Sexual Abuse A Journal of Research and Treatment

Published by SAGE Publications
Online ISSN: 1573-286X
Print ISSN: 1079-0632
One hundred and twenty consecutively evaluated outpatient males with paraphilias (PAs; n = 88, including 60 sex offenders) and paraphilia-related disorders (PRDs; n = 32) were systematically assessed for certain developmental variables and DSM-IV-defined Axis I comorbidity. In comparison with the PRDs, the PA group was statistically significantly more likely to self-report a higher incidence of physical (but not sexual) abuse, fewer years of completed education, a higher prevalence of school-associated learning and behavioral problems, more psychiatric/substance abuse hospitalizations, and increased employment-related disability as well as more lifetime contact with the criminal justice system. In both groups, the most prevalent Axis I disorders were mood disorders (71.6%), especially early onset dysthymic disorder (55%) and major depression (39%). Anxiety disorders (38.3%), especially social phobia (21.6%), and psychoactive substance abuse (40.8%), especially alcohol abuse (30%), were reported as well. Cocaine abuse was statistically significantly associated with PA males (p = .03). There was a statistically significant correlation between the lifetime prevalence of Axis I nonsexual diagnoses and hypersexual diagnoses (PAs and PRDs). The prevalence of retrospectively diagnosed attention deficit hyperactivity disorder (ADHD) was 35.8%, the third most prevalent Axis I disorder. ADHD (p = .01), especially ADHD-combined subtype (p = .009), was statistically significantly associated with PA status. ADHD was statistically significantly associated with conduct disorder, and both of these Axis I disorders were associated with the propensity for multiple PAs and a higher likelihood of incarceration. When the diagnosis of ADHD was controlled, the differences reported above between PAs and PRDs either became statistically nonsignificant or remained as only statistical trends. Thus, ADHD and its associated developmental sequellae and Axis I comorbidities was the single most common nonsexual Axis I diagnosis that statistically significantly distinguished males with socially deviant sexual arousal (PAs) from a nonparaphilic hypersexual comparison group (PRDs). Sex offender paraphiliacs were more likely to be diagnosed with conduct disorder, alcohol abuse, cocaine abuse, and generalized anxiety disorder. The prevalence of any ADHD in the sex offender paraphiliacs was 43.3%, and nearly 25% of offenders were diagnosed with ADHD-combined subtype.
In a survey of 1,439 female college students, 24% reported that they had what they considered consensual sexual intercourse between ages 13 and 15 (2% at age 13, 7% at age 14, and 15% at age 15). Contrary to the impression left by studies of teenage mothers, the majority of their male sexual partners were not substantially older than them but instead were more typically "somewhat older" (2-4 years apart) or similar aged (less than 2 years apart). The percentage of "much older" partners (5 or more years older) was 31% for those who had intercourse at age 13, 17% for those who had intercourse at age 14, and 13% for those who had intercourse at age 15. Women who had intercourse at age 13 endorsed more current symptoms of psychological distress than those who first had intercourse at age 14 or 15. There were no significant differences between the groups in current levels of sexual satisfaction. Partner's age difference was not significantly associated with current levels of either psychological distress or sexual satisfaction. The implications of these results were discussed in light of recent calls in the United States for more strict and rigorous enforcement of statutory rape laws.
The Predictive Validity of the DASH, SAPROF, and ERASOR for Desistence From Sexual and Nonsexual Recidivism. 
Incremental Validity of the DASH-13 and the SAPROF Over the ERASOR for Sexual Recidivism. 
Sexual offending has attracted increasing public concern because of its long-term effects. Although there is an increasing amount of research on the risk factors for recidivism among youth who have sexually offended, there is a dearth of research on the protective factors for desistence from recidivism. The current study investigated the associations between protective factors and recidivism among 97 Singaporean youth who sexually offended (YSO). In addition, the predictive validity with regard to two new measures of protective factors-the Desistence for Adolescents Who Sexually Harm (DASH-13), and Structured Assessment of Protective Factors for Violence Risk (SAPROF)-were also evaluated. Results indicated that both the DASH-13 and the SAPROF were inversely related to the Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR). However, neither the DASH-13 nor the SAPROF were found to have adequate predictive validity or incremental validity for sexual or nonsexual recidivism. The implications for the assessment and management of YSO are discussed. © The Author(s) 2014.
Descriptive Statistics for Measures 
Correlations Between Selected Items of the Stable-2000/2007 and Measures of Beliefs Supportive of Child Molestation and Deviant Sexual Interests 
Descriptive Statistics for Self-Report Measures 
Correlations Between Intimacy and Loneliness Items of the Stable-2000 and Self- Report Measures of Social Intimacy and Loneliness Stable-2000 Items 
We addressed the construct validity of Stable-2000 and Stable-2007 scores by examining correlations between selected items and validated independent measures of relevant constructs in samples of convicted sex offenders. In Study 1, the Child Molester Attitudes item of the Stable-2000 shared 23% of the variance with a self-report measure of beliefs supportive of child molestation, r(19) = .48. The Deviant Sexual Interests items of the Stable-2000 and Stable-2007 shared 7% to 66% of the variance, respectively, with an offense-history-based measure of pedophilic interests, r(18) = .27 for the Stable-2000 and r(11) = .81 for the Stable-2007. In Study 2, the Lovers/Intimate Partners, General Social Rejection/Loneliness, Rapist Attitudes, and Child Molester Attitudes items of the Stable-2000 shared 4% to 19% of the variance with self-report measures of, respectively, intimacy, r(90) = -.44; loneliness, r(88) = .34; beliefs supportive of rape, r(72) = .21; and beliefs supportive of child molestation, r(78) = .36. The results generally suggest that the Stable items examined are associated with measures of similar constructs; however, the degree of convergence was lower than expected. More systematic and comprehensive research is needed to examine convergence of the Stable items with other relevant measures and additional aspects of construct validity. Such efforts will provide a clearer understanding of dynamic risk factors, appropriate areas of focus for treatment efforts, and, more generally, why some sex offenders recidivate.
Correlation Matrix for Risk Assessment Measures 
Predictive Accuracy of the RM2000, Static-99, and SORAG 
The purpose of this study is to examine the predictive accuracy of the Risk Matrix 2000 on an independent sample of 351 sexual offenders, followed in the community for an average duration of 11.4 years (range 0-20 years, SD = 4.4 years). For comparison purposes, this study also examines the predictive accuracy of two other risk assessment instruments, specifically modified versions of the Static-99 and the Sex Offender Risk Appraisal Guide (SORAG). Results indicate that the Risk Matrix 2000 demonstrates convergent validity by correlating with the other risk assessment instruments. Moreover, the Risk Matrix 2000 is predictive of recidivism above chance levels, exhibiting medium to large effect sizes, although in general, the other two instruments, particularly the SORAG, are superior. Results also indicate differences in predictive validity when comparing 2-year, 5-year, and variable follow-up periods. Finally, a cumulative meta-analysis compares and integrates current findings with those obtained from the accumulation of previous studies, and new cumulative estimates are provided.
Risk Matrix 2000 is a statistically derived risk-assessment instrument for use with convicted male sex offenders. It is a core element of the sex offender risk assessments carried out in England, Wales, and Scotland. This study examines its validity in a large cohort of sex offenders released from Scottish prisons. It compares 5-year outcomes with findings from the original Risk Matrix validity sample (a 1979 cohort of sex offenders in England and Wales). The instrument had moderate predictive validity and performed in a similar manner in the two studies in spite of different underlying base rates of reconviction.
The treatment outcome study by Nicholaichuk, Gordon, Gu, and Wong (2000) used a novel method for identifying a comparison group of untreated sex offenders (i.e., drawing from existing criminal history records). A potential problem with their approach is that older records would be expected to include a disproportionate numbers of recidivists. Such an artifact is identified in Nicholaichuk et al.'s (2000) study; nevertheless, their data continue to suggest a small, positive effect for treatment even after eliminating the cases in which bias is most likely.
This study examined the predictive validity of an actuarial risk-assessment tool with convicted sexual offenders in England and Wales. A modified version of the RM2000/s scale and the RM2000 v and c scales (Thornton et al., 2003) were examined for accuracy in predicting proven sexual violent, nonsexual violent, and combined sexual and/or nonsexual violent reoffending in a sample of sexual offenders who had either started a community sentence or been released from prison into the community by March 2007. Rates of proven reoffending were examined at 2 years for the majority of the sample (n = 4,946), and 4 years ( n = 578) for those for whom these data were available. The predictive validity of the RM2000 scales was also explored for different subgroups of sexual offenders to assess the robustness of the tool. Both the modified RM2000/s and the complete v and c scales effectively classified offenders into distinct risk categories that differed significantly in rates of proven sexual and/or nonsexual violent reoffending. Survival analyses on the RM2000/s and v scales (N = 9,284) indicated that the higher risk groups offended more quickly and at a higher rate than lower risk groups. The relative predictive validity of the RM2000/s, v, and c, as calculated using Receiver Operating Characteristics (ROC) analyses, were moderate (.68) for RM2000/s and large for both the RM2000/c (.73) and RM2000/v (.80), at the 2-year follow-up. RM2000/s was moderately accurate in predicting relative risk of proven sexual reoffending for a variety of subgroups of sexual offenders.
Sexual Recidivism in Relation to STABLE-2007 Sumscores (Total Sample, N = 256) 
Smoothed Estimates (Logistic Regression Estimates) and Observed Sexual Recidivism Rates for FECVSO STABLE-2007 Nominal Priority Categories With Fixed Follow- Up Time of 5 Years (B 0 = −5.104, SE B 0 = 1.009, B 1 = 1.217, SE B 1 = 0.394) 
Incremental Validity of the STABLE-2007 After Controlling for STATIC-99 (STABLE Total Scores and FECVSO Risk Categories) STABLE-2007 total score FECVSO STABLE-2007 risk categories Sample size (recidivists/total) Beta SE Wald p χ2 change Beta SE Wald p χ2 change 
The predictive accuracy of STABLE-2000 and STABLE-2007 was examined within a prospective research design in a German-speaking sample of 263 adult male prison-released sexual offenders followed up for an average of 6.4 years. The STABLE-2007 was significantly related to all outcomes (AUC = 0.67-0.71), whereas the STABLE-2000 demonstrated only weak predictive accuracy for sexual reoffense (AUC = 0.62). Supporting the results of the construction sample, the STABLE-2007 incrementally added to the predictive accuracy of the STATIC-99 for violent and general reoffense (conviction and incarceration). Moreover, the STABLE-2007 total scores and the nominal risk/need categories made significant incremental contributions over the SORAG for predicting sexual reoffense.
Comparing observed 5-year sexual recidivism rates per age group to recidivism rates predicted from Static-99 and Static-99R, using data from the validation sample 
Estimated 5-Year Recidivism Rates (Survival Analysis) by Static-99R Risk Category and Age Band 
Observed and Predicted Five-Year Recidivism Rates for Static-99 and Static-99R (All Available Cases) 
Observed and Predicted Five-Year Recidivism Rates for Static-99 and Static-99R (Validation Sample) 
Observed and Predicted Five-Year Recidivism Rates for Static-2002 and Static- 2002R (All Available Cases) 
Actuarial risk assessment scales and their associated recidivism estimates are generally developed on samples of offenders whose average age is well below 50 years. Criminal behavior of all types declines with age; consequently, actuarial scales tend to overestimate recidivism for older offenders. The current study aimed to develop a revised scoring system for two risk assessment tools (Static-99 and Static-2002) that would more accurately describe older offenders' risk of recidivism. Using data from 8,390 sex offenders derived from 24 separate samples, age was found to add incremental predictive validity to both Static-99 and Static-2002. After creating new age weights, the resulting instruments (Static-99R and Static-2002R) had only slightly higher relative predictive accuracy. The absolute recidivism estimates, however, provided a substantially better fit for older offenders than the recidivism estimates from the original scales. We encourage evaluators to adopt the revised scales with the new age weights.
This study examines whether clinically meaningful subgroups could be identified within a large, undifferentiated group of convicted adult male sex offenders. Of eight cluster analyses, a reliable three-cluster solution emerged based on the subscores of the Static-2002R with 345 sex offenders. To establish the validity of the emergent clusters, the three groups of offenders were compared on four domains: criminal history, psychosexual development, sexual attitudes and interests, and recidivism. The findings revealed meaningful differences among the group, and the implications of subgroup membership is discussed in terms of risk, treatment, and supervision.
Incremental Validity of Age, the Static-2002R General Criminality subscale, and the Sexual 
Meta-Analysis of the Logistic Regression Coefficients for Estimating the 5-Year Recidivism Rates of the BARR-2002R 
Given that sexual offenders are more likely to reoffend with a nonsexual offense than a sexual offense, it is useful to have risk scales that predict general recidivism among sexual offenders. In the current study, we examined the extent to which two commonly used risk scales for sexual offenders (Static-99R and Static-2002R) predict violent and general recidivism, and whether it would be possible to improve predictive accuracy for these outcomes by revising their items. Based on an aggregated sample of 3,536 adult male sex offenders from Canada, the United States, and Europe (average age of 39 years), we found that a scale created from the Age at Release item and the General Criminality subscale of Static-2002R predicted nonsexual violent, any violent, and general recidivism significantly better than Static-99R or Static-2002R total scores. The convergent validity of this new scale (Brief Assessment of Recidivism Risk-2002R [BARR-2002R]) was examined in a new, independent data set of Canadian high-risk adult male sex offenders (N = 360) where it was found to be highly correlated with other risk assessment tools for general recidivism and the Psychopathy Checklist-Revised (PCL-R), as well as demonstrated similar discrimination and calibration as in the development sample. Instead of using total scores from the Static-99R or Static-2002R, we recommend that evaluators use the BARR-2002R for predicting violent and general recidivism among sex offenders, and for screening for the psychological dimension of antisocial orientation. © The Author(s) 2015.
In a recent article Looman and Marshall (2005) questioned the validity of phallometric assessment of rapists based on the results of a study of incarcerated rapists and child molesters. In this commentary we offer (1) a critique of the methods used and conclusions reached by Looman and Marshall and (2) a discussion of important methodological issues relevant to phallometry. We conclude that the correct inference from Looman and Marshall's study is that rapists, as a group, show a pattern of sexual arousal to audiotaped scenarios of coercive and non-coercive sex that significantly differs from the pattern of groups of non-sex offenders, in agreement with the general literature on this question.
Comments on the article, The utility of the random controlled trial for evaluating sexual offender treatment: The gold standard or an inappropriate strategy? by W. L. Marshall and L. E. Marshall (2007). The authors argued that randomized clinical trials (RCTs) are not necessary in the evaluation of sex offender treatment, suggesting that the "RCT design is not a suitable model for determining the effectiveness of sexual offender treatment". In making their argument, they criticized RCTs in general and California's Sex Offender Treatment and Evaluation Project (SOTEP) in particular. In presenting their case, we believe that the authors overstated the limitations of RCTs, underestimated the advantages of RCTs relative to other evaluation designs, mischaracterized SOTEP, and unnecessarily pitted accepted scientific standards against clinical practices. They began their critique by citing other authors who are skeptical about the inferential value of RCTs as applied to psychosocial therapies, but they do not cite proponents of RCTs to present a more balanced view. They also claim that withholding treatment from sex offenders who volunteer for it is unethical, noting that potential victims cannot provide informed consent to the research and that the distress experienced by those denied treatment might have negative effects that increase the likelihood that they reoffend. The objection does not recognize the possibility that unproven treatments might have harmful effects. This commentary responds to criticisms raised in their article, and we conclude that RCTs are scientifically and ethically necessary for good clinical practices in sex offender treatment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Multisample age-stratified table of sexual recidivism rates (MATS-1) recidivism estimates based on age and actuarial scores (L = low, M = medium, H = high) are clearly more accurate than estimates based only on scores 
RS-99 and ASRS Likelihood Ratios for Each Risk and Age Group 
Estimated Recidivism Rates Based on Age-Wise Recidivism Rates and Likelihood Ratios From the RS-99 and ASRS From RS-99 age rates and ASRS likelihood ratios 
Likelihood Ratios for Younger Versus Older Sex Offenders for Each RS-99 and ASRS Score RS-99 ASRS 
A useful understanding of the relationship between age, actuarial scores, and sexual recidivism can be obtained by comparing the entries in equivalent cells from "age-stratified" actuarial tables. This article reports the compilation of the first multisample age-stratified table of sexual recidivism rates, referred to as the "multisample age-stratified table of sexual recidivism rates (MATS-1)," from recent research on Static-99 and another actuarial known as the Automated Sexual Recidivism Scale. The MATS-1 validates the "age invariance effect" that the risk of sexual recidivism declines with advancing age and shows that age-restricted tables underestimate risk for younger offenders and overestimate risk for older offenders. Based on data from more than 9,000 sex offenders, our conclusion is that evaluators should report recidivism estimates from age-stratified tables when they are assessing sexual recidivism risk, particularly when evaluating the aging sex offender.
The Static-99 is an instrument commonly used to measure the likelihood of recidivism among sex offenders. The current study explores whether the Static-99 is an effective predictor of relapse among Catholic clergy who have had sexual contact with minors. Static-99 scores were compiled for 337 treated clergy who had offended against minors, including 21 who were known to have relapsed after treatment. Clergy were followed up for 5 to 25 years posttreatment (M = 16.05; SD = 5.12) after their completion of treatment. Post release, they were closely supervised, with explicit rules limiting their contacts with minors and church officials monitoring their compliance with posttreatment plans. Descriptive information on the victims of clergy sex offenders is provided. Although all clergy offenders had the same score on 4 of the 10 Static-99 items, Static-99 total scores still significantly predicted relapse with a moderate to large effect size (area under the curve [AUC] = .672; Cohen's d = .808). Predictive accuracy of each item is also reported. Issues concerning the use of the Static-99 with this population are discussed.
Actuarial risk assessment (Static-99 and Static-99-R) scores were obtained for 399 Australian adult sexual offenders who were subsequently released from prison and followed up with searches of police arrest records (mean follow-up period = 29 months; range = 15-53 months). Indigenous offenders (n = 67; 16.8%) scored significantly higher on both the Static-99 (M = 4.04 vs. 2.89, p < .001) and Static-99-R (M = 3.72 vs. 2.22, p < .001), were more than twice as likely to be arrested for sexual offenses (9.0% vs. 4.1%, ns), and were significantly more likely to be arrested for nonsexual violent (28.4% vs. 1.9%, p < .001), any violent (including sexual; 37% vs. 5.9%, p < .001), and any offenses (58.2% vs. 21.6%, p < .001). For the combined groups, predictive accuracy of both instruments was comparable to results reported elsewhere. Predictive accuracy of the Static-99 was similar for indigenous and nonindigenous offenders. The Static-99-R was only marginally predictive of any violent recidivism (AUC = .65, 95% CI = [.52, .79]), and did not predict sexual (AUC = .61, 95% CI = [.45, .77]) or nonsexual violent recidivism (AUC = .65, 95% CI = [.48, .78]), for indigenous offenders. Higher risk scores, indigenous race, and unsupervised release all contributed unique variance to any violent recidivism. Results suggest that the Static-99 may be appropriate for assessing Australian indigenous sexual offenders, but more research is needed to test the validity of the Static-99-R for this population. We conclude that practitioners should consider the potential effects of racial differences and postrelease factors, as well as static risk factors, in their assessments.
The Static-99 is the most commonly used risk assessment instrument for sexual violence in North America and its results can affect highly consequential decisions made in the criminal and civil justice systems. Despite its influence, few studies have systematically examined how the Static-99 is used by clinicians in practice. The current study compares the Static-99 ratings of clinicians to those of researchers for 100 adult males who completed an outpatient sex offender treatment program and were followed up over an average of about 4 years. Results showed good agreement between the ratings of clinicians and researchers for total scores on the Static-99, as well as for most individual items. Ratings by clinicians tended to be slightly lower than those made by researchers. The predictive validity of ratings made by clinicians and researchers was very similar and moderate in terms of effect size. In 30 cases, clinicians used discretion to "override" or adjust the Static-99 ratings when making final risk judgments, but the predictive validity of the clinical adjusted ratings was worse than that of the original Static-99 ratings made by clinicians. The need for quality assurance and training are discussed along with the need for clear empirically supported guidelines regarding overrides.
Study characteristics 
Five year sexual recidivism rates divided by age and Static-99 risk categories Age at release 
Static-99 (Hanson & Thornton, 2000) is the most commonly used actuarial risk tool for estimating sexual offender recidivism risk. Recent research has suggested that its methods of accounting for the offenders' ages may be insufficient to capture declines in recidivism risk associated with advanced age. Using data from 8 samples (combined size of 3,425 sexual offenders), the present study found that older offenders had lower Static-99 scores than younger offenders and that Static-99 was moderately accurate in estimating relative recidivism risk in all age groups. Older offenders, however, had lower sexual recidivism rates than would be expected based on their Static-99 risk categories. Consequently, evaluators using Static-99 should considered advanced age in their overall estimate of risk.
The predictive validity of 2 risk assessment instruments for sex offenders, modified versions of the Static-99 and the Sex Offender Risk Appraisal Guide, was examined and compared in a sample of 258 adult male sex offenders. In addition, the independent contributions to the prediction of recidivism made by each instrument and by various phallometric indices were explored. Both instruments demonstrated moderate levels of predictive accuracy for sexual and violent (including sexual) recidivism. They were not significantly different in terms of their predictive accuracy for sexual or violent recidivism, nor did they contribute independently to the prediction of sexual or violent recidivism. Of the phallometric indices examined, only the pedophile index added significantly to the prediction of sexual recidivism, but not violent recidivism, above the Static-99 alone.
Current procedures to estimate sex offender recidivism risk typically involve actuarial instruments, either alone or in combination with adjustments based on other considerations. Two of the most commonly employed actuarial instruments for the assessment of sexual recidivism risk are the Rapid Risk Assessment for Sex Offender Recidivism (RRASOR; R. K. Hanson, 1997) and the Static-99 (R. K. Hanson & D. Thornton, 2000). Although multiple studies of the interrater reliability and predictive validity of these instruments have been completed, with very supportive results, there have to date not been any studies of the degree to which the specific risk percentages attached to each instruments score replicate and remain stable despite changes in underlying samples' recidivism base rates. This study, using data from multiple sources, investigated this issue. The findings indicated that the 5-year risk percentages for the RRASOR were replicated and were remarkably stable despite changes in the samples underlying recidivism base rate. The Static-99 5-year risk percentages were mostly replicated and were stable across varying base rates, but to a lesser degree than was found for the RRASOR. Implications of these results are discussed.
This study evaluated the convergent and predictive validity of the Sex Offender Risk Appraisal Guide (SORAG; V. L. Quinsey, G. T. Harris, M. E. Rice, & C. A. Cormier, 1998) and the Static-99 (R. K. Hanson & D. Thornton, 1999, 2000) among 147 male sex offenders committed to a high-security hospital in Belgium (Centre de Défense Sociale "Les Marronniers"). Of the sample, 63.8% were child abusers (victims under 14 years of age), 24.6% were rapists (victims aged 14 years or more), and 11.5% were mixed-victim offenders (victims less than 14 years of age and victims aged 14 years or more). After an average follow-up period of 4.2 years (SD = 3.4 years), the sexual recidivism rate was 25.2%, the violent recidivism rate was 17.1%, and the general (any) recidivism rate was 33.1%. The SORAG and the Static-99 were moderately correlated with each other (r = .55), and both showed strong predictive validity for general and violent recidivism (ROC AUC's ranging from .68 to .72 for the total sample). Both instruments showed moderate predictive validity for sexual recidivism (AUC of .64 for SORAG and .66 for Static-99).
Observed 5-year sexual recidivism rates plotted along with the 5-year sexual recidivism rates derived from logistic and Cox regression analyses  
Stability of odds ratios and base rates of sexual recidivism derived from logistic regression across follow-up time  
Rate Ratios and Odds Ratios for Static-99R Predicted 5-Year Sexual Recidivism 
Schoenfeld residuals plotted as a function of time  
Meta-Analysis of Logistic Regression Parameters From Static-99R Predicting 5-Year Recidivism Rates 
Given the widespread use of empirical actuarial risk tools in corrections and forensic mental health, it is important that evaluators and decision makers understand how scores relate to recidivism risk. In the current study, we found strong evidence for a relative risk interpretation of Static-99R scores using 8 samples from Canada, United Kingdom, and Western Europe (N = 4,037 sex offenders). Each increase in Static-99R score was associated with a stable and consistent increase in relative risk (as measured by an odds ratio or hazard ratio of approximately 1.4). Hazard ratios from Cox regression were used to calculate risk ratios that can be reported for Static-99R. We recommend that evaluators consider risk ratios as a useful, nonarbitrary metric for quantifying and communicating risk information. To avoid misinterpretation, however, risk ratios should be presented with recidivism base rates.
Descriptive Statistics (N = 759) M SD 
Interval-censored survival curves based on GEE analyses Note: Survival rate shown as survival proportion of n during repeated 36-month follow-up; Days to Sexual Reoffense (n = 749), Days to Violent Reoffense (n = 746), Days to Any Reoffense (n = 740), and Days to Return to Prison (n = 729). 
SOTIPS Mean Scores and Sexual Recidivism Rates by Score Times 
Factor Loadings for Exploratory Factor Analysis With Varimax Rotation of SOTIPS Items 
GEE Model Effects and Parameter Estimates for Sexual Recidivism One-year follow-up 
The Sex Offender Treatment Intervention and Progress Scale (SOTIPS) is a 16-item rating scale designed to assess dynamic risk among adult male sex offenders and degree of change at 6-month intervals during treatment. The purpose of the present study was to examine the psychometric properties of the SOTIPS in a construction sample of 759 adult male sex offenders who were under correctional supervision and enrolled in cognitive-behavioral community treatment in Vermont between 2001 and 2007. The scale showed acceptable interrater reliability. SOTIPS scores at 1, 7, and 13 months after participants began treatment predicted sexual, violent, and any recidivism, and return to prison at fixed 1- and 3-year follow-up periods (AUCs = .60 to .85). Combined SOTIPS and Static-99R scores predicted all recidivism types (AUCs = .67 to .89) and outperformed either instrument alone when both instruments had similar predictive power. Participants who demonstrated treatment progress, as reflected by reductions in SOTIPS scores, showed lower rates of recidivism than those who did not.
A review of the psychometric properties of the Abel Assessment for Interest in Paraphilias (AAIP) is presented. The data supporting the AAIP's history, purpose, data, reliability, validity, and norms are reported, with the conclusion that its use with adults is tenuous at best and its use with adolescents is as yet unsupported. Pragmatic concerns are noted, along with recommendations for further research.
Empirical tests of the reliability and validity of the Abel Assessment for Interest in Paraphilias (AAIP) as used with juvenile sexual offenders were performed. Test-retest reliability, screening validity, and diagnostic validity were assessed using several analytical approaches. The temporal stability, sensitivity, and specificity of the AAIP as used with adolescents in residential and day treatment were not demonstrated. The results indicate the need for further refinement of the AAIP.
Canada's Aboriginal peoples face a number of social and health issues. Research shows that Aboriginal youths are over-represented in the criminal justice system and youth forensic psychiatric programmes. Within the literature on sex offending youth, there appears to be no published data available to inform clinicians working with adjudicated Aboriginal youth. Therefore, the present study examines the background, offence characteristics, and criminal outcomes of Aboriginal (n = 102) and non-Aboriginal (n = 257) youths who engaged in sexual offending behaviour and were ordered to attend a sexual offender treatment programme in British Columbia between 1985 and 2004. Overall, Aboriginal youths were more likely than non-Aboriginal youths to have background histories of fetal alcohol spectrum disorders (FASD), substance abuse, childhood victimization, academic difficulties, and instability in the living environment. Both Aboriginal and non-Aboriginal youths had a tendency to target children under 12-years-old, females, and non-strangers. Aboriginal youths were more likely than non-Aboriginal youths to use substances at the time of their sexual index offence. Outcome data revealed that Aboriginal youths were more likely than their non-Aboriginal counterparts to recidivate sexually, violently, and non-violently during the 10-year follow-up period. Furthermore, the time between discharge and commission of all types of re-offences was significantly shorter for Aboriginal youths than for non-Aboriginal youths. Implications of these findings are discussed with regards to the needs of Aboriginal youth and intervention.
The relationship that develops between a client and therapist is arguably one of the most important factors toward achieving positive outcomes from therapy. The present study examined the therapeutic alliance, as measured by Horvath and Greenberg's Working Alliance Inventory (WAI), as a function of Aboriginal ancestry and the relationship of alliance to important program outcomes, in a Canadian correctional sample of 423 treated sexual offenders. The men rated their primary therapists on the WAI 3 months into treatment. Higher self-report ratings on the WAI and its Task, Bond, and Goal subscales were associated with lower rates of treatment non-completion and longer stay in treatment. Aboriginal men scored significantly lower on the WAI's Bond subscale (i.e., the emotional connection between client and therapist) than non-Aboriginal men, although by and large, the offender sample as a whole otherwise registered fairly high mean scores on the tool. Aboriginal men scoring below the median on WAI total score had the highest rates of treatment non-completion. WAI total score and scores on the three subscales were unrelated to post-program recidivism in the community. Cultural implications for correctional client engagement and service delivery within the context of the risk-needs-responsivity model are discussed.
Phallometric profiles of the study groups. Adult F, adult females; Pubes F, pubescent females; Prepub F, prepubescent females; Prepub M, prepubescent males; Pubes M, pubescent males; Adult M, adult males; Neutral, erotically neutral stimuli. 
There are at least two different criteria for assessing pedophilia in men: absolute ascertainment (their sexual interest in children is intense) and relative ascertainment (their sexual interest in children is greater than their interest in adults). The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) used relative ascertainment in its diagnostic criteria for pedophilia; this was abandoned and replaced by absolute ascertainment in the DSM-III-R and all subsequent editions. The present study was conducted to demonstrate the continuing need for relative ascertainment, particularly in the laboratory assessment of pedophilia. A total of 402 heterosexual men were selected from a database of patients referred to a specialty clinic. These had undergone phallometric testing, a psychophysiological procedure in which their penile blood volume was monitored while they were presented with a standardized set of laboratory stimuli depicting male and female children, pubescents, and adults.The 130 men selected for the Teleiophilic Profile group responded substantially to prepubescent girls but even more to adult women; the 272 men selected for the Pedophilic Profile group responded weakly to prepubescent girls but even less to adult women. In terms of absolute magnitude, every patient in the Pedophilic Profile group had a lesser penile response to prepubescent girls than every patient in the Teleiophilic Profile group. Nevertheless, the Pedophilic Profile group had a significantly greater number of known sexual offenses against prepubescent girls, indicating that they contained a higher proportion of true pedophiles. These results dramatically demonstrate the utility-or perhaps necessity-of relative ascertainment in the laboratory assessment of erotic age-preference.
Relapse Prevention (RP) is a cognitive-behavioral approach originally developed for treatment of addictions and has since become an effective and popular method for treating sexual offenders. The Abstinence Violation Effect (AVE) is a pivotal RP construct describing one's cognitive and affective response to re-engaging in a prohibited behavior. We review the literature on the AVE in both addiction and sexual offender applications. We summarize the original and subsequent formulations of the AVE for addictions and modifications adopted for its application to sexual offenders. We argue that these modifications have generally failed to characterize sexual offense relapse cycles accurately or comprehensively. In particular, these modifications fail to specify accurately the AVE's occurrence and influence in the offense cycle. In response to these limitations, we suggest future directions for AVE research in sexual offenders.
With the increasing popularity of family therapies in cases of childhood sexual abuse (CSA), many studies have discussed the importance of familial support in the successful recovery of victims. Therefore, a systematic study exploring family support of victims was undertaken to shed light on the level of family support perceived by adult victims of CSA. It was anticipated that victims of intrafamilial CSA would report more family dissatisfaction and perceive less family support than extrafamilial victims. As hypothesized, intrafamilial victims reported significantly more general family dissatisfaction and specifically, perceived significantly less father, parent, and brother support. Additionally, the gender of the victim played a significant role: Male victims reported less father, parent and sister support and less family protectiveness after disclosure when compared to female victims. Based on the results, clinicians should be aware that issues of gender and relatedness may play a significant part in the effectiveness of their CSA clients' family support systems.
This study examined a sample of 120 adult males convicted of offences involving indecent images of children (IIOC); 60 had a previous contact child sexual offence (dual offenders) and 60 had no evidence of an offence against a child. Analyses explored socio-demographic characteristics, previous convictions, and access to children. Of the 120 offenders, a subsample of 60 offenders (30 dual offenders and 30 non-contact) were further examined in terms of the quantity of IIOC, types of IIOC, and offending behavior. The study found the two offender groups could be discriminated by previous convictions, access to children, the number, proportion, and type of IIOC viewed. The IIOC preferences displayed within their possession differentiated dual offenders from non-contact IIOC offenders. Within group comparisons of the dual offenders differentiated sadistic rapists from sexual penetrative and sexual touching offenders. The paper suggests there may be a homology between IIOC possession, victim selection, and offending behavior. Implications for law enforcement are discussed in terms of likelihood of contact offending and assisting in investigative prioritization.
This study examines intentions to take protective action against peer sexual harassment and abuse (PSHA). The theory of planned behavior (TPB) proposes that attitudes about protective action, perceptions of what others would think about doing this (subjective norms), and behavioral control would be important predictors. A total of 1,531 Chinese secondary school students (769 boys and 762 girls) from Hong Kong were surveyed to test this model. Results showed that the TPB model was predictive for girls, but only subjective norms and behavioral control significantly predicted boys' intentions to protect themselves. Results supported the influence of subjective norms and perceived behavioral control on youths' intentions to reject PSHA. These factors may be useful in guiding the development of an educational program for prevention of PSHA.
Proportions of Victims who used Resistance Strategies (n=94) 
Offence Characteristics by Types of Victim Resistance (n=94) 1, 4 
Regression Analyses of Victim Resistance (n=87)¹ 
Girl Victim Subgroups by Victim Resistance (n=83) 
The use of self-protection strategies and related situation in rape has been studied by several scholars. The circumstances in which children are more likely to resist sexual victimization have, however, not been studied. This study examines the association between offence-related factors-specifically, the preoffence situation, the modus operandi strategies adopted by offenders, and victim characteristics-and victim resistance in sexual offences against children.The sample consisted of 94 adult offenders convicted of having committed a sexual offence against a child (or adolescent) of 16 years of age or younger and who agreed to provide confidential self-report data concerning their offending behavior and victim resistance actions. Victim resistance strategies were regrouped into three categories, namely, physical resistance, forceful verbal resistance, and nonforceful verbal resistance. The total number of resistance strategies was also used in the analyses. Overall, the age of the victim was found to be related to nonforceful verbal resistance, and violence was related to all forms of resistance.Younger girls were found to be more likely to employ nonforceful verbal resistance than older girls and to use a greater number of strategies as well. To provide reliable knowledge to build on for reducing the risk of child sexual abuse, this study suggests the need for prevention programs to include empirical findings regarding the circumstances in which children are more likely to resist sexual victimization.
Levels of Sexual Abuse by Developmental Epoch  
Path Analyses of Sexual Abuse Predicting Sexual Fantasy by Epoch  
Findings in the sexual aggression literature on the link between childhood sexual abuse and future sexual coercion have been inconsistent. In adult sexual offenders, studies have found that the relation of sexual abuse to sexual coercion is mediated by sexually related deviant cognitions, but this mediation is not found when replicated on juvenile sexual offenders. In this study it is hypothesized that this link will be found in juvenile sexual offenders when their sexual abuse history is stratified into discrete developmental epochs. It is further hypothesized that the age range of 3 to 7 years, when children rapidly acquire inhibition and cognitive flexibility skills, will be the most potent predictor. A sample of 193 juvenile sexual offenders is used to examine whether sexual abuse specifically in this discrete period, as opposed to other periods, predicts subsequent sexual fantasy. The results confirm that sexual abuse correlates with later adolescent sexual fantasy only during the 3- to 7-year epoch.
To test the theory that sexual offenders who abuse very young children (0-5 years) have more severe mental health and psychosocial problems than those who victimize older children, authors compared psychiatric diagnoses, social circumstances, and crime-related data in all sexual offenders against minors referred to forensic psychiatric investigation in Sweden during a 5-year period. Thirty-one men had committed index crimes involving victims between the ages of 0 and 5 years (Group 1), 90 had 6-to 11-year-old victims (Group 2), and 41 had 12- to 15-year-old victims (Group 3). All three offender groups were characterized by severe mental health problems, in many cases fulfilling American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for both Axis I and Axis II diagnoses, but these problems did not differ between groups. Neither did social situation or sexual orientation. Offenders with 0- to 5-year-old victims significantly more often abused both boys and girls. Frequencies of retrospectively diagnosed childhood-onset behavior disorders were high in all three offender groups. The authors' data did not support previous findings of increasingly severe mental health problems with decreasing victim age.
This paper reports preliminary data on a sample of therapists with memory of childhood sexual abuse. Therapists who reported experiencing childhood sexual abuse (CSA, n = 131) were compared with therapists who suspected sexual abuse but had no memories (n = 24) on variables related to abuse characteristics, outcomes, and perceived difficulties working with clients with a CSA history. Therapists who suspected abuse, in contrast to those who made definite reports, were more likely to report that the perpetrator was a family member, that their CSA did not involve physical contact, that there was alcoholism in their families of origin, and that the CSA had negative effects on their relationships with their own children, ability to trust others, sexual satisfaction, and work life. Therapists who suspected abuse also reported more difficulty treating CSA clients because of interpersonal pulls during sessions, arousal without memories of abuse, and some countertransferential behaviors. These findings indicate that issues related to personal trauma should be addressed during training and practice.
Test-Retest Reliability of Attachment (Pearson r) and Onset Offense Variables (Pearson r and Kappa) 
Frequencies of parental bonding styles (%) 
Partial Correlations Among Maternal and Paternal Childhood Attachment and Adult Trait and State Attachment Ratings 
Mean (Standard Deviation) Childhood and Adult Attachment Ratings 95% CI 
Confidential self-report data obtained on 107 adult male child sexual abusers were analyzed to test theoretical propositions concerning the role of attachment problems in the onset of sexual offending. Offenders' parent-child attachment relationships were most frequently characterized by affectionless control, reflecting low parental care and high overprotection and control. Offenders reported significantly less secure attachment with their fathers than with their mothers. Overall, weak continuity from childhood attachment to trait (general) adult attachment was found, with insecure attachment more stable than secure attachment. Childhood attachment problems, particularly with fathers, were more clearly reflected in state adult attachment (i.e., in the month preceding sexual offending onset) than in trait adult attachment. Offenders who were in an adult intimate relationship prior to their onset sexual offense reported significant state increases in attachment avoidance, and their onset offenses were more likely to involve a female familial victim. Offenders who were not in a relationship prior to offending onset were younger, and their onset sexual offenses occurred in much more diverse circumstances. These findings provide tentative evidence that directly and indirectly implicates offenders' attachment problems specifically in the onset of their sexual abuse behavior. Implications for developmental prevention and early intervention, situational prevention, and offender treatment are discussed.
Written autobiographies of 48 incarcerated adult male sexual offenders (22 rapists, 13 intrafamilial child molesters, and 13 extrafamilial child molesters) were used to generate retrospective self-report measures of their childhood maternal and paternal attachment, childhood sexual abuse experiences, and onset of masturbation. Contrary to expectation, the offenders as a combined group more often reported secure than they did insecure childhood maternal and paternal attachment. There were no differences between the three offender subgroups with respect to maternal attachment; however the rapists and the intrafamilial child molesters were more likely to report insecure paternal attachment than were the extrafamilial child molesters. There were no differences between these offender subgroups in the frequency with which childhood sexual abuse was reported. However, offenders with insecure paternal attachment were more likely to report having been sexually abused than were those with secure paternal attachment. Sexually abused offenders in turn reported earlier onset of masturbation than did those who were not sexually abused. These results are consistent with contemporary attachment models linking insecure childhood attachment to childhood sexual abuse, and with traditional conditioning models linking childhood sexual abuse, early masturbation, and sexual offending.
This paper reports on a study of all convicted child sexual abusers in S.E. London. Almost half the offenders reported experiences of sexual victimization in childhood, and the authors aimed to explore the differences between the abused and nonabused child sexual abusers. A range of background and offending variables were examined. It was found that sexually victimized child abusers were significantly more likely to have experienced a range of childhood abuse and associated difficulties; they were more likely to have a range of psychosexual difficulties, to report greater levels of deviant offence-related attitudes on psychometric measure, to be recidivists, and to offend against boys. Both emotional abuse/physical neglect in childhood and having homosexual contacts in adulthood significantly contributed to a predictive model, reliably distinguishing between sexually victimized and nonsexually victimized child sexual abusers. The implication of these findings for treatment approaches for sex offenders is discussed.
This article is based on a pilot study conducted in Malawi in 2006 that intended to uncover episodes of violence and abuse against women and girls with disabilities and furthermore to explore the mechanisms behind such acts. The stories of 23 women with disabilities were obtained through in-depth semistructured interviews that covered, among other topics, aspects of sexual abuse experienced by or known to these women. None of the informants reported having been sexually abused during childhood. In adulthood, several had experienced what they themselves defined as sexual abuse: Men came and wanted to "marry" them. When the woman became pregnant, the man disappeared and left her alone. The interviewees were very opinionated regarding this theme and sought both social and political action in this matter, especially a means to enforce men to take economic responsibility for their biological children. The informants stressed that adapted education for women with disabilities would allow them to become more economically independent and be better able to refuse the advances of unserious suitors.
Numbers of observed males and females in the CAAC sample compared with expected rates in the reported literature and given the numbers of males and females seen at the CAAC Note: Differences between observed versus expected rates of males and females, given the base rates in the literature: χ 2 (1) = 13.56, p < .001. Differences between observed versus expected rates of males and females, given the CAAC distribution of males and females: χ 2 (1) = 9.53, p < .01. Differences between expected rates of males and females given the base rates in the literature versus expected rates males and females given the CAAC distribution of males and females: χ 2 (1) = .723, ns.  
Cases of child sexual abuse (CSA) referred to the District Attorney (DA) are not necessarily accepted for prosecution. Two pilot studies sought to investigate whether there were gender differences in whether cases of CSA referred to the DA's office were accepted by the DA and, if they existed, what might account for gender differences in decisions to accept cases and file charges. The results of the first study indicated that cases involving male victims were significantly less likely to be accepted for prosecution than cases involving female victims. Comparisons of acceptance rates were based on expected frequencies given CSA prevalence rates by gender in the literature and on the proportion of males and females seen at a Child Abuse Assessment Center (CAAC) from where the DA referrals were obtained. The second study assessed both disclosure-related variables (assessed by content analyses of disclosures made at a CAAC) and abuse-related variables (that occurred at or near the time of the abuse) that might explain these differences. Few variables were found to significantly differentiate males' and females' cases; these were the relationship of the child to the perpetrator, whether the child was offended by a juvenile, whether the child told someone of the abuse, pornography exposure, whether the child displayed concerning behaviors, and whether the child was questioned about possible abuse. Implications of these results are discussed.
The present study examined the parent-child attachments, typical coping styles, and childhood sexual abuse among 30 child molesters, 24 nonsexual offenders, and 29 nonoffenders. The results indicated that all subjects reported greater security in their attachments to their mothers than to their fathers and the insecure patterns of childhood attachments were related to ineffective adult coping. The only difference observed in characteristic coping showed that child molesters were more likely to engage in emotion focused strategies. Child molesters reported having experienced high levels of childhood sexual abuse and these experiences appear to have been more distressing to them than to other subjects. The results are discussed in terms of their implications for theory and treatment.
Top-cited authors
R. Karl Hanson
  • Carleton University
David Thornton
  • Forensic Assessment Training & Research LLC
Ruth E Mann
  • Ministry of Justice, UK
Kelly M Babchishin
  • Carleton University
Michael C Seto
  • University of Ottawa