It's a controversial test reminiscent of A Clockwork Orange that critics say is unethical, invasive and potentially harmful: Teenage boys with a history of sex offences, some as young as 13, have sensors attached to their genitals while a researcher shows them pictures of adults having sex or children in various states of nudity.
Accompanying the pictures: sexual scenarios that are read out to them, some of them violent.
The little-known B.C. government research program at the Youth Forensic Psychiatric Service, using what's called penile plethysmography (PPG), is aimed at finding indicators of which teenagers will be repeat offenders even after treatment.
But the B.C. Civil Liberties Association says the testing, which is done on a group that is nearly 40 per cent aboriginal, is a violation of human rights and doesn't even appear to be helpful with treatment. Its president, Robert Holmes, is asking the government's child watchdog, Mary-Ellen Turpel-Lafond, to investigate.
"Although they talk about it as treatment, it's really not about treatment at all," Mr. Holmes said. "And when you're talking about young people and the kinds of things you're showing them, it raises a bunch of questions about whether it's proper to be doing that. In our view, serious rights issues are involved with this."
Kulwant Riar, the psychiatric service's clinical director, defended the program, saying it helps therapists provide better treatment because they have independent evidence about the teenage offender's arousal pattern. It also helps the public because it predicts future risks, he said.
The teenage boys, Dr. Riar added, can refuse to participate in the testing, which has been going on for 25 years with the permission of the Ministry of Children and Family Development.
"Some of them do turn it down. We say it's mandatory for the treatment, but we still treat them even if they say no," he said. "It's the parents who mostly complain, but once we give them good information about it, they are all right."
But Mr. Holmes questioned how much pressure the boys and their parents might feel about having to participate in the program.
PPGs have generated legal, ethical and professional debates since they came into use in the 1950s, when they were employed in Czechoslovakia to test young men claiming they were gay to avoid having to go into the army.
Defence lawyers in Canada and the United States have successfully challenged the use of PPGs by prosecutors trying to introduce them as evidence that, based on the results of their arousal patterns, someone accused of a sex crime was likely to have committed it.
They are still used for adult sex offenders, but mainly for therapists to tailor treatment for them or to assess how successful treatment has been.
But many people in the field say the evidence is not clear about whether they are good predictors of sexual predilections for teenagers.
"Adolescence is a time when we're refining our sexual scripts," said James Worling, a Canadian researcher who works with adolescents in Ontario in several programs, including Sexual Abuse Family Education and Treatment in Toronto. "There really isn't convincing evidence of the reliability or the validity of these tests for adolescents."
Dr. Worling said the tests are also dubious ethically, which makes many people unwilling to use them given their uncertain results.
"If it was useful, I would probably use it," he said. "But given the potential for harm, a number of us question whether it should be used routinely."
He also acknowledged that PPG testing has a negative impact both inside and outside the specialist field. " Clockwork Orange is what comes to mind," said Dr. Worling, referring to the Anthony Burgess novel and 1971 movie in which young thugs are treated with aversion therapy. They are forced to watch scenes of violence and are given drugs that make them ill at the same time, with the idea that they will avoid violence because of its Pavlovian association with nausea.
Jan Storch, a professor emeritus at the University of Victoria and former member of several ethics-research boards, said the description of the research process sparked several concerns for her about how consent was obtained.
The authors of the B.C. study, Robert Clift, Gordana Rajlic and Heather Gretton, acknowledge in their conclusions that PPG tests are problematic ethically and should be used only after therapists have carefully weighed the benefits versus the negatives.
Only about 10 per cent of American treatment programs for adolescents use PPGs exclusively as a test, while about 20 per cent of Canadian programs do.