selecting and/or grooming the victim.
The next step is the sexual offense with accompanying pleasure and relief
from tension and emotional pain. After the offense, the offender experiences
self-hatred, fear, or guilt and his pain returns. The next step is to cover up
to self and others through denial and secrecy. The offender pushes people

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away and attempts to regain power and control. Finally, they try to avoid
feelings.
For some unexplained reason, the professional staff at the treatment facility were quite closed and unwilling to connect with outside professionals.
During my monthly visits to the client, I occasionally ran into treatment staff
and a couple of times stumbled across his treatment team meeting, which I
was invited to attend once. Even when a copy of the Ray et al. (2004) article
Challenges to Treating Adolescents with Aspergers Syndrome Who are Sexually Abusive, was sent to his psychiatrist, there was no acknowledgement
or effort to collaborate. The treatment facility communicated with his family,
having regular phone sessions with his parents, and with his probation officer, but his case worker never responded to my calls announcing my visits
or offering input. The clients mother forwarded about half of the monthly
progress reports to me. They were pretty much boilerplate reports with little
actual information about therapy or progress.
The client was able to share with me some of the problems that he encountered in treatment. In his third month, there was an incident where he
brushed up against a female staff member. He claimed that it was accidental. A month later, he entered the bathroom in his residence area, without
knocking, while another resident was in there. Just after the one-year mark,
he was identified as grooming staff due to a situation where he pretended
to be asleep lying on the floor of his bathroom. He was hoping that a female
staff would find him and perhaps want to initiate sex. At the time, he was
described as deep in his sexual cycle. Later on, he confessed to wanting
to kiss a disabled female staff person and thinking of grabbing the rears of
other female staff. He also wanted to smell the rear ends of female staff,
which he had done with his sisters. After a year, his lack of progress resulted
in his probation officer considering a transfer to a more restrictive and penal
facility out of state. His anxiety led staff to be concerned about suicidality. Then, the most serious incident came almost 2 years into treatment. He
scratched Xs and lines in his arms and hands because I was angry when
the screaming of a peer would not stop.
Initial staff reports indicated exposure to oral sex in first grade either
through pictures or observing a baby sitter. However, the client frequently
contradicted himself, especially when confronted about inconsistencies in his
stories. All of this leads others to wonder, was he a victim or a perpetrator,
especially when younger? Since he was small in size as a child, his assertion
that the boy in fourth grade initiated the oral sex seemed plausible.
Staff reported him to be awkward, quiet in groups, obsessive, intrusive
with staff, attention seeking, compulsively putting his fingers in his mouth,
unable to mind his own business (which alienated him from peers), yet
he was intelligent, good in school, compliant, polite, friendly, and quiet.
Other problems that were identified in the treatment notes were attention
seeking, neediness, anxiety, nail biting, agitation, arguing, lack of empathy,

An Aspergers Adolescent Sex Addict, Sex Offender

55

intrusive with staff (poor boundaries like asking personal questions), lying,
not internalizing (rote learning without real understanding), disrespect, and
temper tantrums. He was seen as junior staff to his roommates, bossy, and
getting into petty arguments and bickering with his peers.
He focused on sex offender work such as making victim lists, identifying
his offense cycle, reconditioning sexual arousal, and planning a clarification
session with his siblings. Staff noted that he victimized weaker people and
suggested that he lies to prove he has power over others. He frequently had
to redo assignments such as letters from his victims perspective.
He was given a number of medications; initially Zoloft, then Paxil and
Risperdal at varying levels to help reduce his anxiety, fidgeting, rigidity, and
compulsive nail biting and picking. He experienced significant weight gain
(from 147 to 192 lbs. in the first year) and was put on a diet, which kept his
weight in the 190s.
While the client was able to learn the figure eight model for sex offending (Way & Spiker, 1997), his answers were superficial, repetitive, and
more a reflection of what he thought he was supposed to say than what he
really felt. This failure of the confrontation model is what Ray et al. (2004)
believe suggests Autism Spectrum Disorder in clients. The client seemed to
ignore a book brought to him on Aspergers written by a teenager (Jackson & Attwood, 2002) although he did indicate some interest in Temple
Grandins (1995) book about her experience with autism disorder, both of
which informed the author about autism and Aspergers Syndrome.
Throughout his 3-year stay (some clients finished in 1 year), family
therapy and hope for reunification were especially problematic. Staff noted
that he clearly did not see the impact of his actions on his family. Early
on, his mother said that the sexual abuse ruined my family. At one point,
he said, my mother disowned me and, at another time, his father was
sick and unable or unwilling to visit. There were occasional breaks in
family therapy when his parents were frustrated with his lack of progress,
his lying, and his apparent lack of care for anyone beside himself. This was
the same problem, which led to being stuck on the third level, unable to
meet the required empathy for level four. Staff indicated that he would cry
after calling home at times, but, other times, he simply avoided calling home,
especially to his mother. When asked about his parents, he would usually
lie and say things are all right.
Eventually, especially during the last year of treatment, he seemed institutionalized and comfortable where he was. He turned 18 in the summer
and began his senior year of high school. Rather than being eager to be
released, he wanted to stay and graduate. His probation officer had other
ideas and worked to have him released at the end of his third year.
It is worth mentioning that there was significant institutional trauma
during his residential treatment, which probably impacted his ability to trust
and be open with staff. In his first year, two clients died (one during a

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restraint procedure and the other had an unknown heart defect). The next
year, a female staff member was arrested for having sex with a client. It was
difficult to ascertain the impact of these traumas and the cumulative effect of
trauma over his lifetime. It would be likely that these events fueled whatever
pre-existing anxiety he brought to the treatment program. Events like these
cannot have helped him trust, open up, or rely on staff for help with such
a personal problem as compulsive sexuality. Because he was court ordered
to treatment, his parents did not have any choice in where he received
treatment and his probation officer threatened to send him to a more prisonlike program in Texas, so he stuffed whatever feelings he had about these
institutional traumas to stay with the program that he was familiar with.

AFTERCARE
Not surprisingly, reentry into the community and family was quite difficult.
The client turned 18 in August. A colleague of mine suggested that funding
sources would refuse to pay for treatment after this point and discharge
might be rather abrupt. There seemed to be little planning on the part of
the residential program, especially since he was stuck on Step 3. He did not
want to hear of plans to leave since he wanted to stay until he graduated
from high school. In addition, he commented, Im so close to Step 4, I
can taste it. He also begrudgingly admitted to being institutionalized, Ive
gotten used to the place. Apparently, his probation officer had other plans
and he was discharged after a court hearing on his status. Later, he reported
that his probation officer and parents said that the treatment program kept
him for the money.
Both probation and his family were afraid to allow him to live with his
four sisters. His parents had shared custody and the girls went back and forth
between both parents homes each week. While efforts had begun on family
reunification, they had not progressed to the point of having a meeting with
the client and his siblings. The clients mothers family had been shattered by
the impact of the sexual abuse. His mother was extremely ambivalent about
having him home; although, she did agree to have him live with her while
his sisters were at their fathers house. The four siblings had had some brief
counseling immediately after their abuse had come to light, but no other
family members had had any therapy (other than mostly phone sessions
with the parents) or support for the effects of the sexual offending on them
and others in the family system. So, the client entered individual and group
therapy for sexual offending and sexual compulsivity, but, initially, no one
else was involved in any treatment or support.
Community safety was a primary concern after discharge. Risk was assessed using the Perry and Orchard (1992) Adolescent Sex Offender Risk
Check List and OBrien and Beras (1986) Typology of Adolescent Sex

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57

Offenders. On the Perry and Orchard measure, he had 16 Low Risk items
and 15 High Risk items. According to the OBrien and Bera typology, he
was an Undersocialized Child Exploiter and Sexual Compulsive. With this
moderate level of risk, home schooling seemed to be the best option
for the remaining 5 months of high school. In addition, his parents were
not comfortable with his attending school or community social activities,
e.g., the senior prom or church youth group activities (his four sisters attended these). The client resented these restrictions and just wanted to be
normal.
The focus of his treatment was similar to that recommended by Ray
et al. (2004) and Matich-Maroney et al. (2005) for clients with developmental disabilities, especially in the latters trauma, psychosexual disorders, and
forensic sections of the continuum of care. The intensive, evening program
involved a psycho-education group, a psychotherapy group, and a Sex and
Love Addicts Anonymous meeting. The client, at one point in the psychoeducation group, was able to articulate the similarities between the figure
eight sexual offense cycle (Way & Spiker, 1997) and the Carnes (1991) cycle
of sexual addiction. Both groups dealt with topics similar to Matich-Maroney
et al.s (2005) recommendations of dealing with boundaries, shame, alexithymia, trauma, social skills, self-care, self-governance, self-regulation, and
healthy sexuality. In addition, education and therapy included attention to
addictions, relapse prevention, triggers, slips, and healthy coping skills.
Life for this 18 year old, adjudicated sex offender involved home schooling, shuttling between parents (on the opposite schedule as his four, female
siblings), and attending outpatient individual therapy as well as group therapy and 12-Step meetings, both of which were with people who were older
than he was. He made sporadic efforts to regain trust in his family and to
make progress in therapy and recovery, but he also relapsed with frequent
lying and occasional, overt sexual acting out. An example of this mixed message was his almost automatic lying to his mother the second day that he
was home and then, taking his parents out to dinner with the money that he
made working over the past summer.
In individual sessions, he seemed to be opening up although he had
difficulty seeing what he needed to change. He expressed his disappointment
about not attending regular school because he felt that he had grown in his
ability to socialize and to speak up for himself. He shared that he masturbated
compulsively until getting caught for his offenses in seventh grade. He told
of a peer initiating oral sex in second grade and admitted to initiating oral
sex with a peer in fourth grade. He seemed less anxious. He was chewing
his nails less. He started attending a small, daytime meeting of Sex and Love
Addicts Anonymous (S.L.A.A.). His parents expressed fears that he would be
taken advantage of in these meetings. He was impatient with their concerns
and restrictions while, at the same time, making unrealistic plans for going
to college the next year.

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He continued to be inconsistent in his stories, which had created numerous problems with his parents and treatment staff at his residential program.
He volunteered that he was masturbating 34 times per day to medicate his
anxiety and that he was becoming entranced when playing video games.
Then, in the third month home, he was caught using the Internet while his
stepmother was away and lied about it. His parents, as with most family and
friends of addicts, said that the lying was the worst part of his slip. He
again asked his therapist intrusive, personal questions. On the positive side,
he shared being teased about his Assbergers while in residential treatment.
The client underwent testing of sexual interest and brief personality assessment utilizing the Abel Assessment of Sexual Interest-2 (AASI-2, Abel
et al. 2001) and MMPI-2 (Butcher et al. 1989). Results indicated sufficient
effort and valid results. There were no diagnostic considerations on his personality testing and his profile was deemed within normal limits. His AASI-2
results indicated that he demonstrated no cognitive distortions regarding sexual contact with minors. His results suggested that he responded truthfully.
The clients victims were Caucasian therefore results were initially viewed
for that racial group. AASI-2 results indicated sexual interest in Caucasian
latency aged boys and girls beyond his conscious awareness. Additionally,
he demonstrated sexual interest in Caucasian and Black adult and adolescent
females. He also indicated sexual interest in Black adult males. He acknowledged some sexual confusion regarding his interest in adult males. He said
that he believed sex with latency-aged children to be disgusting. Some
meetings with his parents had been started and the results were reviewed
with them as well as being the basis for relapse prevention planning. Some
of his attraction pattern could have been due to the presence of African
American staff members at his residential program.
In another incident, almost 6 months into his outpatient treatment, he
ordered an adult movie while at his mothers house and, then, called the
author panic-stricken when his slip was discovered by her on her cable bill.
His parents continued to be frustrated and impatient with his progress. Each
incident ripped open their wounds and prevented healing for them. After
this incident of sexual acting out, his mother wanted to cut off family therapy
and his father and stepmother wanted to remove him from the house. While
they all had been severely traumatized by his offending, his parents could
not see that their intense reactivity, a clear symptom of Post Traumatic Stress
Disorder, might be playing a role, at least a part, in continuing his shame
and anxiety. They had not followed recommendations early on to get their
own therapy for this trauma.
In addition, his parents strong need for control, lack of empathy, and
ongoing difficulty understanding his problems with empathy or his desire to
be normal might have been fueling his oppositional behavior. Their behavior
may have served to trigger his sexual acting out. His need for acceptance,
to be normal, was shaken by their threats of abandonment. There was a

An Aspergers Adolescent Sex Addict, Sex Offender

59

growing power struggle between their insistence on his earning their trust
and his developmental desire to become more independent and prove that
he could handle peer relationships. Unfortunately, his fear of his parents
anger (often displayed before their divorce) kept him from being direct and
open. For example, he wanted to write to an aunt who wrote to him at
his residential program, but, due to previous conflicts between them, his
father did not talk to this sibling and could not understand why he would
want contact with her. To his father, this was more betrayal, ingratitude and
self-centeredness. He could not see his sons need for support.
The clients high school graduation half way through his first year postresidential treatment was a dramatic event. He looked forward to this event,
bought a school ring, and invited his family. Afterwards, he was in tears
overwhelmed with the realization that he knew no one. His father reacted
with anxiety about a mark on his face, which he thought could be selfharm. Therapeutic discussions went nowhere trying to convince him that
being normal is a fantasy and his tendency to fantasize is what set him up
for disappointment at the graduation. He continued to complain about his
stepmothers rigidity, he called her the warden, while they, in turn, were
annoyed with his disrespect. Family reunification was on hold because the
family therapist had requested that the four girls be re-evaluated.
After a period of passivity and avoidance and with the help of a family
connection, he did get a part time job later in the summer at a convenience
store, which led to his first connections with people outside of family and
recovery groups, including some peers. The family needed him to work to
get him out of the house and did not consider the level of risk for him, i.e.,
his likely exposure to children in this type of work setting. He had to report
to work at 4:30 a.m., to which his family dutifully drove him. Apparently, his
stepfather offered to give him driving lessons, but he did not take him up on
the offer. In therapy, he did occasionally own up to being manipulative, i.e.,
he admitted that he had threatened to tell his parents that his oldest sister
had a boyfriend to coerce her cooperation in his sexual acting out. He also
acknowledged some coasting at his residential program and in job hunting.
He said currently he was afraid of bullying or lack of peer acceptance at a job.
Later, he switched his tune and said that he was offended by the accusation
of lack of effort and tried to prove that he was trying hard.
As with most Aspergers clients, awareness of and talking about feelings
was difficult. He confessed at this point to masturbation twice a day to
manage feelings, but he was afraid to share this with his group or at 12-Step
meetings. He outright denied feeling sad that his father and stepmother took
his four sisters to Disneyland, but he did admit to being angry with them for
not trusting him with the house keys while they were gone. He also threw
a stress ball at me, which he hadnt done since beginning therapy, in anger
at my pushing him to share his emotions. Even as he turned 19, he was in
conflict with his family around the lifelong issue of empathy. After their trip

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to Disneyland, he told his father and stepmother that he did not miss them.
When he got a card for his mothers birthday, his father was terribly hurt that
his son had ignored his birthday.
These family issues were complicated by his sexual compulsivity. Again,
since his story changed, it was hard to know what was the truth. However,
when he reported feeling proud of reducing his masturbation from 14 times
a day as a young teen to once daily now, he seemed genuinely pleased with
his progress. When it came to masturbation, he said, Its part of my life
like breathing. In S.L.A.A., he was encouraged to make masturbation one
of his bottom lines meaning that sexual sobriety required abstinence from
masturbation. So, for him, going from almost hourly acting out to once a day
was indeed progress. His family had little awareness of his sexual recovery,
so he needed the support that he got from his 12-Step meetings and group
therapy.
To be cool and to manage his anxiety, he took up smoking cigarettes,
like his mother and stepfather. Another family crisis arose when he refused
to follow the no smoking in the house rule at both houses. He was caught,
confronted, lied, and continued the cycle of distrust and frustration. Again,
there were parental threats to throw him out of the house. This time, even
his stepfather got in the act with comments like, Weve had it with him
and Nothings working. There were no relatives nearby who did not have
children and no programs for young adults like him.
Meanwhile, he was working on a sexual addiction workbook and reported sobriety from pornography for a month and masturbation for two and
a half weeks. He was having trouble with his relationship with his Higher
Power since he felt that God was pushing my face in shit every day. He
could not understand his mothers hurt and frustration and commented, She
should have gotten over it by now. Clearly, Aspergers and addiction were
intertwined. He compulsively scribbled his name on a worksheet, which also
identified his family as his main concern in recovery.
When his stepfather and mother said that they were separating, he was
shocked, hurt, and angry. He blamed himself for the stress on their marriage
that broke them apart (which could be a repeat of his earlier experience). He
showed his own rigidity in his anger that they were not living their vows.
He could not talk to them about his thoughts and feelings, so he continued
to hold back genuine sharing from his parents.
More ups and downs came when he was caught looking at pictures of
girls in swimsuits on the computer at the library. He had gone there with
his stepmother when his sisters were visiting. Again, he lied at first. Later, he
volunteered, My life sucks, but he had few ideas for how he could change.
He reported only masturbating twice a week, which is progress from multiple
times a day. He was taken off probation, but he did not seem happy at not
having legal supervision. His parental supervision was still quite tight. He
wanted to date a girl from the convenience store where he worked, but he

An Aspergers Adolescent Sex Addict, Sex Offender

61

had no idea how to get to her house. He was upset when his father got mad
that he lost his high school ring and tried to hide it from his parents.
Another attempt was made to work on family reunification through a
meeting with both sets of parents, although his stepfather did not attend. His
parents confronted his lying and self-centeredness. He became tearful, but
his father was dismissive since hed seen this behavior before. They did not
hear any of his progress in recovery. His mother said that her health might
require that she cut him off because it was so stressful for her. The parents
felt used and offended. While he wanted to take responsibility for his impact
on them, his lack of maturity made it seem almost impossible at this point.
The final straw came when he took money from his bank account and
gave it to the girl at work to help her pay her bills. His stepmother discovered
him and he again lied. In a family session, his father was both over-protective
and rejecting. He did not want people to take advantage of his son but, then,
exploded, saying Ive had it and walked out. Despite having been encouraged to come back and find some middle ground, therapy and recovery
ended there.

ISSUES REMAIN
Family reunification remained unresolved. The courts initially required a
therapist with sex offender certification, but the client was removed from
probation after only 6 months. There was a serious split between the parents
in terms of their readiness for reunification. Suggestions to have his four, female siblings reevaluated were ignored or put off. A meeting with his parents
led to a harsh attack on the client for his apparent unwillingness to follow
rules, to be honest, and to care about others more than about himself, so no
efforts to address the siblings were considered. To his parents, he continued
to be an offender. His lying and self-centeredness continued to trigger their
post-traumatic stress. Perhaps in retrospect, the harm to both family systems
was not adequately considered and support and understanding given to the
parents of this child with such complex problems. Clearly, the parents had
pre-existing issues and unresolved trauma that had not been addressed.
There remained significant developmental issues such as finding peers,
learning to socialize, and the need to separate from his family and develop
independence. He was ambivalent about growing up. His parents had a
strong need to supervise him due to fears of both future offending or of
him being taken advantage of due to his immaturity. The push/pull between
over-protection and rejection made separating from family almost impossible
for him and crazy making for everyone.
In his recovery support groups, he was working on the integration of addiction recovery and sex offender work. While his overt sexual slips, mainly
with online pornography and adult movies on television, helped to confirm

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E. Griffin-Shelley

his identification as a sex addict, both he and others were uncomfortable


with his participation in 12-Step meetings. At one meeting, some one asked,
Are you an adult? He was always the youngest in the rooms. Masturbation
was more clearly used to alter his mood. While he made progress from acting
out many times a day to less than daily, he still could not go for more than
a couple of weeks without masturbating. Was this in part a developmental
problem? What was normal for a sex addicted adolescent sex offender?

DISCUSSION
Complex problems require complex and lengthy treatments. In this particular case, the treatment was ended prematurely and would most likely have
continued on an outpatient basis for a number of years. Clearly, better integration of treatments could have provided more in this particular case. The
clients anxiety, Aspergers syndrome and difficulties in relationships were
predisposing factors for this clients sexual acting out. Family conflict, early
sexual exposure, and teasing by peers added to his distress. Having younger
siblings created the opportunity for offending. Hence, his sexual problems
seemed to be a means of coping and opportunity as opposed to pure antisocial motivations. The rewards of his sexual behavior in terms of reducing
anxiety and providing a false sense of relationships and connection fueled
sexually compulsive behavior. Failure to recognize the psychodevelopmental aspects and sexual addiction components of this clients behavior may
have contributed to the poor outcome.
Better staff training that included managing Aspergers Syndrome clients
in the milieu, more adequate family therapy, and coordination with outpatient professionals, especially ongoing therapy for the parents and the
victims, could have improved the outcome. Ray et al. (2004) have begun
the process of identifying what works with this population, but much more
research and writing is needed. The author (1994, 1995, 2002) has sought
to bring attention to adolescent sex and love addiction, but the literature remains sparse on this subject and research is almost totally non-existent. The
Society for the Advancement of Sexual Health (S.A.S.H.) has encouraged
presentations on adolescents with sexual addiction at their annual conferences, but these have not often led to published papers on the subject. One
author (R., 2009) did recount the difficulty with having a 12-Step meeting
for adolescent sex addicts in the journal. However, resources for adolescents
with sexual problems, and particularly those with developmental problems,
are scarce.
Confrontation therapy used by the residential program did not seem appropriate for this client given his Aspergers syndrome. In this case, the quasicorrectional-facility quality and the insular attitude of the residential program led to more psychological defenses, shame, and extreme guardedness

An Aspergers Adolescent Sex Addict, Sex Offender

63

on the part of the client. This may have perpetuated his lying and sexual
addiction. The offender approach used by the residential program emphasized cognitive change and arousal reconditioning to appropriate stimuli that
could have been helpful. Unfortunately, the main exposure to adult females
was treatment staff who were understandably uncomfortable being thought
of in sexual ways. This led them to be distant and critical of the client rather
than supportive and re-directive. Further, the offender approach left the
client feeling more isolated and misunderstood, pathologized his immature
psychosexual development, and contributed to his anxiety and shame.
In this case, working with a sexually compulsive person who has Aspergers Syndrome may have better fit into addiction recovery rather than
the offender model. The recovery approach includes focusing on behavior
change, identification of triggers (often emotional issues), learning to ask
for and use support, and the need for honesty. While support groups like
S-Anon and Alanon were suggested to the family, none were used. Perhaps
these suggestions would have been better explained in ongoing family therapy. Such programs help members detach but do so lovingly. This could
have assisted the family in being less reactive to their own reminders of the
trauma. For instance, the clients ongoing dishonesty seemed to constantly
reopen the wounds of the parents and frustrate them to the point of abandoning him. For him, abandonment was a deep fear. Family support and
treatment could have improved outcomes. This is true for other addictions
and, consequently, it is likely true of sex and love addiction.
Problem sexual behaviors in a developmentally disabled client blur the
lines between sexual compulsivity, sexual offending, and psychosexual delay. This can present new and challenging needs in the interface among the
patient, the family, the legal system, and the clinical treatment team. Clearly,
family and community safety are an important element of this difficult treatment process. However, taking exclusively a sexual offending approach to a
case such as this did not yield positive outcomes for the patient or the family.
The difficulties of cases like these suggest ways that sexual offending and
sexual addiction treatments could be integrated and provide for community
safety as well as personal recovery. Much more needs to be done in terms
of research and professional development for these clients, families, and
communities to successfully negotiate these painful and traumatic problems.

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