Assessment and Treatment of
People Who Have Been Convicted of
Sex Offenses
Gregory DeClue, Ph.D., ABPP
gregdeclue@mailmt.com
http://gregdeclue.myakkatech.com
Florida Psychological Association
Sarasota, Florida
July 15 & 16, 2006
What do we know about people
who have been convicted of a sex
offense?
1. Causes
2. Consequences
3. Legal and Ethical Issues
4. Assessment
5. Treatment
6. Civil Commitment
1: Causes
1: Causes
Definitions – Legal
Definitions – Psychological &
Anthropological
Definitions – Biological
Incidence
Prevalence
Causes
Definitions – Legal
A “sex offender” is a person who
has been convicted of one or more
sex offenses.
What is a sex offense?
FS 394.912(9) "Sexually violent offense"
means:
(a) Murder of a human being while
engaged in sexual battery in violation of s.
782.04(1)(a)2.;
(b) Kidnapping of a child under the age of
13 and, in the course of that offense,
committing:
1. Sexual battery; or
2. A lewd, lascivious, or indecent assault or
act upon or in the presence of the child;
(c) Committing the offense of false
imprisonment upon a child under
the age of 13 and, in the course of
that offense, committing:
1. Sexual battery; or
2. A lewd, lascivious, or indecent
assault or act upon or in the
presence of the child;
(d) Sexual battery in violation of s.
794.011;
(e) Lewd, lascivious, or indecent
assault or act upon or in presence
of the child in violation of s. 800.04;
(f) An attempt, criminal solicitation,
or conspiracy, in violation of s.
777.04, of a sexually violent
offense;
(g) Any conviction for a felony
offense in effect at any time before
October 1, 1998, which is
comparable to a sexually violent
offense under paragraphs (a)-(f) or
any federal conviction or conviction
in another state for a felony offense
that in this state would be a sexually
violent offense; or
(h) Any criminal act that, either at
the time of sentencing for the
offense or subsequently during civil
commitment proceedings under this
part, has been determined beyond
a reasonable doubt to have been
sexually motivated.
Juvenile sexual offender behavior
ranges from noncontact sexual
behavior such as making obscene
phone calls, exhibitionism, voyeurism,
and the showing or taking of lewd
photographs to varying degrees of
direct sexual contact, such as frottage,
fondling, digital penetration, rape,
fellatio, sodomy, and various other
sexually aggressive acts.
[s. 39.01(7), F.S.]
"Sexual abuse of a child" means one
or more of the following acts:
(a) Any penetration, however slight, of
the vagina or anal opening of one
person by
the penis of another person, whether or
not there is the emission of semen.
(b) Any sexual contact between the
genitals or anal opening of one person
and the
mouth or tongue of another person. …
(c) Any intrusion by one person into
the genitals or anal opening of
another person, including the use of
any object for this purpose, except
that this does not include any act
intended for a valid medical
purpose.
(d) The intentional touching of the genitals
or intimate parts, including the breasts,
genital area, groin, inner thighs, and
buttocks, or the clothing covering them, of
either the child or the perpetrator, except
that this does not include:
1. Any act which may reasonably be
construed to be a normal caregiver
responsibility, any interaction with, or
affection for a child; or
2. Any act intended for a valid medical
purpose.
(e) The intentional masturbation of the
perpetrator's genitals in the presence of a
child.
(f) The intentional exposure of the
perpetrator's genitals in the presence of a
child, or any other sexual act intentionally
perpetrated in the presence of a child, if
such exposure or sexual act is for the
purpose of sexual arousal or gratification,
aggression, degradation, or other similar
purpose.
(g) The sexual exploitation of a
child, which includes allowing,
encouraging, or
forcing a child to:
1. Solicit for or engage in
prostitution; or
2. Engage in a sexual performance,
as defined by chapter 827.
[s. 39.01(63), F.S.]
REPORTING
ABUSE, NEGLECT,
THREATENED HARM and
EXPLOITATION of CHILDREN,
and VULNERABLE ADULTS:
INFORMATION PACKET
FOR
PROFESSIONALLY
MANDATED REPORTERS
http://www.dcf.state.fl.us/abuse/publicat
ions/mandatedreporters.pdf
1.When can a minor lawfully
consent to sexual intercourse?
Answer: This question depends on
the age of the minor. A minor under
the age of 16 can never lawfully
consent to sexual intercourse. A
minor who is at least 16 years of
age or older can lawfully consent to
intercourse if the second party is
less than 24 years of age and at
least 16 years old.
2.What will happen if children less
than 16 years of age engage in
sexual intercourse and both minors
had expressed a desire to
participate?
Answer: The age of the minors involved
can factor into this question. If the
minors are both between the ages of 12
but less than 16, they both can be
charged. If one minor is less than 12
and the other over 12, the child over 12
will be charged. Child on child acts
committed by minors who are both
under the age of 12 are evaluated on a
case by case basis.
Definitions – Psychological &
Anthropological
Rape (narrow) = the forceful act of
sexual intercourse against a
person’s will
Rape (broad) = any physical sexual
contact performed with the use or
threat of physical force
Sexual Coercion = any physical
sexual contact performed without a
person’s consent using any
coercive methods (e.g., using a
position of authority or verbal
pressure)
Lalumière, M. L., Harris, G. T.,
Quinsey, V. L., and Rice, M. E.
(2005). The causes of rape:
Understanding individual
differences in male propensity for
sexual aggression. Washington,
D.C.: American Psychological
Association.
Definitions - Biological
According to Wakefield (1999), a
phenomenon should be called a
disorder when it is a “harmful
dysfunction.” To be a harmful
dysfunction, two criteria must be
met:
Disorder? (Wakefield)
First, a structure or a process does
not function as designed by natural
selection.
Second, the dysfunction results in
suffering, distress, or social
impairment.
Wakefield, J. D. (1999). Evolution
versus prototype analyses of the
concept of disorder. Journal of
Abnormal Psychology, 108, 374399.
“From a Darwinian perspective, the
function of the male sexual
preference system is to direct male
sexual behaviors toward
reproductively capable females. …
“Thus, Wakefield’s definition
suggests that pedophilic preference
is pathological because it would be
expected to decrease fitness in
ancestral environments. …
“Preferences for coercive sexual
activity could well increase male
fitness, because rapes may result in
a man fathering more children than
he would have otherwise under
some conditions” (Lalumière et al.,
2005, 128-129).
Forced Copulation in the Animal
Kingdom
(Lalumière et al., 2005)
White-cheeked pintail:
Almost all forced copulation
involves a paired male and a fertile
female other than his mate.
Forced copulation is often
detrimental to females.
Female resistance can serve as a
screen to select the best males,
either indirectly by inciting malemale competition or directly by
mating with the strongest, healthiest
male (the one that overcame female
resistance).
Forced copulation involves the
negation of female choice.
Sand Bubbler Crab:
Courtship is absent; all copulations
are resisted by females.
The last male to mate has the
reproductive edge.
Henmi, Koga, & Murai (1993):
Forced mating can easily evolve
and courtship disappear when
members of the species live in very
dense areas and when males can
overcome female resistance. Males
that spend time courting in dense
areas lose to males that simply
capture females.
Orangutans:
Females prefer large, mature
males, and males prefer fertile,
adult females.
The most dominant male was the
least likely to engage in forced
copulation.
Small males engage in an alternate,
low-cost reproductive strategy.
Many insect species:
A fundamental conflict between
males and females stems from the
fact that additional partners or
copulations are likely to benefit
males in terms of reproductive
success, but not females.
Across many species:
From the male’s reproductive point
of view, females are most of the
time in short supply.
From the female’s point of view,
there are too many males (and,
often, too few good ones).
Reproductive output is the bottom
line in nature. Any behavior that
increases it is selected and has
greater representation in the next
generations. …
… The use of methods to seduce,
persuade, coerce, or force females
to copulate would be selected over
generations when it has greater net
reproductive benefit than cost for
males. …
… The use of methods to resist
male seduction, persuasion,
coercion, or force would be selected
over generations when it has
greater net reproductive benefit
than cost for females. …
Conflict between males and
females over mating can lead to
“evolutionary arms races” between
the sexes.
Strategies and Tactics in the
“Evolutionary Arms Race”
Strategy = a genetically based
decision rule that guides
development and behavior.
Tactic = a phenotype (e.g., a
preference, a behavior, a bodily
structure) that results from a
strategy.
In developmentally flexible
conditional strategies, the animal
can switch back and forth from one
tactic to the other as the situation or
its status changes over time.
STRATEGIES POSSIBLY
UNDERLYING FORCED
COPULATIONS
•
•
•
•
•
Circumstantial Opportunists
The Opportunistic Spouse
The Cuckold
The Competitively Disadvantaged
The Morph
Circumstantial Opportunists are
males that generally court receptive
females but switch to forceful tactics
when females are unreceptive.
This occurs in some species that do
not form pair bonds.
Opportunistic Spouses are males
who have attracted a mate but who
also obtain additional matings by
forcing copulation on other females.
Forced copulation in mallards is
common, usually involving multiple
attackers (average = 4).
When a female duck is attacked by
a gang of rapist ducks, her mate
tries to protect her.
But if the male duck is unsuccessful
in protecting his mate from being
raped, he rapes her, too.
In birds, forced copulation is almost
always a special kind of extra-pair
copulation, in that perpetrators and
victims already have a mate.
The cuckold attempts to force
copulation on his own mate when
he suspects that she has engaged
in extra-pair copulation (forced or
not). It is a conditional strategy
used by males under that specific
circumstance.
The forceful behavior of the cuckold
likely serves his reproductive
interests through sperm
competition.
The use of forced copulation as a
result of competitive disadvantage
occurs in many species.
Forced copulation in grasshoppers
seems to be a conditional mating
tactic used by relatively low-quality
males to secure mating
opportunities with reluctant females.
In contrast, attractive male zebra
finches were more often involved
than unattractive males in unforced
extra-pair mating, but were just as
often involved in forced extra-pair
mating.
In a few species, males that use
forced copulation are genetically
different from males who do not.
These morphs use an alternate
mating strategy.
Examples: swordtail, bluegill sunfish
Opportunists, cuckolds, and
competitively disadvantaged males
use forced copulation as an
alternative tactic under those
conditions that favor it.
The tactic of forced copulation is
likely part of a single strategy
shared by all males of the species.
Forced copulation is proximally
caused by particular cues (which
vary by species).
Forced Copulation in the Animal
Kingdom
(Lalumière et al., 2005)
Conclusions:
(ATSA's Mission:
Elimination of sexual
victimization
http://www.atsa.com/)
Forced copulation occurs in a wide
variety of species.
Are there patterns in which species
engage in forced copulation, or in
the conditions under which it could
be expected to evolve?
1) Sexual size dimorphism favoring
males (males can physically
overpower females)
2) polygynous mating systems
(some males obtain more
mating partners than others)
3) male-biased operational sex
ration (there are more males than
females available to mate)
4) asynchronous breeding (not all
females copulate and breed at the
same time)
5) Group living or breeding (a male
has easy access to more than one
female)
6) lesser male than female parental
investment (larger sex difference in
maximum reproductive rates)
All of these characteristics are
present in Homo sapiens.
But wait  more conclusions from
Forced Copulation in the Animal
Kingdom
(Lalumière et al., 2005)
1) Forced copulation is something
males do to females.
2) Forced copulation does not
appear to be an anomalous
behavior generated by unusual
conditions such as
overcrowding, captivity, or poor
health.
3) Males tend to target fertile
females.
4) Forced copulation sometimes
leads to insemination, fertilization,
and offspring.
5) Males in most species do not
engage exclusively in forced
copulation; males that engage in
forced copulation are generally also
seen courting females at other
times.
6) Some males are more likely than
others to engage in forced
copulation, and some are more
successful at it than others.
Which all leads to the general
conclusion:
Forced copulation is a tactic used
by some males under some
conditions to increase reproduction.
And a final comment:
The threat of forced copulation has
probably been a strong selection
pressure for female mating behavior
towards males.
Legal, psychological, and biological
definitions of “sex offense,” “sex
offender,” and “sexual disorder”
overlap imperfectly.
Sex offense?
1) Two unmarried people voluntarily
engage in sexual activity.
Age?
Gender?
Private/public?
Jurisdiction?
2) Two people engage in sexual
activity on their wedding night.
Age?
Gender?
Private/public?
Jurisdiction?
3) Child marriage.
Most countries have declared 18 as
the minimum legal age of marriage.
Despite the sanctions on child
marriage, however, more than 100
million girls are expected to marry in
the next decade.
Impoverished parents often believe
that child marriage will protect their
daughters. In fact, however, it
results in lost development
opportunities, limited life options
and poor health.
Child marriage is a health issue as
well as a human rights violation.
Because it takes place almost
exclusively within the context of
poverty and gender inequality, it
also has social, cultural and
economic dimensions.
Married adolescents have been
neglected from the global
adolescent reproductive health
agenda because of the incorrect
assumption that their married status
ensures them a safe passage to
adulthood.
Married adolescents are typified by:
• Large spousal age gaps
• Limited social support, due to social
isolation
• Limited educational attainment and no
schooling options
• Intense pressure to become pregnant
• Increased risk of maternal and infant
mortality …
• Increased vulnerability to HIV and other
STIs
• Restricted social mobility/freedom of
movement
• Little access to modern media (TV,
radio, newspapers)
• Lack of skills to be viable to the labor
market
It is no coincidence that the same
countries in Africa, Asia and the Middle
East that have high rates of child
marriage are those with:
• High poverty rates, birth rates and
death rates
• Greater incidence of conflict and
civil strife
• Lower levels of overall
development, including schooling,
employment, health care
The East Asian “Miracles” like Taiwan,
South Korea, Thailand that have
successfully eradicated the harmful
traditional practice of child marriage are
characterized by:
• Economic growth and opportunity
• Declines in birth and death rates
• Increase in educational and
employment options for girls
• In Southern Asia, 48 per cent
(nearly 10 million) of young
women were married before the
age of 18.
• In Africa, 42 per cent were married
before turning 18.
• In Latin America and the
Caribbean, 29 per cent of young
women were married by age 18.
In some countries, more than half of all girls
under 18 are married. Specifically, the
percentage of girls married by age 18 is:
• 76 percent in Niger
• 74 per cent in the Democratic Republic of
Congo
• 54 per cent in Afghanistan
• 50 per cent in India
• 51 per cent in Bangladesh
Child marriage curtails
girls' education
Child marriage undermines
reproductive health
Child Marriage & Maternal
Mortality: Maternal
Mortality by Age
In Cameroon, Ethiopia and Nigeria,
maternal mortality among
adolescents under 16 was found to
be six times higher than for young
women aged 20-24.
Parents may consider early
marriage as a strategy to safeguard
their daughters from HIV infection,
but it often has the opposite effect.
Studies in parts of Kenya and
Zambia show that teenage brides
are contracting HIV at a faster rate
than sexually active single girls in
the same locales.
Further evidence indicates that
about 17-22 per cent of girls
between 15-19 years in subSaharan Africa are already living
with HIV, compared to 3-7 per cent
of boys on the same age.
Studies in Kisumu, Kenya and in
Ndola, Zambia, show higher rates
of HIV infection in some groups of
married adolescent girls compared
with unmarried, sexually active
counterparts.
Women who marry younger are
more likely to be beaten or
threatened, and more likely to
believe that a husband might
sometimes be justified in beating
his wife.
Married adolescents are particularly at risk.
Teenage girls in many parts of the world are
often married off early as a povertyreduction strategy by impoverished parents.
But according to recent studies in Kenya
and Zambia , adolescent married women
are at a higher risk of HIV infection than
their unmarried, sexually active
counterparts. The research found that
adolescent girls married to much older men
had a greatly increased risk of getting
infected with HIV/AIDS.
Older married women also appear
at high risk from HIV/AIDS. In SubSaharan Africa 60 to 80 per cent of
HIV+ women report having had
sexual relations only with their
husbands. In India, “marriage is
actually women’s primary risk
factor” according to one
epidemiologist studying HIV and
gender issues.
The popular AIDS prevention
slogan, ABC – Abstain, Be faithful,
use Condoms – doesn’t
automatically protect married
women. As long as they are not
able to enforce condom use in their
marriage, faithfulness will not
automatically protect women from
HIV/AIDS infection.
So, globally, Child Marriage and
Marital Rape may be the most
frequent and the most deadly sex
offenses.
Common Themes
• Men dominating women
• Sex
• Reproduction
Additional web reference:
PANOS Global AIDS Programme
Is female genital mutilation (FGM) a
sex offense?
Female genital mutilation (FGM) is
the term used to refer to the
removal of part, or all, of the female
genitalia. The most severe form is
infibulation, also known as
pharaonic circumcision. An
estimated 15% of all mutilations in
Africa are infibulations.
The procedure consists of
clitoridectomy (where all, or part of, the
clitoris is removed), excision (removal
of all, or part of, the labia minora), and
cutting of the labia majora to create raw
surfaces, which are then stitched or
held together in order to form a cover
over the vagina when they heal. A small
hole is left to allow urine and menstrual
blood to escape.
In some less conventional forms of
infibulation, less tissue is removed
and a larger opening is left.
An estimated 135 million of the
world's girls and women have
undergone genital mutilation, and
two million girls a year are at risk of
mutilation - approximately 6,000 per
day.
- Amnesty International
Is sexual repression a sex offense?
DHAKA: An Islamist militant group
blamed for a series of bombings in
Bangladesh has threatened to kill
women, including non-Muslims, if
they do not wear the veil, a
statement said.
Juvenile sexual offender behavior
ranges from noncontact sexual
behavior such as making obscene
phone calls, exhibitionism, voyeurism,
and the showing or taking of lewd
photographs to varying degrees of
direct sexual contact, such as frottage,
fondling, digital penetration, rape,
fellatio, sodomy, and various other
sexually aggressive acts.
[s. 39.01(7), F.S.]
Incidence of rape in the United
States:
Increasing or Decreasing?
June 19, 2006, 1:13AM
Statistics show rape on the decline
in U.S.
The number of rapes per capita in
the United States has plunged by
more than 85 percent since the
1970s, and reported rape fell last
year even while other violent
offenses increased, according to
federal crime data.
In 1979, according to a Justice
Department estimate based on a
wide-ranging public survey, there
were 2.8 rapes for every 1,000
people. In 2004, the same survey
found the rate had decreased to 0.4
per thousand.
The Justice Department's National
Crime Victimization Survey asks
thousands of respondents 12 and
older about crimes that have
happened to them. This survey,
which is meant to capture offenses
that weren't reported to police, is
the one that depicted the 85 percent
decline in the per-capita rape rate
since 1979.
"Overall, there has clearly been a
decline over the last 10 to 20
years," said Kim Gandy, president
of the National Organization for
Women. "It's very liberating for
women, in terms of now being able
to be more free and more safe."
The Juvenile Sex Offender
SECOND EDITION
EDITED BY
Howard E. Barbaree
William L. Marshall
© 2006 The Guilford Press
Chapter 4:
Biological Factors in the
Development of Sexual Deviance
and Aggression in Males
Ray Blanchard
James M. Cantor
Lori K. Robichaud
“summarizes the available evidence
for biological influences on
paraphilias and other factors
affecting men’s risk of sexual
offending”
“Our goals were to present the few
conclusions about pathogenic
biological factors that do appear to
be justified by the available data
and to highlight the various
theoretical and empirical questions
that remain to be answered.”
Across various samples, mean IQs
of sex offenders have ranged from
60 to 114, but typically fall in the low
90s.
A large meta-analysis found that
adult sexual offenders (5,647) had
lower IQs than nonsexual offenders
(16,222). Lower IQs men who
offended against children < 13.
Lower IQ: more child victims
Higher IQ: more consenting, adult
partners
Lower IQ scores were associated
with greater phallometric responses
to sexual stimuli involving children.
Child molestation is related to lefthandedness.
Phallometrically diagnosed
pedophilia is related to lefthandedness, even after controlling
for age and IQ.
It is possible that associations exist
among pedophilia, left-handedness,
and poor cognitive functioning
because neurodevelopmental
problems during prenatal life
predispose a male to develop all
three.
What about neuropsychological test
results of sex offenders?
Stone and Thompson (2001)
suspected that sexual offenders
suffered from an impairment in the
frontal lobes of the brain.
Results: Yes, but …
Across studies, there is not
consistent support for the
frontal/dysexecutive hypothesis of
sexual offending. Failures to
replicate far outnumber replications.
Offenders’ performances on
neuropsychological tests were
typically either normal on nearly
every test or subnormal on nearly
every test of the battery employed
(true in most of the larger samples).
Thus any deficits in
neuropsychological functioning
among sex offenders appear to be
broad in nature, and studies
powerful enough to find any of them
find all of them.
Alternatively, specific cognitive
deficits may exist among specific
subtypes of sex offenders – but
attempts to dis-aggregate offenders
have not shown promising results.
Current conclusion:
“[Neuropsychological] tests have
provided little information beyond
that provided by the IQ studies”
(p. 84).
HRB & LNNB studies have
variously concluded that sex
offending results from impairment to
1) left hemisphere
2) right hemisphere
3) temporal and frontal lobes
4) left temporal and frontal lobes
only …
5) left temporal and parietal lobes
only, or
6) whole cortex globally
Conclusion: No reliable findings
regarding localization of impairment
of sex offenders’ brains
Brain Imaging
has focused primarily on either
1) frontal/dysexecutive hypothesis
or
2) temporal/lymbic hypothesis
So far –
0 published MRI studies
11 published CT studies, 8 from the
same researchers with overlapping
samples of participants; sometimes
the number of comparisons
exceeds the number of participants;
results inconsclusive
Brain Functioning studies:
PET and rCBF
Overall, imaging studies provide
some data supporting the general
conclusion that sexual offenders
against children may show elevated
rates of neuropathology. But –
small studies; no consistent, strong
results.
Hormones
methodological problems,
no firm conclusions,
two possible trends
Testosterone and sexual
aggression?
Studies show either nonsignificant
results or findings that groups with
more sexual violence have higher
levels of testosterone.
Testosterone and Pedophilia?
Studies show either nonsignificant
results or findings that groups of
pedophiles have lower levels of
testosterone when compared with
controls or nonviolent nonsexual
offenders.
Comorobidity with Other Disorders
Clues to the nature of a disorder?
Raymond et al. (1999)
systematically studied 45 male
pedophiles and found that all but 3
would have met criteria for some
other major psychiatric disorder at
some point in their lives, especially
anxiety and mood disorders, most
especially major depression.
Retrospective Self-Report Studies
of Head Injury
Blanchard et. Al (2002): Among
patients referred to a clinical
sexology service, pedophiles (as
measured via PPG) reported more
childhood accidents resulting in
unconsciousness before age 13
(3 overlapping samples totaling
1,891 subjects).
Two possible interpretations:
1) Subtle brain damage after birth
increases a boy’s risk of pedophilia
or
2) neurodevelopmental problems
before birth increase a boy’s
accident-proneness, along with his
risk of pedophilia
Head Injury and Late-Onset Sexual
Offending or Paraphilia
Rare reports; possible explanations:
1) Patient using head injury as an
excuse
2) Head injury has disinhibited the
patient, causing either
indiscriminate increase in sexual
behavior or loss of control over a
previously suppressed paraphilia
Genetics
Gaffney, Lurie, & Berlin (1984)
found higher rates of pedophilia in
the first-degree relatives of
pedophiles and higher rates of
nonpedophilic paraphilias in the
first-degree relatives of
nonpedophilic pedophiles, but …
Small samples: 33 pedophiles
21 nonpedophilic paraphiles
33 psychiatric controls
and
unlikely to be replicated
(at least in USA) due to
mandatory reporting laws
Summary and Conclusions from
Blanchard, Cantor, & Robichaud
(2006)
“The available data suggest that
anomalous neurodevelopment,
whether of genetic or environmental
origin, does increase a male’s risk
of problematic sexual behavior,
especially pedophilia.
More detailed conclusions are
difficult to justify. …
“… It may well be that specific brain
structures or functions are
implicated in erotic pathology, but
this has not yet been convincingly
demonstrated by
neuropsychological testing or brain
imaging techniques” (p. 99).
“For many decades, anomalous
sexual behavior has been widely
viewed as the product of anything
but anomalous brain development:
classical conditioning,
operant conditioning,
psychodynamic processes, …
“… sexual politics,
deficient social skills,
reenactment of childhood trauma,
and so on. …
“In this context, the simple
proposition that abnormal brains
may produce abnormal sexual
behavior is a radical one, with the
potential to energize a whole new
generation of more sophisticated
and more powerful research
studies” (p. 100).
Consequences of Sexual Abuse
 to society
 to the person abused:
a) immediate
b) long term
A meta-analytic examination of
assumed properties of child
sexual abuse using college
samples.
By Rind, Bruce; Tromovitch, Philip;
Bauserman, Robert
Psychological Bulletin. 124(1), Jul
1998, 22-53.
Many lay persons and professionals
believe that child sexual abuse
(CSA) causes intense harm,
regardless of gender, pervasively in
the general population. …
The authors examined this belief by
reviewing 59 studies based on
college samples. …
The college data were completely
consistent with data from
national samples. …
Meta-analyses revealed that
students with CSA were,
on average, slightly less well
adjusted than controls. …
However this poorer adjustment could
not be attributed to CSA because family
environment (FE) was consistently
confounded with CSA,
FE explained considerably more
adjustment variance than CSA, and
CSA-adjustment relations generally
became nonsignificant when studies
controlled for FE.
Self-reported reactions to and
effects from Childhood Sexual
Abuse indicated that negative
effects were neither pervasive nor
typically intense, and that men
reacted much less negatively than
women. …
Basic beliefs about Childhood
Sexual Abuse in the general
population were not supported.
Summary and Conclusion
Beliefs about Childhood Sexual
Abuse in American culture center
on the viewpoint that Childhood
Sexual Abuse by nature is such a
powerfully negative force that …
(a) it is likely to cause harm,
(b) most children or adolescents
who experience it will be
affected,
(c) this harm will typically be
severe or intense, and
(d) CSA will have an
equivalently negative impact on
both boys and girls.
Despite this widespread
belief, the empirical evidence from
college and national samples
suggests a more cautious opinion.
Results of the present
review do not support these
assumed properties; CSA does not
cause intense harm on a pervasive
basis regardless of gender in
the college population.
The finding that college samples
closely parallel national samples
with regard to prevalence of CSA,
types of experiences, self-perceived
effects, and relationships between
symptoms and CSA strengthens the
conclusion that CSA is not a
propertied phenomenon.
Childhood Sexual Abuse has no
inbuilt or inevitable outcome or set
of emotional reactions.
If the question is, does childhood
sexual abuse lead to long-term
negative emotional consequences,
then, as Joel Dvoskin always says,
that depends …
(Controversy: “A willing encounter
between an adolescent and an
adult with positive reactions
on the part of the adolescent would
be labeled scientifically
as adult-adolescent sex, while an
unwanted encounter with
negative reactions would be labeled
adolescent sexual abuse.”)
Sex with children is abuse:
Comment on Rind, Tromovitch,
and Bauserman (1998).
By Ondersma, Steven J.; Chaffin,
Mark; Berliner, Lucy; Cordon, Ingrid;
Goodman, Gail S.
Psychological Bulletin. 127(6), Nov
2001, 707-714.
As expected, structural equation
modeling showed powerlessness
and stigmatization largely mediated
the effects of sexual abuse severity
on women’s psychological distress
in adulthood.
Childhood and Adolescent Sexual
Abuse of Community Women:
Mediated Effects on Psychological
Distress and Social Relationships.
By Kallstrom-Fuqua, Amanda C.;
Weston, Rebecca; Marshall, Linda L.
Journal of Consulting and Clinical
Psychology. 72(6), Dec 2004, 980-992.
Self-definition as a survivor of
childhood sexual abuse among
Navy recruits.
By Stander, Valerie A.; Olson,
Cheryl B.; Merrill, Lex L.
Journal of Consulting and Clinical
Psychology. 70(2), Apr 2002, 369377.
The results of this study clearly
demonstrate the influence
exerted by methodology on self-reports
of childhood sexual abuse.
All 2,010 participants in Group 1
reported at least one sexual
experience before age 18 with a person
at least 5 years older,
criteria meeting an a priori operational
definition for childhood
sexual abuse. …
However, only 39% said “yes” when
specifically asked whether they
believed they had been
sexually abused.
… For instance, a higher
percentage of women than men
experienced threats–force, CSEs
with family members, and CSEs at
a young age. In multivariate
analysis, these three CSE
characteristics contributed most in
explaining
self-definitions of abuse.
3. Legal and Ethical Issues
When conducting an
assessment/evaluation related to
sex offending:
1) Know the referral question
2) Be familiar with the relevant
statutory and case law
When conducting an
assessment/evaluation related to
sex offending:
Conform with
Ethical Principles of Psychologists
and Code of Conduct, and with
Specialty Guidelines for Forensic
Psychologists
You may also wish to consider The
Association for the Treatment of
Sexual Abusers’ (ATSA) 2005
Practice Standards and Guidelines
(PSG) and Association for the
Treatment of Sexual Abusers
Professional Code of Ethics (2001)
But see
DeClue, G. (in press). Practice
standards and guidelines for the
evaluation, treatment, and
management of sexual abusers:
Bamboozle no more. Journal of
Psychiatry & Law.
There has never been an empirical
basis for restricting the pool of
approved sex-offender treatment
providers to those who have done
thousands of hours of treatment
with people who have been
convicted of sex offenses {while
under the supervision of someone
with an ATSA credential} …
… and there has never been an
empirical basis for declaring that “it
is very clear” that certain treatments
are more effective than others. In
the absence of definitive research
showing that particular treatments
are more effective in reducing
recidivism, requiring supervision by
members of a particular club is
illogical. …
There is no reason to expect that
treatment effectiveness would be
enhanced by restricting the pool of
approved sex-offender treatment
providers to those who have done
thousands of hours of treatment
with people who have been
convicted of sex offenses.
4. Assessment
Some assessment methods:
1) Psychological
2) Psychophysiological
Juvenile Sexual Offenders and
Their Victims: Final Report
A Report Submitted to the
Governor and the Florida
Legislature
Task Force on Juvenile Sexual
Offenders and Their Victims
January 18, 2006
Findings of the Task Force:
The Task Force reviewed research
findings from national studies and
from the State of Florida that
indicated:
• The per capita incidence of juvenile
sexual offending crimes in Florida has
slightly decreased over a six-year
period.
• Juveniles who commit sexual offenses
have an extremely low re-offense rate.
• A significant percentage of juveniles
who commit sexual offenses were
themselves victimized. …
• The use of the label ‘Juvenile Sex
Offender’ is inappropriately applied
to youth who are very young or who
engaged in ‘consensual’ sexual
behavior with victims of the same
age or developmental stage with no
criminal intent.
• It is estimated that nearly half of
all child molestations and one-fifth
of all rapes are committed by
juveniles.
• Compared to adults who sexually
offend, juveniles who sexually
offend are less aggressive and less
serious in their sexual offenses. …
• Most adolescent sex offenders are
not sexual predators, do not meet
the definition of pedophile, do not
have deviant sexual arousal, and do
not have the same long-term
tendencies as adults. …
Recommendation 7:
The Florida Legislature should require
and fund ($290,000) comprehensive
psychosexual evaluations, to be
conducted by qualified practitioners and
included as part of the pre-disposition
report, on all adjudicated juveniles with
a history of sexual delinquency or
sexually inappropriate behavior. The
psychosexual evaluation should
address the following areas:
Summary and Diagnosis:
• Culpability
• Risk Assessment
• Amenability
• Treatment Recommendations
Culpability Assessment:
What psychological tests or
assessment methods are useful for
helping to determine whether a
particular suspect has committed a
particular sex offense?
Candidates:
• Ability tests (e.g., IQ)
• Neuropsychological tests
• Objective personality tests
• Projective personality tests
• Psychological interview
• Other
Answer (DeClue’s opinion):
None
Culpability Assessment:
What psychophysiological tests or
assessment methods are useful for
helping to determine whether a
particular suspect has committed a
particular sex offense?
Candidates:
• PPG
• Able Screen
• Polygraph
• Other
Answer (DeClue’s opinion):
None
A summary statement:
Psychological assessments do not,
and at this point cannot, assist in
determining whether a particular
person committed a particular
sexual offense.
Can psychological assessments
assist in determining whether a
particular person is a sexual
offender or a “the type of person
who would be likely to commit a
sexual offense”?
Answer (DeClue’s opinion):
No
Can a psychological assessment
assist in estimating likelihood of
committing a sexually violent act in
the future?
Answer (DeClue’s opinion):
Yes
DeClue, G. (2002). Avoiding
garbage in sex offender re-offense
risk prediction: A case study.
Journal of Threat Assessment, 2,
73-92.
DeClue, G. (2005). Avoiding
garbage 2: Assessment of risk for
sexual violence after long-term
treatment, Journal of Psychiatry &
Law, 33, 179-204.
Hanson, R. K. (1998). What do we
know about sex offender risk
assessment? Psychology, Public
Policy, and Law, 4, 50-72.
Hanson, R. K. & Bussière, M. T.
(1998). Predicting Relapse: A
Meta-Analysis of Sexual Offender
Recidivism Studies. Journal of
Consulting and Clinical Psychology,
66(20), 348-362.
Hanson, R. K. & Bussière, M. T.
(1996). Predictors of sexual
offender recidivism: A meta-analysis
(User Report 96-04). Department of
the Solicitor General: Ottawa,
Ontario, Canada.
“Sexual offense recidivism was best
predicted by measures of sexual
deviancy (e.g., deviant sexual
preferences, prior sexual offenses)
and, to a lesser extent, by general
criminological factors (e.g., age,
total prior offenses)” (Hanson, 1998,
p. 348).
Approaches to risk assessment:
• Pure clinical
• Pure actuarial
• Structured Professional Judgment
• Adjusted Actuarial
Which approaches to risk
assessment does Hanson (1998)
consider to be viable?
Which are never used in practice?
Which is required by SVPP for civilcommitment evaluations in Florida?
What are the current most
popular/most accepted riskassessment instruments?
Which were most accurate in
Hanson & Morton-Bourgon’s 2004
meta-analysis?
Hanson, R. K. & Morton-Bourgon,
K. Predictors of sexual recidivism:
An updated meta-analysis, 200402, p. 1. Downloaded 9/2/04 from
http://www.psepcsppcc.gc.ca/publications/corrections
/pdf/200402_e.pdf.
Answer (according to DeClue):
• SVR-20
• SIR
• MnSOST-R
• Static-99
• SORAG
• VRAG
SVR-20:
Boer, D. P., Hart, S. D., Kropp, P.
R., & Webster, C.D. (1997). Manual
for the Sexual Violence Risk – 20.
Vancouver, BC: British Columbia
Institute against Family Violence.
SIR:
Statistical Information on
Recidivism (SIR; Bonta, Harman,
Hann & Cormier, 1996; Nuffield,
1982)
MnSOST-R:
Epperson, D. L. (2000a). CrossValidation Update (Retrieved April
9, 2001 from the World Wide Web:
http://psychserver.iastate.edu/faculty/epperson/
mnsost_download.htm)
Static-99:
Hanson, R. K., & Thornton D.
(2000). Improving risk assessments
for sex offenders: A comparison of
three actuarial scales. Law and
Human Behavior, 24, 119-136.
SORAG & VRAG:
Quinsey, V. L., Harris, G. T., Rice,
M. E., Cormier, C. A. (1998). Violent
Offenders: Appraising and
Managing Risk. Washington, DC:
American Psychological
Association.
Some recent developments in
sexual offender risk assessment:
Hart et al. (in press)
Thornton (in press)
The Precision of Actuarial Risk
Assessment Instruments:
Evaluating the “Margins of Error” of
Group Versus Individual Predictions
of Violence
Stephen D. Hart
Christine Michie
David J. Cooke
Background: Actuarial risk
assessment instruments (ARAIs)
estimate the probability that
individuals will engage in future
violence.
Aims: Evaluate the “margins of
error” at the group and individual
level for risk estimates made using
ARAIs.
Method: An established statistical
method was used to construct
95%CIs for group and individual risk
estimates made using two popular
ARAIs.
Results: The 95% CIs were large
for risk estimates at the group level;
at the individual level, they were so
high as to render risk estimates
virtually meaningless.
Conclusions: ARAIs cannot be used
to estimate an individual’s risk for future
violence with any reasonable degree of
certainty and should be used with great
caution or not at all. In theory,
reasonably precise individual estimates
could be made using ARAIs if
developers used very large
construction samples and if the tests
included few score categories with
extreme risk estimates.
We conclude by advising readers
that we have addressed only the
rather limited issue of the margins
of error of group- and individuallevel risk estimates using ARAIs.
We did not address other critical
issues in construction and forensic
use of ARAIs (e.g., Hart, 2001,
2003; Litwack, 2001), …
… including such things as the
questionable representativeness of their
construction samples; the absence of
calibration or cross-validation research on
risk estimates, especially by independent
researchers; problems with their legal
relevance, due to a failure to consider the
presence of mental disorder and the
presence of a causal nexus between
mental disorder and violence risk; and
their potential prejudicial impact on triers
of fact.
Evaluating Sexual Offenders:
Actuarial Assessment and
Beyond
David Thornton, Ph.D.
Sand Ridge Secure Treatment
Center
Integrating multiple static
actuarial instruments via a
dimensional framework
The Problem
• There are a range of actuarial instruments with
similar predictive accuracy but which give
conflicting assessments of particular individuals
• Solutions
– Pick the best scale (but which is best varies
between samples)
– Average
– Only weight consistent results
– Personal favorite
– Dimensional integration
Dimensional Integration
• Decompose scales into underlying
dimensions
• Predictive value carried by underlying
dimensions rather than by particular
operationalizations of them
• Understand discrepancies between scales
in terms of
– Weighting of particular dimensions
– How scale operationalizes dimensions
Previous attempts to identify
dimensions
Roberts, Doren and Thornton
(2002)
• In addition to analyzing scales, also
conducted a PCA on 10 actuarial items
taken from the Static-99 and the Risk
Matrix 2000, an actuarial instrument widely
used in the UK. Three clearly identifiable
factors emerged:
– General Criminality,
– Sexual Deviance,
– Detached youthful assaults.
Langton, Harkins, Peacock, and
Barbaree (2003, August)
• A principal component analysis of 31 nonredundant actuarial items from 4 actuarial
risk instruments (SORAG; RRASOR;
Static-99; MnSOST-R;) and VASOR.
• Three factors
– Sexual Deviance,
– Lifestyle Maladjustment/ Instability,
– Detached Predatory Behavior.
Barbaree, Langton & Peacock
(forthcoming)
• Factor analyses of items from Static-99, VRAG,
SORAG, and MnSOST-R.
• There were 42 non-redundant items contained in
the 5 instruments
–
–
–
–
–
–
–
N=311; Varimax Rotated principal components
Antisocial Behavior
Child Sexual Abuse
Persistence,
Detached Predatory Behavior
Young and Single,
Male Victim(s).
Barbaree et al found
• Three of the factors to be predictive of
sexual recidivism
– Child Sexual Abuse
– Persistence
– Young and Single
Knight and Thornton
• Variables from Static-99, Static-2002,
RM2000, MnSOST-R, VRAG, SORAG,
ASOAP, SVR-20
• Included static historical variables, criminal
history, childhood and adolescent crime
related behavior, simple demographics
• Excluded abstract trait variables, needs
and vulnerabilities
• N=458 cases where no missing data
Factor I: Persistent General
Criminality
• VRAG Non-violent
• RM Criminal Apps
• SVR Past non-sexual,
non-violent offenses
• S02 Sentencing Apps
• S99 Sentencing Apps
• ASO Multiple types of
offenses
• ASO Adult ASB
• VRAG Failure on CR
•
•
•
•
•
•
•
•
•
•
S02 Breach of CR
ASO Juvenile ASB
SVR Supervision Failure
SVR Past Non-sexual
violent offenses
RM Violent Apps
MNS Adolescent ASB
ASO Ever charged before
age 16
S99 Prior NSV
S02 Prior NSV
S02 Years Free pre Index
Factor II: Persistence and Rate of
Sexual Offending
•
•
•
•
•
•
S02 Prior Sexual App
RM Sex App
S99 Sex Priors
ASO Sex Priors
MNS Sex Convictions
S02 High Rate of Sexual
Offending
• SORAG Prior Sex
Convictions
• ASO N of Sexual Abuse
Victims
• S02 Non contact
convictions
• RM Non contact
convictions
• ASO Duration of Sex
Offense History
Factor III: Young and Single
• RM-S Age on
Release
• RM-V Age on
Release
• S02 Age on Release
• VRAG Age at Index
• MNS Age at Release
• S99 Young
• S99 Single
• RM Single
• VRAG Marital Status
Factor IV: Violent Stranger Assault
•
•
•
•
•
S02 Stranger Victims
RM Stranger Victims
S99 Stranger Victims
MNS Stranger Victims
ASO Expressive
Aggression in Sex
Offenses
• SVR Physical Harm to
Sex Offense Victim
• MNS Force/Threat in Sex
Offense
• SVR Use of Weapons or
Threats of Death in Sex
Offense
• S99 Index Non Sexual
Violence
• VRAG Victim Injury (-)
Factor V: Male Victim Choice
•
•
•
•
•
RM Male Victim of Sex Offense
S99 Any Male Victims
S02 Male Victims
ASO Male Child Victims
VRAG Index offense victim female (-)
Comment
• Factors typically reflect similar items in
multiple scales
Correlations between Scales and
Factors
Factor
SVR20 SORAG
VRAG
ASOAP
Criminal P 0.65
0.76
0.74
0.63
Sexual P
0.19
0.26
0.04
0.31
Young
-0.09
0.29
0.41
-0.05
Violent
Stranger
Male
0.39
0.19
0.17
0.18
0.17
0.24
0.14
0.28
Correlations between Scales and
Factors – Continued
Static
2002
Criminal P 0.40
Static 99 RRASOR
MNS
0.43
0.16
0.38
Sexual P
0.72
0.63
0.71
0.53
Young
0.37
0.21
0.13
0.22
Violent
Stranger
Male
0.18
0.40
0.00
0.40
0.18
0.26
0.48
0.14
Correlations between Scales and
Factors - Continued
RM - S
RM - V
RM - C
Criminal P
0.77
0.57
0.52
Sexual P
0.62
-0.09
0.33
Young
0.42
0.47
0.55
Violent
Stranger
Male
0.21
0.27
0.30
0.24
-0.20
0.03
Comment
• Scales differ in their profiles over the factors,
sometimes in quite subtle ways
• It is more than just greater or lesser weighting of
antisociality or sexual deviance
• The mere presence of an item in a scale does
not mean that it will have a substantial influence
on the total scale score
• How much variance in scale scores is accounted
for by the five components?
Percent of Scale Variance Accounted for by
the Five Components
SORAG
83%
RRASOR
VRAG
77%
MnSOSTR 66%
ASOAP
62%
RM-S
73%
Static-2002 88%
RM-V
67%
Static-99
RM-C
78%
85%
78%
Comment
• Two-thirds to four fifths of scale variance is
accounted for by the rotated components
• Note that we did not have PPG for SORAG
• So is the remaining variance carrying useful
predictive value or is all the predictive value
carried by the components?
Logistic Regression Analysis
• 5 Year Sexual Recidivism rate
• Step 1: Predict sexual recidivism from the scale
• Step 2: Add the components to the prediction
equation
• Q. Does the scale continue to have significant
predictive value when the Components are
controlled?
• Q. Do the Components have predictive value
when the scale is controlled?
Comment
• SORAG
– Has no significant predictive value beyond the
components
– The components have significant predictive
value after controlling SORAG
– SORAG underweights Sexual Persistence
and Male Victims
Comment
• VRAG
– Has no significant predictive value beyond the
components
– The components have significant predictive
value after controlling VRAG
– VRAG underweights Sexual Persistence and
Male Victims
Comment
• Static-2002
– Has no significant predictive value beyond the
components
– The components have significant predictive
value after controlling Static-2002
– Static-2002 underweights Male Victims and
perhaps Violent Stranger
Comment
• Static-99
– Has no significant predictive value beyond the
components
– The components have significant predictive
value after controlling Static-99
– Static-99 underweights Sexual Persistence
and Male Victims
Comment
• MnSOST-R
– Has no significant predictive value beyond the
components
– The components have significant predictive
value after controlling MnSOST-R
– MnSOST-R underweights Sexual Persistence
and Male Victims, and perhaps Violent
Stranger
Comment
• SVR-20
– Has no significant predictive value beyond the
components
– The components have significant predictive
value after controlling SVR-20
– SVR-20 underweights Sexual Persistence
and Male Victims
Results for Orphan Sum
• ROC AUC = 0.66
• So by itself it is moderately predictive
• However, once the five components were
controlled its predictive value reduced to
zero (B coefficient = 0)
• Thus the orphaned items have not
predictive value over and above the five
components
Comment
• It really does seem to be the case that the
five components capture all the predictive
value of the simple static items (and age)
in the actuarials
How much difference does
weighting the components make?
• Weighting the five components equally
leads to a predictor with an AUC of 0.70
• Double weighting Sexual Persistence and
unit weighting the rest of the components
leads to 0.71
• Triple weighting Sexual Persistence,
Double Weighting Male Victims, and unit
weighting the rest leads to 0.73
Comment
• Although an equally weighted sum of the
components does fairly well, we need to
establish whether the unequal weightings
that do better than this in the present
sample, also perform better in other
samples.
Summary and Conclusions
• The five rotated components identified here represent
elements that are shared by the prediction scales
• The prediction value of individual scales is very largely
accounted for by the common components
• Individual scales can be characterized in terms of (a)
their correlation with the different components and (b)
the extent to which they underweight components in
prediction
• There is a common pattern of Sexual Persistence and
Male Victims being underweighted across all the Scales,
though to differing degrees; RASSOR and Static-2002
are the two scales that more nearly weight them
correctly
Future Possibility
• Risk assessment based on underlying risk
dimensions defined in a way that is
independent of any particular instrument
• This results in two distinguishable issues
– Issue of level of risk associated with
particular combinations of dimensions
– Issue of how precisely the individual has
been placed on these dimensions
Factor I: Persistent General
Criminality
Factor II: Persistence and Rate of
Sexual Offending
Factor III: Young and Single
Factor IV: Violent Stranger Assault
Factor V: Male Victim Choice
tease
The Value of Need
Assessment
What is Need Assessment?
• Don Andrews and colleagues introduced the
concept of Criminogenic Needs
• Criminogenic Needs are relatively stable but
potentially changeable factors that predispose to
some form of re-offending
• Need Assessment is assessment of the extent to
which the offender shows Needs that are
relevant to the kind of re-offending that you are
concerned with
• They can also be called psychological risk
factors or stable dynamic factors
The Characteristics of Persistent
Sexual Offenders: A MetaAnalysis of Recidivism Studies.
By Hanson, R. Karl; MortonBourgon, Kelly E.
Journal of Consulting and Clinical
Psychology. 73(6), Dec 2005, 11541163.
5. Treatment
How many of Anne Sullivan’s teeth
did Helen Keller knock out during
their first session together?
1
2
3
4
March 3, 1887
Helen hit, pinched, and kicked her
teacher and knocked out one of her
teeth.
Answer: only 1
Marques, J. K., Nelson, C., Alarcon,
J.-M., & Day, D.M. (2000).
Preventing relapse in sex offenders:
What we learned from SOTEP’s
experimental treatment program. In
D. R. Laws, S. M. Hudson, & T.
Ward (Eds.), Remaking Relapse
Prevention with Sex Offenders: A
Sourcebook. Thousand Oaks, CA:
Sage.
DeClue, G. (2002). Remaking
relapse prevention with sex
offenders: A source book, and
Practice standards and guidelines
for members of the Association for
the Treatment of Sexual Abusers
(ATSA). Journal of Psychiatry &
Law, 30, 285-292. (book review)
Evaluating Community Sex
Offender Treatment Programs: A
12-Year Follow-Up of 724
Offenders.
By Hanson, R. Karl; Bloom, Ian;
Stephenson, Marylee
Canadian Journal of Behavioural
Science. 36(2), Apr 2004, 87-96.
Abstract
Although some studies suggest
positive effects of treatment for
sexual offenders, most studies have
been hampered by the unknown
influence of selective attrition (e.g.,
volunteers and drop-outs). …
In the 1980s, the Correctional
Service of Canada began to require
weekly community treatment
sessions for all sex offenders
released in the Pacific Region. …
This policy change provided a
unique opportunity for comparing an
unselected cohort of treated sex
offenders (n = 403) to an untreated
cohort (n = 321) released in earlier
years. …
After an average 12-year follow-up
period, no differences were
observed in the rates of sexual
(21.1% vs 21.8%), violent (42.9%
vs. 44.5%) or general (any)
recidivism (56.6% vs 60.4%) for
treated and untreated groups,
respectively. …
The outcome remained comparable
after controlling for length of followup, year of release, age, and seven
static risk factors coded from official
criminal history records. …
Retrospective ratings of the
treatment quality also showed no
relationship to observed recidivism
rates. …
The static risk factors coded in the
current study accounted for
considerable variance in recidivism
and could easily be used to improve
statistical controls in future
evaluations.
Based on the complete follow-up
period, the unadjusted sexual
recidivism rates were 21.1% (85 out
of 403) for offenders who received
treatment compared to 21.8% (70
out of 321) for the comparison
group.
The study does not allow
conclusions about what was
effective or ineffective in the CSOP
interventions. The findings do
suggest, however, that some highly
plausible interventions may have
little overall effect.
The first report of the Collaborative
Data Project (Hanson et al., 2002)
examined all the relevant studies in
the Hall (1995) and Gallagher et al.
(1999) reviews, as well as many
recent studies (42 usable studies;
20 published, 22 unpublished).
Hanson et al. focused on two
questions: 1) To what extent could the
different research designs (e.g.,
random assignment, incidental
assignment, drop-outs versus
completers) inform the evaluation of
treatment effectiveness? and 2) What
was the evidence for treatment
effectiveness given the best available
research designs and treatment
programs that meet current standards?
In response to these questions,
Hanson et al. found that studies
comparing treatment drop-outs to
completers consistently found
higher recidivism rates among the
treatment drop-outs – regardless of
the type of treatment received.
Such a finding confirmed previous
concerns that the results of drop-out
studies are largely determined by
selective attrition of high-risk cases
rather than by differences in the
amount of treatment received.
Surprisingly, Hanson et al. did not
find any difference in the sexual
recidivism rates between offenders
who explicitly refused treatment and
those who volunteered.
Next:
Incidental assignment studies
Hanson et al. found a significant
difference between the older (pre1980) forms of treatment and the
current treatment programs for
sexual offenders.
Current treatments (cognitivebehavioural and systemic) were
associated with significant
reductions in sexual (17% to 10%)
and general recidivism (51% to
32%) after 4-5 years of follow-up.
No treatment effects were found for
older treatments (purely
behavioural, unspecified
psychotherapy).
Back to:
Evaluating Community Sex
Offender Treatment Programs: A
12-Year Follow-Up of 724
Offenders.
By Hanson, R. Karl; Bloom, Ian;
Stephenson, Marylee
Canadian Journal of Behavioural
Science. 36(2), Apr 2004, 87-96.
The findings of the current study
contrast with the positive effects of
cognitive-behavioural treatment
found in previous reviews
(Gallagher et al., 1999; Hanson et
al., 2002). …
No single study is sufficient to
determine whether treatment works
or not. …
Those inclined to believe that
treatment is effective will emphasize
that the interventions examined in
the current study did not meet
contemporary standards;
those inclined to doubt the
effectiveness of treatment will
emphasize the methodological
weaknesses in the other studies
that have shown positive treatment
effects. …
The current study is unique, to our
knowledge, for the lack of selection
bias in the treatment and
comparison groups. …
Understanding of sex offender
treatment will advance as individual
studies improve, and the cumulative
results of these studies are
meaningfully integrated through
meta-analyses.
Friedrich Lösel
Director of the Institute of
Criminology at Cambridge
fal23@cam.ac.uk
Abstract.
The article reports a meta-analysis
on controlled outcome evaluations
of sexual offender treatment. From
2,039 documents published in five
languages, 69 studies containing 80
independent comparisons between
treated and untreated offenders
fulfilled stepwise eligibility criteria
(total N = 22,181). …
Despite a wide range of positive
and negative effect sizes, the
majority confirmed the benefits of
treatment. Treated offenders
showed 6 percentage points or 37%
less sexual recidivism than controls.
…
Effects for violent and general
recidivism were in a similar range.
Organic treatments (surgical
castration and hormonal
medication) showed larger effects
than psychosocial interventions. …
However, this difference was
partially confounded with
methodological and offender
variables. Among psychological
programs, cognitive-behavioral
approaches revealed the most
robust effect. …
Nonbehavioral treatments did not
demonstrate a significant impact.
There was no outcome difference
between randomized and other
designs, however, group
equivalence was associated with
slightly larger effects. …
Various other moderators had a
stronger impact on effect size (e.g.,
small sample size, quality of
outcome reporting, program
completion vs. dropout, age
homogeneity, outpatient treatment,
and authors’ affiliation with the
program). …
More differentiated, high-quality
evaluations are needed to clarify:
What works for whom under which
circumstances?
Discussion:
Due to a recent increase in
research and the multilingual
approach of our review, this metaanalysis contains 80 comparisons
between treatment and control
groups containing a total of more
than 22,000 individuals.
This is currently the most
comprehensive database on the
outcome of sex offender treatment.
Nearly one-third of the studies have
been published since 2000, and
approximately one-third come from
countries outside of North America.
…
These are indicators of a strong
international interest in ‘what works’
for sex offenders. However, even
though we have excluded studies
containing no control group or only
a comparison with dropouts, the
methodological quality of the
studies still remains moderate. …
Bearing the methodological
problems in mind, one should draw
very cautious conclusions from our
meta-analysis. …
The most important message is an
overall positive and significant effect
of sex offender treatment. …
Sexual offender treatment also has
an effect on general recidivism. …
However, our analysis also shows
that unspecific offender programs
have no impact on sexual
recidivism. …
The mean rate of sexual recidivism
is 11.1% in TGs and 17.5% in CGs.
At first glance, this absolute
difference of a little more than 6
percentage points may seem small.
…
This is equivalent to a reduction of
nearly 37%.
For general recidivism, the
reduction is 31%. …
Particularly in sexual recidivism, our
general effect is larger than that
found by Hanson et al. (2002) in
their meta-analysis of psychological
treatment (27%). Most probably,
this is due to our inclusion of both
psychological and medical modes
of treatment. …
The average effect of physical
treatment is much larger than that
of psychosocial programs. The
main source for this difference is a
very strong effect of
surgical castration,
although hormonal medication also
shows a relatively good outcome.
…
Sex offenders receiving surgical
castration are a highly selected and
motivated group. They apply for this
very intensive intervention
voluntarily. …
Most sex offenders do not have an
abnormally high level of male sex
hormones (Hucker and Bain 1990;
Fedoroff and Moran 1997). As with
surgical castration, we must take
this into account when considering
the relatively strong effect of
hormonal medication. …
Treatment with medroxyprogesteronacetate (in the US; e.g.,
Provera) or cyproteronacetate (in
Europe; e.g., Androcur) does not
seem to work by normalizing
extreme testosterone levels, but by
strongly reducing more or less
normal levels of sexual arousal
(Rösler and Witztum 2000). …
In addition, there are serious
negative side effects that frequently
lead to noncompliance and dropout
(e.g., Langevin 1979). The
termination of medication may
rapidly increase the risk of
recidivism (Meyer et al., 1992). …
A regression analysis shows that
only three modes of treatment have
a significant impact: hormonal,
behavioral, and cognitivebehavioral. … Only the cognitivebehavioral orientation shows an
independent treatment effect. …
However, the effect size for
cognitive-behavioral programs in
our analysis is
slightly smaller than that reported
by Hanson et al. for current
programs that
consist of mainly cognitivebehavioral approaches. …
Overall, we have not found that
more recent programs are superior
in outcome. Although treatment
before the 1970s was clearly
ineffective, neither programs from
the 1990s nor publications after
2000 reveal stronger effects than in
previous decades. …
Even within the cognitive-behavioral
category, more current programs
are not more effective than older
ones. …
Some recent evaluations have
revealed rather small or no positive
effects (e.g., Friendship et al. 2003;
Hanson et al. 2004; Ruddijs and
Timmerman 2000; Worling and
Curwen 2000). …
A follow-up of one of the soundest
evaluations has also found no
positive effect (Marques et al.
2005). …
Due to the necessary follow-up
lags, even recent studies may not
represent all the features of the
current state of the art in sexual
offender treatment. …
One must also bear in mind that
outcomes of treatment often decline
when model projects are
transformed into routine practice
(Lösel 2001b). …
In practical terms, the relation
between sample size and treatment
effectiveness is particularly
important. Small studies (N < 50)
reveal a large ES and large studies
(N > 500) a small ES. …
A further finding supports the
interpretation in terms of integrity:
Programs in which the study
authors were involved have a larger
effect. …
Voluntary treatment leads to a
slightly better outcome than
mandatory participation, and
programs for adolescents are a little
more effective than those for adults
[but] these differences are not
significant. …
Lösel and Schmucker (2005)
conclude:
“Overall, there is evidence for a
positive effect of sexual offender
treatment.”
But …
DeClue:
Due to methodological
imperfections, the studies do not
clearly show that differences
between treated and control groups
are due to the effects of treatment.
Methodology matters!
“People who take their medicine as
recommended tend to live longer …
… even if the prescription is a
placebo.”
Pharmacy professor Scot Simpson
of the University of Alberta and his
colleagues analyzed 21 studies
involving more than 46,000 people
prescribed drugs.
http://www.cbc.ca/story/science/nati
onal/2006/06/29/doctor-orders.html
Of the studies, eight were
randomized trials that reported
adherence among those receiving
drugs and a placebo.
The therapies ranged from drugs
prescribed to people who recently
had a heart attack to those used to
treat HIV, Type 2 diabetes and high
cholesterol.
People who take drugs as
recommended may also tend
to eat more healthily and exercise
regularly, which may independently
affect mortality risk, the study's
authors said in the July 1 issue of
the British Medical Journal.
6. Civil Commitment
2005 FLORIDA STATUTES
CHAPTER 394, PART V
INVOLUNTARY CIVIL
COMMITMENT OF
SEXUALLY VIOLENT
PREDATORS
394.910 Legislative findings and
intent.--The Legislature finds that a
small but extremely dangerous
number of sexually violent
predators exist who do not have a
mental disease or defect that
renders them appropriate for
involuntary treatment under the
Baker Act …
In contrast to persons appropriate
for civil commitment under the
Baker Act, sexually violent
predators generally have antisocial
personality features which are
unamenable to existing mental
illness treatment modalities, and
those features render them likely to
engage in criminal, sexually violent
behavior. …
he Legislature further finds that the
likelihood of sexually violent predators
engaging in repeat acts of predatory
sexual violence is high. The existing
involuntary commitment procedures
under the Baker Act for the treatment
and care of mentally ill persons are
inadequate to address the risk these
sexually violent predators pose to
society. …
The Legislature further finds that the
prognosis for rehabilitating sexually
violent predators in a prison setting is
poor, the treatment needs of this
population are very long term, and the
treatment modalities for this population
are very different from the traditional
treatment modalities for people
appropriate for commitment under the
Baker Act. …
It is therefore the intent of the
Legislature to create a civil
commitment procedure for the longterm care and treatment of sexually
violent predators.
394.911 Legislative intent.—
… Less restrictive alternatives are
not applicable to cases initiated
under this part.
394.9155 Rules of procedure and
evidence.--In all civil commitment
proceedings for sexually violent
predators under this part, the following
shall apply:
(1) The Florida Rules of Civil
Procedure apply unless otherwise
specified in this part.
(2) The Florida Rules of Evidence
apply unless otherwise specified in this
part. …
(3) The psychotherapist-patient
privilege under s. 90.503 does not
exist or apply for communications
relevant to an issue in proceedings
to involuntarily commit a person
under this part. …
(4) The court may consider
evidence of prior behavior by a
person who is subject to
proceedings under this part if such
evidence is relevant to proving that
the person is a sexually violent
predator.
(7) If the person who is subject to
proceedings under this part refuses to be
interviewed by or fully cooperate with
members of the multidisciplinary team or
any state mental health expert, the court
may, in its discretion:
(a) Order the person to allow members of
the multidisciplinary team and any state
mental health experts to review all mental
health reports, tests, and evaluations by
the person's mental health expert or
experts; or …
(b) Prohibit the person's mental
health experts from testifying
concerning mental health tests,
evaluations, or examinations of the
person.
394.912 Definitions.--As used in
this part, the term:
(2) "Convicted of a sexually violent
offense" means a person who has
been:
(a) Adjudicated guilty of a sexually
violent offense after a trial, guilty plea,
or plea of nolo contendere;
(b) Adjudicated not guilty by reason of
insanity of a sexually violent offense; or
(c) Adjudicated delinquent of a sexually
violent offense after a trial, guilty plea,
or plea of nolo contendere.
(4) "Likely to engage in acts of
sexual violence" means the
person's propensity to commit acts
of sexual violence is of such a
degree as to pose a menace to the
health and safety of others.
(5) "Mental abnormality" means a
mental condition affecting a
person's emotional or volitional
capacity which predisposes the
person to commit sexually violent
offenses.
(8) "Sexually motivated" means
that one of the purposes for which
the defendant committed the crime
was for sexual gratification.
(9) "Sexually violent offense"
means:
(a) Murder of a human being while
engaged in sexual battery in
violation of s. 782.04(1)(a)2.;
(b) Kidnapping of a child under the
age of 13 and, in the course of that
offense, committing:
1. Sexual battery; or
2. A lewd, lascivious, or indecent
assault or act upon or in the
presence of the child;
(c) Committing the offense of false
imprisonment upon a child under
the age of 13 and, in the course of
that offense, committing:
1. Sexual battery; or
2. A lewd, lascivious, or indecent
assault or act upon or in the
presence of the child;
(d) Sexual battery in violation of s.
794.011;
(e) Lewd, lascivious, or indecent
assault or act upon or in presence
of the child in violation of s. 800.04;
(f) An attempt, criminal solicitation,
or conspiracy, in violation of s.
777.04, of a sexually violent
offense;
(g) Any conviction for a felony
offense in effect at any time before
October 1, 1998, which is
comparable to a sexually violent
offense under paragraphs (a)-(f) or
any federal conviction or conviction
in another state for a felony offense
that in this state would be a sexually
violent offense; or
(h) Any criminal act that, either at
the time of sentencing for the
offense or subsequently during civil
commitment proceedings under this
part, has been determined beyond
a reasonable doubt to have been
sexually motivated.
(10) "Sexually violent predator" means
any person who:
(a) Has been convicted of a sexually
violent offense; and
(b) Suffers from a mental abnormality
or personality disorder that makes the
person likely to engage in acts of
sexual violence if not confined in a
secure facility for long-term control,
care, and treatment.
394.913 Notice to state attorney
and multidisciplinary team of
release of sexually violent
predator; establishing
multidisciplinary teams;
information to be provided to
multidisciplinary teams.--
(2) The agency with jurisdiction
shall provide the multidisciplinary
team with the following information:
(a) The person's name; identifying
characteristics; anticipated future
residence; the type of supervision
the person will receive in the
community, if any; and the person's
offense history;
(b) The person's criminal history,
including police reports, victim
statements, presentence investigation
reports, postsentence investigation
reports, if available, and any other
documents containing facts of the
person's criminal incidents;
(c) Mental health, mental status, and
medical records, including all clinical
records and notes concerning the
person;
(d) Documentation of institutional
adjustment and any treatment received
and, in the case of an adjudicated
delinquent committed to the Department
of Juvenile Justice, copies of the most
recent performance plan and
performance summary; and
(e) If the person was returned to
custody after a period of supervision,
documentation of adjustment during
supervision and any treatment received.
(b) Each team shall include, but is
not limited to, two licensed
psychiatrists or psychologists or
one licensed psychiatrist and one
licensed psychologist. The
multidisciplinary team shall assess
and evaluate each person referred
to the team. …
The assessment and evaluation
shall include a review of the
person's institutional history and
treatment record, if any, the
person's criminal background, and
any other factor that is relevant to
the determination of whether such
person is a sexually violent
predator.
(c) Before recommending that a
person meets the definition of a
sexually violent predator, the person
must be offered a personal
interview. If the person agrees to
participate in a personal interview,
at least one member of the team
who is a licensed psychiatrist or
psychologist must conduct a
personal interview of the person. …
If the person refuses to fully
participate in a personal interview,
the multidisciplinary team may
proceed with its recommendation
without a personal interview of the
person.
(4) The provisions of this section
are not jurisdictional, and failure to
comply with them in no way
prevents the state attorney from
proceeding against a person
otherwise subject to the provisions
of this part.
394.916 Trial; counsel and
experts; indigent persons; jury.--
(4) If the person is subjected to a
mental health examination under this
part, the person also may retain experts
or mental health professionals to
perform an examination. If the person
wishes to be examined by a
professional of the person's own
choice, the examiner must be provided
reasonable access to the person, as
well as to all relevant medical and
mental health records and reports.
And now some slides from
Linda Hatzenbuehler
and Amy Phenix:
PARAPHILIAS
Pattern of Behavior
• Recurrent, intense sexually arousing
fantasies, sexual urges or behaviors
generally involving:
1. Non-human objects,
2. The suffering or humiliation of oneself or
one’s partner, or
3. Children or other nonconsenting persons.
PEDOPHILIA
• Recurrent, intense sexually arousing
fantasies, sexual urges or behaviors
involving sexual activity with a
prepubescent child or children (generally
age 13 or younger)
PARAPHILIAS (Cont’d.)
• 6 months
• The person has acted on these sexual
urges, or the sexual urges or fantasies
cause marked distress or interpersonal
difficulty
PARAPHILIAS WITH NONCONSENTING
PERSONS
• No specific diagnosis in DSM-IV-TR
• First specifically defined in the DSM-III as
“repetitive sexual activity with nonconsenting
partners.”
• Rape vs. Sexual Sadism
– Rape: The force necessary to complete the act.
– Sadism: Chronic; high risk; close supervision; more
violence beyond necessary to complete act.
SEXUAL SADISM
• Involves acts (real, not simulated) in which
the individual derives sexual excitement
from the psychological or physical
suffering (including humiliation of the
victim)
– High risk
– Aroused by physical suffering of another
CHARACTERISTICS OF
SEXUALLY SADISTIC OFFENSES
•
•
•
•
•
•
N = 12-30
Intentional torture
Careful planning
Bound, blindfolded, gagged
Unemotional or detached
Taken to preselected place
Sexual bondage
(Dietz et al., 1990)
%
100.0
93.3
86.7
86.6
76.7
76.7
CHARACTERISTICS OF SEXUALLY
SADISTIC OFFENSES (Cont’d.)
• Anal rape and anal sexual
sadism
• Murder victim
• Forced victim perform fellatio
• Variety of sexual acts
• Concealed victims corpse
• Beaten
• Captivity 24 hours or >
(Dietz et al., 1990)
%
73.3
73.3
70.0
66.7
66.6
60.0
60.0
CHARACTERISTICS OF SEXUALLY
SADISTIC OFFENSES (Cont’d.)
•
•
•
•
•
•
%
Vaginal rape
56.7
Serial murders (3 or > victims)
56.6
Recorded offenses
53.3
Sexual dysfunction during crime 43.3
Foreign object penetration
40.0
Kept personal item victim
(Dietz et al., 1990)
CHARACTERISTICS OF SEXUALLY
SADISTIC OFFENSES (Cont’d.)
• Partner assisted
• Told victim what to say
• Impersonate police
%
36.7
23.3
23.3
Rapist may be on a continuum of sexual
sadism.
(Dietz et al., 1990)
ASSOCIATED DIAGNOSES
• Personality Disorders
– An enduring pattern of inner experience and
behavior
– Inflexible and pervasive
– Causes life problems
– Starts childhood or adolescence
– Increase risk
ANTISOCIAL PERSONALITY DISORDER
•
•
•
•
•
Repeatedly arrested, unlawful behaviors
Deceitfulness
Impulsive
Irritability and aggressiveness
Reckless disregard for safety of self and
others
• Irresponsibility
• Lack of remorse
SUBSTANCE USE DISORDERS
• Alcohol dependence
– 2 in 5 sexually aggressive individuals
– 1 in 3 pedophiles
(Langevin, 1985)
PREDICTING SEXUAL RECIDIVISM
•
•
•
•
Unstructured clinical judgment
Structured Professional Judgment
Pure Actuarial
Clinically Adjusted Actuarial
BASE RATES
• The proportion of a population/sample that
exhibits the phenomenon of interest
• Percentage of people who will commit a
detected sexual offense in a given number
of years
HANSON & BUSSIERE (1998)
• Sexual offenders = 28,972
• Average reoffense rate = 13.4%
• (4-5 yr. follow-up)
– 18.9% for rape over 3 years
– 12.7% for child molest
(N=1,839)
(N=9,603)
PRENTKY, LEE, KNIGHT, CERCE (1997)
• 251 Sex offenders (136 rape, 115 CM)
• Follow up 25 years
• Recidivism rates
– Rape
– CM
39% failure rate
52% failure rate
LONG-TERM RATES OF OFFENDING
(Cont’d.)
• “It is quite apparent for both of these
samples that the ‘decay process’ is
relatively slow and constant. Contrary to
conventional wisdom, most re-offense did
not occur within the first several years.”
(Prentky, Lee, Knight & Cerce, 1997)
LONG-TERM RATES OF OFFENDING
(Cont’d.)
• “The greatest risk period appears to be the
first five to ten years, but child molesters
appear to be at significant risk for reoffending throughout their life.”
(Hanson, Steffy & Gauthier, 1993)
BASE RATE CAUTIONS
• Most sex offenses are undetected (Bonta
& Hanson, 1994)
• Follow-up studies vary in length
• Reconviction as a measure of recidivism
excludes many actual offenses
RISK FACTORS NOT EMPIRICALLY
RELATED TO RECIDIVISM IN A
META-ANALYSIS
•
•
•
•
•
Empathy
Denial
Employment instability
Low motivation treatment
Sexual abuse as a child
*Number of studies
r
.03
.02
.07
.01
.01
N
4670 (3)*
762 (6)
762 (5)
435 (3)
5051 (5)
CONCLUSION AND REMINDER
NOT ALL SEX IS OFFENSIVE