There are several approaches to Sexual Adjustment Inventory (SAI) scale interpretation, ranging from viewing the SAI as a self-report to examining elevated scale scores and relationships between scale scores. As shown in the table below, the four SAI scale risk ranges are Low Risk, Medium Risk, Problem Risk and Severe Problem.

With any Sexual Adjustment Inventory (SAI) scale, a problem is not identified unless a scale score is at or above the 70th percentile. Scores at the 70th percentile or higher are referred to as elevated scores. Scores at the 70th to 89th percentile are in the problem range, and scale scores at or above the 90th percentile are in the severe problem range.

A description and discussion of each Sexual Adjustment Inventory (SAI) scale follows. Scales (measures) are divided into two groups: sex-related and non-sex related scales. A discussion of non-sex-related scales follows the discussion of sex-related measures.

SEX-RELATED SAI SCALES

Sex-Item Truthfulness Scale: Measures how truthful the offender was while completing the Sexual Adjustment Inventory (SAI) in terms of their responses to sex-related items. The SAI has two separate Truthfulness Scales; for more information and a detailed discussion, click on the Truthfulness Scales link. It is well-established in the literature that many sex offenders are prone to denial, problem minimization or rationalization of their offenses (Schneider & Wright, 2004; Nugent & Knoner, 1996; Winn, 1996; Schlank & Shaw, 1996), and this is especially true for sex-related tendencies or actions (Maletzky, 1996; Happel & Auffrey, 1995; Marshall & Eccles, 1991; Pollock & Hashmall, 1991). SAI items are direct with no attempt to deceive or trick respondents, consequently items with a sexual connotation are easily recognized. The Sex Item Truthfulness Scale is designed to detect the bright sex offender who answers non-sex-related items honestly, but minimizes, denies or attempts to fake sex-related item answers. SAI sex-related scales include: Sexual Adjustment Scale, Child Molest Scale, Sexual Assault Scale, Exhibitionism Scale and the Incest Classification. Sex Item Truthfulness Scale scores at or above the 70th percentile do not occur by chance. These elevated scale scores require a definite pattern of deviant answers for them to occur. Sex Item Truthfulness Scale scores at or below the 89th percentile mean that all sex-related scale scores are accurate. Sex Item Truthfulness Scale scores at or above the 90th percentile mean that all sexual deviate/paraphiliac scales are inaccurate or invalid. Reasons for such invalidity include client problem minimization, reading things into test items that aren't there or the client was attempting to fake good. Clients with reading impairments may also score in the severe problem (90 to 100th percentile) range. A few questions about the client's education and reading abilities usually clarify the presence of a reading impairment.

Sexual Adjustment Scale: measures a client's self-reported sexual satisfaction. This scale reflects the client's satisfaction or dissatisfaction with their sex life. Elevated scores (70th percentile or higher) indicate dissatisfaction, whereas severe problem (90 to 100th percentile) scorers reveal an impaired or very unsatisfying sexual adjustment. Sexual Adjustment scores at or above the 70th percentile do not occur by chance. Elevated scale scores require a definite pattern of deviant answers to the scales' items for a score at or above the 70th percentile to occur. A person's sexual adjustment is compared with society's standards, rules, norms and statutes. Some people's sexual attitudes and behaviors are unacceptable in our society because they are harmful to others. Some sex offenders are found to have different beliefs regarding sex, domination and gender roles (Lisak & Roth, 1990) that can factor into deviate sexual behaviors. In these cases the people involved are classified as sexually maladjusted. Sexual adjustment begins in childhood and shapes adult sexual behaviors (Borneman, 1994). We do not have to judge the causes, motives or purposes of such behaviors to classify them as maladjusted. Most people in our society agree (or disagree) with each Sexual Adjustment Scale item. The assessor (evaluator or staff) should review all other SAI scale scores to identify codeterminants and stressors. For example, a client could have an elevated Sexual Adjustment Scale score along with other sexual deviate scores. The "other" elevated scale score(s) could add guilt, concern or distress to the respondent's perceived sexual adjustment. Other elevated SAI scale scores could exacerbate existing problems or concerns and thereby contribute to a client's perceived sexual maladjustment. Sexual Adjustment Scale scores can be interpreted independently or in combination with other SAI scale scores.

Sexual Assault Scale: measures sexual violence proneness. Sexual assault or rape refers to sexual assault or sexual intercourse against the will and over the objections of the partner. Sexual assault is often accompanied by force or the threat of force. Many believe rape is not so much a sexual act as an act of hostility and aggression. Cultures or societies having high levels of male hostility, dominance and aggression are often likely to have high incidences of rape (Sanday, 1981). Rape is a crime of violence. Rapists usually inflict some degree of bodily injury in forcing themselves upon their victims. A need for dominance and control can also be a factor (Anderson, Cooper & Okamura, 1997), as can family environment and parental views on gender roles (Bennett, 1992). However Sexual Assault and Violence Scale scores can vary because of the sexual versus non-sexual nature of these scales' items. A problem risk (70 to 89th percentile) Sexual Assault Scale score is observed in sexually aggressive people with sexually violent tendencies. A severe problem (90 to 100th percentile) Sexual Assault Scale score identifies people that either fantasize or engage in violent sex. These individuals are capable of sexual assault. An elevated (70 to 89th percentile) or severe problem (90 to 100th percentile) Sexual Assault Scale score does not occur by chance. A definite pattern of deviant responses is required to have an elevated Sexual Assault Scale score. Severe problem (90 to 100th percentile) Sexual Assault Scale scorers have a high probability of sexual assault. Other elevated SAI scale scores in conjunction with a severe problem Sexual Assault Scale score can provide insight into the sex offender's situation while identifying important areas for subsequent inquiry. For example, a severe problem Violence Scale score in conjunction with an elevated Sexual Assault Scale score would influence subsequent inquiry and treatment. This person is violent in life as well as in sexual relationships. All that is needed is a triggering mechanism like opportunity, alcohol or drugs. The Sexual (Rape) Assault Scale can be interpreted independently or in combination with other SAI scale scores.

Child Molest Scale: measures pedophilia or the client's interests and sexual urges involving prepubescent children. Note that isolated sexual acts with children do not necessarily warrant the pedophile label. Pedophilia refers to a pathological sexual interest in children. Many pedophiles gain access to children through caretaker roles (Elliott, Browne, & Kilcoyne, 1995). Pedophiles are prone to attempts at rationalizing their sexual interest in children (Saradjian & Nobus, 2003). Problem risk (70 to 89th percentile) Child Molest Scale scorers are attracted to young boys and girls. Severe problem (90 to 100th percentile) scorers have established sexual interests in young boys and/or girls. They have a high probability of engaging in pedophilia. They are capable of acting on their urges. However, child molestation should be independently corroborated whenever possible. An elevated (70th or higher percentile) Child (Pedophile) Molest Scale score does not occur by chance. A definite pattern of deviant responses is required to have an elevated Child Molest score. Other elevated sexual deviate/paraphiliac scales in conjunction with an elevated Child Molest Scale score identifies other important areas for further inquiry. Similarly, elevated non-sex-item scales could identify psychosocial stressors. For example, a severe problem Alcohol or Drugs Scale score in combination with an elevated Child Molest Scale score could influence the direction of subsequent inquiry. The Child (Pedophile) Molest Scale score can be interpreted independently or in combination with other SAI scale scores.

Exhibitionism Scale: measures the probability of the client exposing their genitals to a stranger. In these instances there is generally no attempt at further sexual activity with the stranger. A recently-published study found that one-fourth of exhibitionists commit other types of sex offenses in addition to exhibitionism (Psychiatric News, 2006). Exhibitionism is defined in the DSM-IV as �recurrent intense sexually arousing fantasies, sexual urges, or behaviors involving the exposure of one's genitals to an unsuspecting stranger� (APA, 2000). Exhibitionism is one of the most common or prevalent sexual deviations. A characteristic common to all forms of sexual deviation is their repetitive, compulsive and patterned nature. This is particularly evident in exhibitionism. A problem risk (70 to 89th percentile) Exhibitionism Scale score identifies people with exhibitionistic tendencies. A severe problem (90 to 100th percentile) Exhibitionism Scale score identifies people with a high probability of being exhibitionists. The Exhibitionism Scale can be interpreted independently or in combination with other SAI scale scores.

Incest Classification Scale: identifies incestuous behavior. This is a classification scale, not a measurement scale; it identifies the presence or absence of incestuous behavior. Incest refers to coitus between persons related by blood or marriage, i.e., parents, siblings or children. Non-coital forms of sexual intercourse do not constitute incest. Incest is most common between brother and sister, and the next most common form is between father and daughter (Parker & Parker, 1986). Incest is a criminal act. Of the six non-sex-item scales, the Alcohol Scale, Drugs Scale and the Judgment Scale could be important factors involved in initial incestuous relationships. However, incest has many character disorder features. It is a complex term involving moral, social and religious attitudes. In fact, many incestuous families are highly religious (Pruitt, 1987). The Incest Scale can be interpreted independently of other scale scores.

NON-SEX-RELATED SAI SCALES

Test Item Truthfulness Scale: measures how truthful the client was while completing non-sex-items in the SAI. It identifies guarded and defensive people who attempt to minimize their problems or fake good. It also identifies reading impaired clients. The SAI has two separate Truthfulness Scales; for more information and a detailed discussion, click on the Truthfulness Scales link. These proprietary truthfulness scales provide a wealth of respondent information before staff even look at SAI scale scores. Other assessment instruments and tests do not provide such information about client honesty. Comparison of these truthfulness scales provides considerable insight into client motivation, evasiveness strategies (if they exist) and intent. Denial in patients, offenders and clients often accompanies lack of accountability, resistance or lack of motivation to change and general uncooperativeness in terms of treatment and/or rehabilitation. Problem minimization and avoiding responsibility can also amplify lack of progress in treatment and be a predictor of lack of treatment progress (Murphy & Baxter, 1997) treatment dropout (Daly & Peloski, 2000; Evans, Libo & Hser, 2009) and of recidivism in offenders (Nunes, Hanson, Firestone, Moulden, Greenberg, Bradford, 2007; Kropp, Hart, Webster & Eaves, 1995; Grann & Wedin, 2002). The Test Item Truthfulness Scale has been correlated with non-sex-item scales in the SAI. A Truth-Correction equation then converts raw scale scores to truth-corrected scores. Raw scores reflect what the client wants you to know. Truth-corrected scores reveal what the client is trying to hide. Truth-corrected scores are more accurate than raw scores. Test Item Truthfulness Scale scores at or above the 90th percentile mean that all non-sex-item scales are inaccurate or invalid. Reasons for such invalidity include client minimization of problems, reading things into items that aren't there, or the client was attempting to fake good. Test Item Truthfulness Scale scores at or below the 89th percentile mean that all non-sex-item scale scores are accurate. Clients with reading impairments may also score in the severe problem (90 to 100th percentile) range. A few questions about the client's education and reading abilities usually clarifies the presence of a reading impairment. If the client can read the newspaper he/she can read the SAI. Determining truthfulness is very important when evaluating sex offenders.

Alcohol Scale: measures the severity of alcohol use or abuse. Alcohol refers to beer, wine or other liquor. Alcohol use or abuse is often an important factor to be understood when evaluating people accused or convicted of a sex offense. Alcohol abuse is often a comorbid disorder in some subgroups of sex offenders (Raymond, Coleman, Ohlerking, Christenson & Miner, 1999). Alcohol is a significant problem in our society. The harm associated with alcohol abuse -- mental, emotional and physical -- is well documented. All too frequently sex offenders state they were intoxicated when the offense occurred (Peugh & Belenko, 2001). A problem risk (70 to 89th percentile) Alcohol Scale score identifies emerging drinking problems. An Alcohol Scale score in the severe problem (90 to 100th percentile) range identifies serious and established drinking problems. Elevated Alcohol Scale and Drugs Scale scores indicate polysubstance abuse and the higher score often reflects the client's substance of choice. Elevated Alcohol Scale and Violence Scale scores are a malignant sign. Alcohol abuse can magnify a person's violent tendencies. Similarly, alcohol abuse can serve as a release mechanism for antisocial thinking and behavior. Alcohol Scale scores in the severe problem (90 to 100th percentile) range compound client risk even more. Judgment often decreases as alcohol consumption increases. Elevated Alcohol and Distress Scale scores may initially represent an attempt to self-medicate, while intoxication may exacerbate suicidal ideation. The more of these scales that are elevated with the Alcohol Scale the more problem prone the client�s situation becomes. The Alcohol Scale can be interpreted individually or in combination with other SAI scale scores. When alcohol abuse is problematic it becomes an important part of the sex offender�s treatment program.

Drugs Scale: measures drug use and the severity of abuse. Drugs refer to marijuana, crack, cocaine, ice, ecstasy, amphetamines, barbiturates and heroin. These are illicit substances. A recent study noted that approximately 21.0% of incarcerated sex offenders were under the influence of either marijuana or cocaine when the offense occurred (CASA, 1999). An elevated (70 to 89th percentile) Drugs Scale score is indicative of an emerging drug problem. A Drugs Scale score in the severe problem (90 to 100th percentile) range identifies serious illicit drug users. Similar to the Alcohol Scale, a history of drug-related problems could result in an abstainer (drug history, but not presently using or abusing drugs) attaining a low to medium risk score. Precautions have been built into the SAI to correctly identify "recovering" drug abusers. The client's answer to the "recovering drug abuser" question (item 216) is printed on page 5 of the SAI report for easy reference. In addition, elevated Drugs Scale paragraphs caution staff to clarify if the client is a recovering drug abuser. In intervention and treatment settings the client's Drugs Scale score helps staff work through client denial. This is particularly effective when it is explained to the client that the SAI is a standardized assessment instrument that has been administered to thousands of defendants and patients. When both the Drugs and Alcohol Scales are elevated, the higher score typically represents the client's substance of choice. When both the Alcohol and Drugs Scale are in the severe problem (90 to 100th percentile) range, poly-substance abuse is likely.

Violence (Lethality) Scale: measures the client's use of physical force to injure, damage or destroy. The Violence Scale identifies people who are dangerous to themselves and others. An ever-present concern when evaluating sex offenders is their violence and lethality potential. Several states in the U.S. have implemented new laws regarding involuntary commitment of "sexually violent predators" (Lieb, 2006). Some researchers (Webster, Douglas, Eaves and Hart, 1997) believe that any sexual assault should be classified as violent behavior. An elevated (70 to 89th percentile) Violence Scale score is indicative of emerging violent behavior in a potentially dangerous person. A Violence Scale score in the severe problem (90 to 100th percentile) range identifies very dangerous individuals. Excluding the two truthfulness scales, violence scale findings are of special interest when reviewing both sex-related scales and non-sex-related scale scores. This wide applicability emphasizes the important role of the Violence Scale in the SAI.

Antisocial Scale: measures the attitudes and behavior of selfish, ungrateful, callous and egocentric people who seem to be devoid of responsibility and fail to learn from experience. From a social perspective their conduct often appears hostile with little guilt or remorse. Extreme cases are called sociopaths. Individuals that are clinically diagnosed with Antisocial Personality Disorder (APD) often have histories of conduct disorders prior to age 15, which may include substance abuse, delinquency, truancy or police contact (APA, 2000). A significant proportion of sexually sadistic offenders are known to have comorbid personality disorders, including Antisocial Personality Disorder (Berger, Berner, Bolterauer, Gutierrez, Berger, 1999). An elevated (70 to 89th percentile) Antisocial Scale score identifies people in an early antisocial stage of development. An Antisocial Scale score in the severe problem (90 to 100th percentile) range identifies people with severe antisocial attitudes. Court-related evaluators are increasingly interested in exploring a defendant's antisocial tendencies. This reflects the growing awareness of the role of antisocial attitudes and thinking in violent crimes. Antisocial behavior is a major predictor of deviant sexual recidivism (Hanson & Morton-Bourgon, 2005).

Distress Scale: measures two symptom clusters (anxiety and depression) that taken together represent distress. The blending of these symptom clusters is clear in the definition of dsyphoria, i.e., a generalized feeling of anxiety, resentment and depression. Anxiety is an unpleasant emotional state characterized by apprehension, stress, nervousness and tension. Depression refers to a dejected emotional state that includes melancholy, dsyphoric mood and despair. Added together you have a very uncomfortable person who may be overwhelmed and in extreme cases -- on the verge of giving up. Sex offenders are subject to dysphoric mood (Grodon & Grubin, 2004). An elevated (70 to 89th percentile) Distress Scale score identifies hurting individuals that need help. A Distress Scale score in the severe problem (90 to 100th percentile) range identifies people on the verge of being emotionally overwhelmed. These individuals are often desperate and need help. Consideration might be given to referring such individuals to a certified/licensed mental health professional for a diagnosis, prognosis and treatment plan. Psychological distress in offenders is commonly addressed in sex offender treatment programs (Hanson & Morton-Bourgon, 2005).

Impulsiveness Scale: identifies people that abruptly engage in activities without adequate forethought, reflection or consideration of consequences. There are several definitions of "impulsive" on the web that use a variety of words like "without forethought," "capricious," "whim," "undue haste" and "impetuous." High levels of impulsiveness are common in sex offenders (Giotakos, Vaidakis, Markianos & Christodoulou, 2003). An elevated (70th percentile or higher) Impulsiveness Scale score characterizes people that are impulsive and often act without deliberation. As impulsivity is often a characteristic of antisocial orientation (APA, 2000), an elevated Impulsiveness Scale with an elevated Antisocial Scale is a possible interaction. Although quick to act or respond these people are not out of control. Problem risk (70 to 89th percentile) scorers are hasty and tend to act without reflection or consideration of consequences. Problem risk Impulsiveness Scale scorers are capable of impulsive offending. In contrast, Low Risk (zero to 39th percentile) scorers and Medium Risk scorers would not engage in impulsive offending as they would typically deliberate think of the consequences and act with forethought. Severe Problem Risk (90 to 100th percentile) scorers are very impulsive people who typically act without forethought or consideration of consequences in most, if not all of their life. Impulsivity could be a factor in their offending if such were to occur. Impulsiveness could be an important contributing factor in sexual offending per se.

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