An examination of the interrater reliability between practitioners and researchers on the static-99.

Many studies have validated the psychometric properties of the Static-99, the most widely used measure of sexual offender recidivism risk. However much of this research relied on instrument coding completed by well-trained researchers. This study is the first to examine the interrater reliability (IRR) of the Static-99 between practitioners in the field and researchers. Using archival data from a sample of 1,973 formerly incarcerated sex offenders, field raters' scores on the Static-99 were compared with those of researchers. Overall, clinicians and researchers had excellent IRR on Static-99 total scores, with IRR coefficients ranging from "substantial" to "outstanding" for the individual 10 items of the scale. The most common causes of discrepancies were coding manual errors, followed by item subjectivity, inaccurate item scoring, and calculation errors. These results offer important data with regard to the frequency and perceived nature of scoring errors.

Cartografiando la pedofilia: eficacia de los tratamientos y estrategias futuras / No disponible

Para orientar el trabajo de los profesionales de la salud mental que trabajan con pedófilos se necesitan evaluaciones clínicas rigurosas que aporten evidencias de la eficacia de las intervenciones psicoterapéuticas y/o psicofarmacológicas. Con ese propósito, se revisan aquí distintos hallazgos obtenidos hasta hoy en el tratamiento de los pedófilos. Aunque los hallazgos son incipientes, la literatura científica sugiere ciertas anomalías en el neurodesarrollo asociadas a tal parafilia. También hay evidencia empírica que avala la eficacia del abordaje multimodal que combina los tratamientos cognitivo- conductuales usados con medidas psicosociales y/o jurídicas. Los avances que puedan producirse en la explicación etiológica de la pedofilia ayudarán en el futuro a adoptar programas de prevención y tratamiento más eficaces

To guide the work of mental health professionals who work with pedophiles rigorous clinical evaluations that provide evidence of the effectiveness of psychotherapeutic interventions and / or psychopharmacological are needed. To that aim, here they are reviewed various actual findings in the treatment of pedophiles. While the findings are emerging, the scientific literature suggests certain neurodevelopmental abnormalities associated with such paraphilia . There is also empirical evidence supporting the effectiveness of multimodal approach combining cognitive-behavioral treatments used with psychosocial and / or legal actions. The advances that may occur in the etiological explanation of pedophilia help in the future to adopt prevention programs and more effective treatment

Does consideration of psychopathy and sexual deviance add to the predictive validity of the static-99R?

The Static-99 is the most commonly used actuarial risk assessment tool for the prediction of sexual recidivism. In addition, the use of psychopathy and sexual deviance has been common in assessing sexual offenders, based on research suggesting that these factors have predictive validity. It has also become common practice to modify risk assessments based on the Static-99/99R because of the presence of psychopathy and indicators of deviant sexual interests, although to date there has been no research validating this procedure. The current research was conducted to fill this gap in the literature. Using a sample of 272 sexual offenders, the extent to which psychopathy, sexual deviance, and their interaction added to the predictive validity of the Static-99R was examined. Analyses were conducted using the whole sample as well as subgroups of rapists and child molesters. It was found that although the Static-99R predicted sexual recidivism, adding psychopathy and sexual deviance in a Cox regression analysis did not improve the prediction. This held true for child molesters when examined on their own. For rapists, although psychopathy and sexual deviance did not contribute to the prediction of sexual recidivism, for serious (i.e., violent including sexual) recidivism, the inclusion of psychopathy added to the prediction. Results are discussed in terms of implications for practice.

Community reintegration of sex offenders of children in new zealand.

Reintegration of offenders following incarceration is most successful if matched to the needs of offenders, victims, and the community. This study explored child sex offenders' expectations for and experiences of reintegration into the community. A longitudinal design was used in which semistructured interviews covered issues identified in the literature as being related to reintegration. Nine offenders were interviewed within 1 week prior to release, 3 months post release, and 6 months post release. Interviews were analysed using thematic analyses producing six key themes. The interviews revealed that most of the participants feared their release from prison into the community and once released struggled to live in society. Overall, reintegration planning was simplistic and aimed primarily to manage risk factors rather than promote reintegration. Those participants who reported most satisfaction with their adjustment following release had more comprehensive reintegration plans, which enabled them to visualise what life would be like after release.

Androgen deprivation therapy of self-identifying, help-seeking pedophiles in the Dunkelfeld.

Androgen deprivation therapy (ADT) is considered an effective strategy in sexual offender treatment. However, the evidence base concerning its effects on sexual arousal control is limited. Past research has focused almost exclusively on men in forensic contexts. The present retrospective observational study provided data on ADT in a sample of self-identifying, help-seeking pedohebephilic men applying for a one-year group therapy program. Factors possibly influencing the readiness to take up or discontinue ADT were presented. Effects of a combination of ADT and group psychotherapy program on changes in paraphilic sexual behavior and associated psychological factors were examined. The proportion of men having taken up ADT was rather small (n=15). Greater awareness of potentially risky situations to commit child sexual offenses and self-rated uncontrollability of sexual urges were identified as characterizing men resorting to ADT. Additionally, these men were initially more open to include medical treatment. Examination of the effects of ADT and psychotherapy was limited to a sample of six men providing complete data sets. Descriptive data demonstrated a reduction of paraphilic sexual behaviors, an increase of risk-awareness and self-efficacy, and a decrease of offense-supportive cognitions and self-esteem. The present study underlined the importance of careful education and monitoring of self-identifying, help-seeking pedohebephilic patients interested in ADT concerning the effects and side effects of the treatment in a clinical context.

Comparing indicators of sexual sadism as predictors of recidivism among adult male sexual offenders.

OBJECTIVE: In this longitudinal study, the predictive validity of a psychiatric diagnosis of sexual sadism was compared with three behavioral indicators of sadism: index sexual offense violence, sexual intrusiveness, and phallometrically assessed sexual arousal to depictions of sexual or nonsexual violence. METHOD: Five hundred and eighty six adult male sexual offenders were assessed between 1982 and 1992, and these offenders were followed for up to 20-years postrelease via official criminal records. Assessment information included the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis, offense characteristics, phallometric assessment results, and an actuarial risk measure (the Sex Offender Risk Appraisal Guide). RESULTS: Predictive validity was demonstrated in univariate analyses for the behavioral indicators of sexual sadism (area under the curve [AUCs] from .58 to .62) but not psychiatric diagnosis (AUC = .54). Cox regression analyses revealed that phallometrically assessed sexual arousal to violence was still significantly associated with violent (including sexual) recidivism after actuarially estimated risk to reoffend was controlled. A psychiatric diagnosis of sexual sadism, in contrast, was unrelated to recidivism. CONCLUSIONS: The results support the use of more behaviorally operationalized indicators of sexual sadism, especially phallometric assessment of sexual arousal, and suggest the DSM criteria for sexual sadism require further work.

Pornography use and sexual aggression: the impact of frequency and type of pornography use on recidivism among sexual offenders.

In this study, we examined the unique contribution of pornography consumption to the longitudinal prediction of criminal recidivism in a sample of 341 child molesters. We specifically tested the hypothesis, based on predictions informed by the confluence model of sexual aggression that pornography will be a risk factor for recidivism only for those individuals classified as relatively high risk for re-offending. Pornography use (frequency and type) was assessed through self-report and recidivism was measured using data from a national database from the Royal Canadian Mounted Police. Indices of recidivism, which were assessed up to 15 years after release, included an overall criminal recidivism index, as well as subcategories focusing on violent (including sexual) recidivism and sexual recidivism alone. Results for both frequency and type of pornography use were generally consistent with our predictions. Most importantly, after controlling for general and specific risk factors for sexual aggression, pornography added significantly to the prediction of recidivism. Statistical interactions indicated that frequency of pornography use was primarily a risk factor for higher-risk offenders, when compared with lower-risk offenders, and that content of pornography (i.e., pornography containing deviant content) was a risk factor for all groups. The importance of conceptualizing particular risk factors (e.g., pornography), within the context of other individual characteristics is discussed.

Defense styles of pedophilic offenders.

This pilot study investigated the defense styles of pedophile sexual offenders. Interviews with 20 pedophiles and 20 controls were scored using the Defense Mechanisms Rating Scales. Results showed that pedophiles had a significantly lower overall defensive functioning score than the controls. Pedophiles used significantly fewer obsessional-level defenses but more major image-distorting and action-level defenses. Results also suggested differences in the prevalence of individual defenses where pedophiles used more dissociation, displacement, denial, autistic fantasy, splitting of object, projective identification, acting out, and passive aggressive behavior but less intellectualization and rationalization.

What sex abusers say about their treatment: results from a qualitative study on pedophiles in treatment at a Canadian penitentiary clinic.

This exploratory study used qualitative methodology to examine what pedophiles think about treatment, as well as their daily experience of a treatment program. To this end, twenty-three offenders receiving treatment from the La Macaza federal penitentiary clinic were interviewed using non-directive semi-structured interviews. Comparative analysis was used to analyze the resulting material. The following themes are discussed based on the results of this analysis: (a) the participants' past experience of therapy; (b) motivations for choosing the La Macaza clinic for treatment; (c) the structure of the program; (d) the group dynamics; (e) the therapists; and (f) the hardships and difficulties of treatment. Results suggest that the therapists and the program may have a function of containment or holding. Although part of the therapeutic process involves a focus on identifying and reducing cognitive distortions, results also warn therapists against misusing this concept by applying it to legitimately different opinions. Findings are discussed in terms of possible program improvements. The authors conclude that greater attention must be given to process research.

A plan analysis of pedophile sexual abusers' motivations for treatment: a qualitative pilot study.

Many authors have suggested adapting treatment programs to the specific needs of sexual abusers. However, little research has been conducted to understand what these patients seek in therapy or what elements play a key role in keeping them in treatment. In this pilot study, fifteen (N=15) pedophile sexual abusers from La Macaza clinic for sexual abusers were interviewed. Plan analysis was used to investigate the most prevalent components involved in staying in or leaving therapy. Results suggest that many components involved in the plans leading to doing and to avoiding treatment were similar. Differences were found in regards to the outcome of confrontations with the therapists, a tendency to isolate and overcomply, guilt related to the abuse, a need for a stable environment, and a need to be accepted. These results are discussed along with possible ways to improve the patients' involvement in treatment.

The impact of sex offender residence restrictions: 1,000 feet from danger or one step from absurd?

Several states have enacted public policies that prohibit sex offenders who have abused children from living within close proximity to a school, park, day care center, or school bus stop. The purpose of this exploratory study was to describe the impact of residence restrictions on sex offender reintegration and to better understand sex offenders' perceptions of these laws. A survey of 135 sex offenders in Florida was conducted. Most of the molesters who responded to the survey indicated that housing restrictions increased isolation, created financial and emotional stress, and led to decreased stability. Respondents also indicated that they did not perceive residence restrictions as helpful in risk management and, in fact, reported that such restrictions may inadvertently increase triggers for reoffense. Implications for policy and practice are discussed.

Mapping child molester treatment progress with the FoSOD: denial and explanations of accountability.

A continuing challenge in the treatment of sexual offenders involves the identification of measurement instruments that can be used to monitor treatment progress. This paper provides evidence that the Facets of Sexual Offender Denial (FoSOD; pronounced "façade") Scale maps critical aspects of treatment progress, yet avoids problems typically associated with self-report measures. Fifty-three child molesters completed the FoSOD twice with an 18-month interval between administrations. The Time 1 and Time 2 FoSOD scores were analyzed as a function of advancement through a court-sanctioned sexual offender treatment program. Results demonstrated not only that advancement in treatment corresponded with predictable changes in FoSOD scores, but also that FoSOD component scores, representing denial associated with refutation, minimization and depersonalization of the offense, revealed critical patterns indicative of the issues with which offenders contend at various points within treatment. These results are discussed within a conceptual framework that recognizes the relationships between denial in its various forms and the explanations that offenders develop to limit their accountability for alleged offenses, associated thoughts or behaviors, and deviant predispositions.

The economics of child sex-offender rehabilitation programs: beyond Prentky & Burgess.

In a 1990 article in this journal, Prentky and Burgess examined cost-effectiveness of the rehabilitation of child molesters. Their estimates were based on the tangible costs of incarceration and particular recidivism rates. This paper extends those findings by estimating the intangible costs of child sexual abuse and a range of recidivism rates. The result is to focus greater attention on the efficacy of treatment programs and the potential economic damage done to children by child molesters.

Treatment of adolescent sex offenders with intellectual disabilities.

The problems of male adolescent sex offenders with intellectual disabilities were described and issues for treatment reviewed. A group treatment based on cognitive therapy was offered. Treatment methods and assessment of attitudes related to commission of sexual offenses were described. Four case studies of teenage male adolescent sex offenders with intellectual disabilities were presented. All subjects responded to treatment. Their individual differences related to their responses were discussed in the context of the type of denial exhibited by each subject. At the time of this study, 3 years had elapsed for 2 subjects and 4 years for the other 2 without a recurrence of an offense.

Psychiatry and paedophilia: a major public health issue.

OBJECTIVE: The aim of this study was to provide a brief review of current perspectives on paedophilia as well as some suggestions regarding the place of psychiatry in dealing with the problem. METHOD: A literature survey was conducted. RESULTS: Child sexual abuse has unfortunately been ignored and minimised by psychiatry until recently. The current evidence strongly indicates that it is a common event which is highly likely to cause both short- and long-term harm to its victims. The perpetrators generally are psychiatrically otherwise 'normal' men who are skilled at both planning their offending behaviours and denying their existence. CONCLUSIONS: Psychiatrists have an important role to play in assessment and treatment of both offenders and victims, although they may have to learn new clinical skills. Their preventative role is also important, particularly in the field of public education.