Recent Research on Sex Offenders with
Intellectual and Learning Disability
Prof. Bill Lindsay
Danshell Health
Univ Abertay,Dundee,
Bangor Univ.
Deakin Univ. Melbourne
Recent Research on Sex
Offenders with Intellectual
and Learning Disability
Prof. Bill Lindsay
Danshell Health
Univ Abertay,Dundee,
Bangor Univ.
Deakin Univ. Melbourne
Email: bill.lindsay@danshell.co.uk
Community and Security?
• Many clinical developments are about security.
• Access to an ordinary life.
• Communities, GP surgeries, sports, public transport,
shops, pubs, entertainment, education.
• Courts, criminal justice, disposals.
• Vulnerabilities, exploitation.
• Lund (1990). Denmark, 1970s to 1980s – doubling of
the incidence of sex offenders with ID.
Referral source percentages by year.
90
80
Court
Community
Other
70
60
Lindsay, Haut and Steptoe,
,J Foren. Psychiat Psychol. 2011
50
N=309
40
30
20
10
0
1990-1995
1996-2002
2003-2008
Characteristics – change setting only (Hogue
Lindsay, Taylor et al 2006 Criminal Behaviour and Mental
Health)
50
45
40
35
30
25
20
15
10
5
0
N=212
Offences across
lifespan.
High
Med/low
community
Sex
offence
Violent
offence*
Bodily
harm*
Weapon
use
Characteristics – change setting only (Hogue
Lindsay, Taylor et al 2006 CBMH)
50
45
40
35
30
25
20
15
10
5
0
Index offence
High
Med/low
community
Sexual
assault
Violent
assault*
Arson
Alcohol
1988- 2008
Lindsay,
Steptoe,
Haut,
Brewster
Individual
treatment
motivation
(2013)
CBMH
20 year
follow up
of 309 p
community
forensic ID
service
Treatment of
criminal
issues,
ISB, anger,
fire interest
Psychiatric
review and
management
Offender
treatment.
Community
integration,
family social
contact..
social skills
and offence
related
thinking.
Work and
occupation
Percent of each cohort reoffending (any reported incident) up
to 20 year follow up. Lindsay, Haut et al (2013), CBMH
60
Other off.
N=126
50
40
Sex offenders
N=156
Females
N=27
30
20
10
0
Reoffending
Harm Reduction (Lindsay, Haut, Steptoe and Brewster 2013):
Reduction in number of incidents (total cohort)
1400
1200
*
1000
800
600
2 YEARS
BEFORE
UP TO 20
YRS AFTER
*
400
200
0
SEX OFF
OTHER OFF
WOMEN
Assessment Issues in Inappropriate
Sexual Behaviour (ISB)
•
•
•
•
•
Cognitive ability
Sexual Knowledge
Abuse in childhood
Mental health issues
Social background and family attachment
issues
• Emotional stability
• Cognitions consistent with ISB
Pathways through forensic ID services
(Lindsay, Holland et al 2010, AmJ IntDevDis). n=197.
Inappropriate Sexual Behaviour
• SSKAAT-R (Griffiths & Lunsky 2002).
• SEXKEN (McCabe, Cummins & Deeks. RIDD, 1999, 24154).
• ASK (Galea, Butler, Lambrick et al.. JIDD, 2004, 350-65).
• Puberty, parts of the body, sexual health, contraception,
having sex, relationships, use of alcohol, safety,
pregnancy and childbirth, masturbation, legal issues
(ASK).
Counterfeit Deviance
Counterfeit Deviance (Griffiths, Hingsburger) –
Sexual Knowledge. Sex Offenders V Non Sex Offenders.
Sexual Knowledge Score
(Michie et al 2006 Sexual Abuse. Lunsky et al 2007 JIDD)
45
100
90
80
70
60
50
40
30
20
10
40
35
Type 1 D
Type 2 I
Controls
30
25
Anatomy Birth Control Dating
Intercourse
STD
Assessment areas
Menstruation
20
anatomy
Sex Off(24)
Non-Sex Off(41)
BC
boundaries
total
Abuse in childhood in Offenders with ID.
(Lindsay, Steptoe and Haut 2011. J.Int.Dis.Res.)
*
60
50
40
Male Sex Off
*
Other Male
Off.
*
30
Females
20
10
0
CSA
NAI
Cognitive Distortion – Faulty Thinking Mechanisms
(Ward et al., 1997. Clinical Psychology Review)
• Denial of an offence
• Denial of intent
• Mitigation of responsibility through victim action- victim
shares the blame, victim encouragement
• Mitigation of responsibility through life events – life stress,
lack of sexual outlets, work stress
• Minimisation of incident/consequences – little harm, victim
enjoyed experience,learning experience for victim
• Denial of normal state – alcohol, mental illness
Lindsay, Whitefield & Carson (2007), Legal & Criminological
Psychology
6
5
4
SO/ID
))/ID
NO/ID
Mainsream
3
2
1
0
Rape
Voyeur
Exhib.
Children
QACSO Scores (n=10, Sex Off. gps.)
Lindsay et al (2006) JARID
25
QACSO results replicated by:
20
Rose et al 2002, 2012
Langdon et al 2007
Craig et al 2013
Murphy et al 2011
Heaton and Murphy 2013
Mean Score
15
10
5
0
Rape
Children
Type of Of f ence
Vchild
Vadult
exhibit.
nonOff (n=19)
Sex offending pathways (Hudson and Ward)
•
•
•
•
Avoidant active
Avoidant passive
Approach explicit
Approach automatic
Keeling and Rose(2005) Sexual Abuse
Hypothesis : passive and automatic pathways
Sex offending pathways
Keeling, Rose and Beech(2006) Sexual
Abuse (n=16)
Mainstream
Bickley and Beech (2002),n=87
Active V Passive
Approach V Avoid
Special needs
60
Avoid A
50
Avoid P
40
Appr. Ex
30
Appr. Au
45
40
35
30
25
20
20
15
10
10
5
0
0
Sex offending pathways
Langdon,et al (2007 JIDD) Lindsay et al 2009 SAJRT
Active V Passive
Approach V Avoid 45
Active/Ex
Higher IQ
Greater sex K
LowerQACSO
40
Avoid A
35
Avoid P
30
50
Appr. Ex
25
20
Approach
Higher IQ
Greater denial
60
15
10
5
0
Appr. Au
40
30
20
10
0
Russell - Avoidant Active
Risk of Re-offending
(Elliot, Lindsay & Astell, 2004, J.App.Res.Int.Dis.)
•
•
•
•
Offence involving violence, r=0.295*
Juvenile crime, r=0.284*
Sexual abuse ,r=0.327,*
Poor relationship with mother, r=0.346*
•
•
•
•
•
•
•
Anti-social attitude, r=0.309*
Low self-esteem, r=0.374**
Poor response to treatment, r=0.45**
Denial of Crime, r=0.335*
Low treatment motivation, r=0.303*
Poor compliance with man/treat routine, r=415*
Allowances made by staff, r=0.409**
Risk Prediction – Receiver Operator
Characteristics (ROC)
•
•
•
•
•
Auc =.5 – toss a coin
Auc= 1 - perfect
Auc =.65 - ok
Auc = .75 - good
Auc - .85 – very good
RISK PREDICTION – auc. (Lindsay, Hogue et al, in press,
Int J Off Ther Comp Crim.)
VRAG
HCR20
HCR -H
HCR - C
HCR-R
RM2000S
RM2000V
RM2000C
STATIC99
SDRS
EPS
50
55
60
65
70
75
ARMADILO - Boer, Tough & Haaven (2004)
Journal of Applied Research in Intellectual Disabilities
• First complete the Static-99
•
•
•
•
Stable Client Items - 12 Items
Stable Environment Items – 5 items
Acute Client Items – 9 Items
Acute Environment Items – 4 Items
• All of the validating research has been done on this
version. The 2010 vision retains the original
structure but changes the items.
Stable Client Items
Attitude towards compliance with supervision and treatment
Knowledge of faulty thoughts/crime cycle/risk factors/relapse
prevention plan
Stable Environment Items
Attitudes towards sex offenders with ID
Communication amongst supervisory staff
Acute Client Items
Changes in social support
Changes in substance use
Acute Environment Items
New supervisory staff
Monitoring of offender by staff
Recent studies
27
Blacker, Beech, Wilcox & Boer. Psychology Crime & Law, 2011
• ARMIDILO-S stable unofficial AUC 0.56; Official AUC 0.61 n=44
• ARMIDILO-S Acute unofficial AUC 0.76; Official sexual AUC 0.73
All special needs sex offenders but Offenders with ID n=10 (IQ < 75)
ARMIDILO-S stable AUC 0.86.
ARMIDILO-S acute AUC 0.75
Sindall & Murphy, unpublished
N=16
Stable client. – Auc= .85
Acute client. - Auc = .46
Stable environment – Auc= .41
Acute environment Auc =.50
Armadilo total - Auc= .83
Lofthouse, Lindsay, Totsika, Hastings et al. JARID, 2013.
•
•
•
•
•
•
•
•
64 sexual offenders with ID
Average age 32
94% referred through community services
Average IQ 67; range 54-75
4% were in-patients
96% lived in the community
21 engaged in ISV throughout follow-up
Follow up – 6 years
ARMADILO – auc.
(Lofthouse, Lindsay, Hastings et al, 2013. JARID)
VRAG = .55
Sensitivity
Static – 99 = .72
Armidilo = .91
1 - Specificity
Treatment studies
Early work was case
studies
Lambrick and
Glaser (2002)
Rose et al (2002)
O’Conner (1996)
Lindsay et al
(1998)
Treatment
studies
Early work was
case studies
Lambrick and
Glaser (2002)
Rose et al
(2002)
O’Conner
(1996)
Lindsay et al
(1998)
VALENTINE
IN THE PUB
Danny
Celia
D
Y
IN THE
STREET
Lindsay et al. (1998), Research in Developmental
Disabilities
Frank Lambrick and
co workers.
Melbourne, Victoria
corrections.
Lambrick & Glaser
(2002) SAJRT
Sex Offender Response to Treatment
(Lindsay & Smith, 1998. Journal of Intellectual Disability
Research)
Average Scores as %
100
80
Re-offending
60
1 Year
Probation: 64%
40
2 Year
Probation: 0%
20
0
Pre-treatment
Post-treatment
Follow-up
QACSO Assessment Scores
1 Year Probationary Sentence
2 Year Probationary Sentence
Status Following Discharge From Treatment
(Lindsay et al., 2002. Journal of Applied Research in Intellectual
Disability)
100
% Patients
80
60
40
20
0
Planned Discharge
Unplanned Discharge
Discharge Details
Reoffending Documented / Suspected
No reoffending
Murphy et al SOTSEC ID
J. App.Res.Int.Dis., 2010
55
50
*
45
N = 46
9% reoffending
*
40
Baseline
Post Treatment
F.U. 6 Mths
35
30
25
20
QACSO
SAKS
SOSAS
VES
Responses on QACSO Offences against children scale
Lindsay, Michie et al 2011 JARID
25
F. U. 6 Years
Reoffending – 23%
attirudes score
20
15
10
5
0
Baseline
6mth
12mth
18mth
24mth
30mth
36mth
Assessment areas
Adults.n=15
Children.n=15
Rose et al 2012 J. Foren. Practice
55
50
*
N = 12
1 reoffended
*
45
40
Baseline
Post Treatment
F.U. 12 Mths
35
30
25
20
QACSO
SSKATT
A MODEL UNDERPINNING TREATMENT FOR SEX OFFENDERS
WITH MILD INTELLECTUAL DISABILITIES
( Lindsay 2005, Int. & Dev. Dis., 2009)
1. Motivation
2. Strategies for offending
3. General theories of
criminality
4. Community
engagement
Conclusion
Good evidence for first 2 strands:
• Cognitive intervention
• Self-restraint
• Motivation and strategies
Good evidence for second 2 strands:
• Community engagement
• Q.O.L.
CAUTION
R.P. and contact with victims
Community engagement
why would we tolerate sexual offenders in the
community?
• Sex offenders have a lower reoffending rate than violent
offenders. 20% V 75%
• We are more afraid of stranger rape than most other crime.
• We are more afraid of child abduction than most other crime
• Stranger rape is relatively uncommon. If you are raped it is
most likely to be by a friend or acquaintance.
• A child is far more likely to be sexually abused by her/his
father, brother, uncle or grandad.
Attachments, Relationships and QOL
Steptoe, Lindsay, Forrest & Power, (2006) JIDD
Significant
Other Scale
(Power
et al., 1988)
6
5
2.5
**
2
4
1.5
3
1
2
L. E. C.
(Ager, 1988)
Offenders only
Support (SOS)
1
0.5
0
0
Relationships Domain
Sex Offenders
Control
SOS
Actual
Ideal
Relationships and Personal wellbeing
Wheeler et al, (2013) JARID
• Personal
• Wellbeing
Index
(Cummins)
7
6
5
**
*
4
3
2
• L. E. C.
(Ager, 1988)
1
0
Relationships
Domain
Offenders
PWI
Control
Community Engagement – GLM (Tony Ward)
• Control theory – masses of evidence to support the
importance of community engagement to cut crime.
• Good Lives Modal (GLM) – Ward’s theory of human needs and
sexuality. The importance of fulfilling human needs without
diminishing risk management.
• Most sex offenders live in the community anyway.
• Treatment in the community is far more realistic. Treatment in
secure settings is always second best.
• Even if we wanted to the cost of locking everyone up for life is
prohibitive.
PREDICTIONS
• Appropriate engagement alone will not
produce reduction in recidivism
• Treatment in isolation (institution) is
unlikely to produce gains in recidivism
• Both are needed – address primary
motivation and social engagement
Treatment of
criminal issues,
ISB, anger, fire
interest
Individual
treatment
motivation
Psychiatric
review and
management
Offender
treatment.
1990 - 2008
social skills
and offence
related
thinking.
Work and
occupation.
Community
integration,
family social
contact..
Harm Reduction (Lindsay, Haut, Steptoe and Brewster 2013):
Reduction in incidents (total cohort)
1400
1200
*
1000
800
600
*
2 YEARS
BEFORE
UP TO 20
YRS AFTER
400
200
0
SEX OFF
OTHER OFF
WOMEN
Responsivity to criminogenic need.
Lindsay, Carson, Holland, Taylor et al 2013,
Journal of Intellectual Disability Research
Referred
24 mths
12
mths
Treatment
Treatment
ISB
Violence
Alcohol
Firesetting
Treatment across 24 months: Sexual index offence
(Lindsay, Carson, Holland, et al 2012)
35
Referred
30
12 Mths
24 Mths
25
20
15
10
5
0
Gen. Community
Foren. Community
Low/Med secure
High Secure
CONCLUSIONS.
• Research has been developing at a steady pace across the
field.
• This research has high social validity and is in response to
cultural and societal changes – very important.
• Research suggest treatment is highly effective
• Important to develop reliable, valid assessments.
• Risk assessment research has been conducted and seems
promising.
• Treatment work on sexual offending has long follow up.
• Treatment is most likely to happen in a designated
forensic community service.
• We should consider comprehensive service evaluations as
legitimate and theoretically sound research.
Recent research on sex offenders with
intellectual & learning disability.
Prof Bill Lindsay
Danshell Health.
Univ. Abertay, Dundee
Bangor Univ.
Deakin Univ., Melbourne
Email: bill.lindsay@danshell.co.uk