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Research and literature on sex offenders with intellectual and developmental disabilities
Abstract
The present paper sets out to review the literature on several aspects of sex offenders with intellectual and developmental disabilities, including the relationship between sex offending and developmental disabilities, the prevalence and characteristics of sex offenders in this client group, assessment, treatment, and outcome of intervention. Several important variables were identified as influencing the disparate results found in different prevalence studies. These include variations in inclusion criteria, differences in the source of the sample, differences in determination of IQ, the impact of deinstitutionalization, and the effect of changing social and penal policies in the area where studies have been conducted. Although some studies have suggested an increasing incidence, there is no clear evidence for the over- or under-representation of people with developmental disabilities amongst sex offenders. One of the main methodological flaws in several reports listing the characteristics of sex offenders is that considerations are based on clinical samples. Therefore, there is no control group to show that these characteristics do not exist in other samples of individuals with intellectual disability (ID). It does appear that sex offenders with ID are more likely to commit offences across categories and to be less discriminating in their victims. There may also be an association with sexual abuse in childhood. The primary issue considered has been assessment of competency, in that people with ID are considered to be disadvantaged by the criminal justice process. While several authors have delineated the important areas for assessment, there are few assessment measures with robust psychometric properties. Pharmacological, behavioural, educational and cognitive treatments are reviewed. Several comprehensive treatments which include all of the aforementioned methods are also considered. Although most studies do not report particularly positive outcomes, several authors have found better outcomes with treatment lasting at least 2 years.
... There is a dearth of reliable empirical evidence on the prevalence of cognitive disability among adults who sexually offend. Two studies (Craig & Hutchinson 2007;Lindsay 2002) reviewed available literature, finding no clear evidence on whether sexual offenders were more likely than the general population to have a cognitive disability. However, the authors of these studies found that sexual offenders with cognitive disability differ from non-disabled sexual offenders in several important ways, which has implications for their management and treatment. ...
... However, the authors of these studies found that sexual offenders with cognitive disability differ from non-disabled sexual offenders in several important ways, which has implications for their management and treatment. One found that sexual offenders with cognitive disability are more likely to commit offences across sexual offence categories and to be less discriminating in their victims (Lindsay 2002). The second found that the rate of sexual reoffending among sexual offenders with cognitive disability was 6.8 times greater than for non-disabled sexual offenders at two-year follow-up, and 3.5 times greater at four-year follow-up (Craig & Hutchinson 2007). ...
... Similarly, research has emphasised the unique treatment needs of sexual offenders with cognitive disability (Craig & Hutchinson 2007;Lindsay 2002), and that cognitive disability is common among young people with harmful sexual behaviour (Fyson 2007;Hackett et al. 2013). The present study found initiatives aiming to prevent CSAM and CSA offending among adults and young people with cognitive disability are very rare. ...
This study reviews initiatives that aim to prevent child sexual abuse material (CSAM) offending, including evidence of effectiveness. Information was sourced via a literature search and input from an international expert advisory group. The study identified 74 initiatives in 16 countries, and 34 eligible studies measuring implementation and effectiveness. The CSAM offending prevention initiatives identified in the study include helplines, therapeutic treatment and psychoeducation, online self-management courses, education and awareness campaigns, and other forms of support. Importantly, findings indicate that media and social media campaigns have successfully reached large numbers of offenders, both detected and undetected. While outcomes of programs are mixed, findings indicate that prevention initiatives can encourage help-seeking, reduce risk factors for offending, enhance protective factors, and reduce contact sexual offending against children. Findings also suggest that initiatives aimed at contact child sexual abuse offenders are not necessarily effective in reducing CSAM offending. Evaluations of initiatives aimed specifically at CSAM offending show promise but are limited methodologically. Further and more robust evaluations are required to determine their effect on CSAM use.
... Although paraphilic interests are occasionally reported in people with developmental disorders [e.g., autistic spectrum disorder; (46)(47)(48)], their prevalence is not established in people with low IQ. Individuals with low IQ are not overrepresented among paraphilic sexual offenders (49) and the characteristics of victims of MIQSO are less specific (lower sexual discrimination, with victims of varied age and gender), on average, than those of MSO (23,38,50), which argues against the hypothesis of elevated rates of paraphilia among MIQSO. As stressed by Day (51) some time ago, "True sexual deviance is rare. ...
... However, some studies report higher rates of child victims among MIQSO compared with MSO (23), whereas others do not (49). Children victimization from MIQSO may also be due to a lower sexual selectivity, both for age and gender, instead of genuine pedophilia (38,50). The functional age of the offender may also be causally involved (i.e., attractiveness toward children), as well as general hypersexuality (61) and sexual preoccupations (62). ...
... Rates of child sexual offenses or pedophilia may also be inflated in MIQSO due to referential bias (child sexual abuse being more likely to be reported; 19). In any case, it is plausible that past sexual victimization, limited opportunities for consenting sexual relations with adults, circumstantial opportunities with minors, a lack of socio-sexual knowledge (37) or a lower discrimination toward sexual targets [low sexual specificity; (38,50)], rather than a genuine paraphilic interest, explain most of the commissions of a paraphilic sexual offense by MIQSO. For instance, ranges of victim age and gender are clearly larger for MIQSO than for mainstream sexual offenders [e.g., (43, 59)]. ...
Although risk factors associated with offending and recidivism are relatively well-established for mainstream sexual offenses, much less is known about men with a low IQ who have sexually offended (MIQSO), let alone those with forensic involvement. In this exploratory study, 137 convicted for the commission of at least one sexual offense and found not criminally responsible because a mental disorder were recruited in a maximum-security hospital. They were all assessed with the SORAG (static risk factors) and the RSVP (dynamic risk factors). Compared with MIQSO (N = 76), men with an average or higher IQ who have sexually offended (MSO, N = 61) obtained significantly higher scores on static factors related with general delinquency (histories of alcohol abuse, non-violent criminality, violent criminality, and sexual offense) and dynamic factors related with sexual delinquency, paraphilia, and recidivism (chronicity, psychological coercion, escalation, sexual deviance, and substance abuse). In contrast, MIQSO obtained significantly higher scores on major mental illness, problems with planning and problems with self-awareness. Logistic regressions revealed that both the SORAG and RSVP were useful to predict group membership. It is concluded that risk factors related with general and sexual delinquency better describe offenses committed by MSO, whereas risk factors related with mental disorder, lack of insight and contextual impulsivity better describe offenses committed by MIQSO.
... differences in sample sources (e.g., clinical, forensic) or methods of determining ID (e.g., clinical diagnoses, IQ cutoffs; Lindsay, 2002). Sexual offenders with ID might differ from those without ID in terms of the etiology and nature of offending behavior, as well as associated psychosocial characteristics (Craig & Lindsay, 2010). ...
... Estimates of the prevalence of ID among offenders have varied widely, though most researchers agree that levels of ID are elevated among populations of sexual offenders (Lindsay, 2002). A meta-analysis of the prevalence of ID among 12,000 prisoners (both sexual and nonsexual offenders) found that most studies reported rates between 0.5% and 1.5%, although some studies using more basic screening methods found that up to 10% of offenders had ID (Fazel et al., 2008). ...
... A meta-analysis of the prevalence of ID among 12,000 prisoners (both sexual and nonsexual offenders) found that most studies reported rates between 0.5% and 1.5%, although some studies using more basic screening methods found that up to 10% of offenders had ID (Fazel et al., 2008). While few studies have provided estimated rates of ID among sex offenders specifically, the relationship between ID and sexual offending is well-documented (Lindsay, 2002). A meta-analysis of intelligence testing in criminal offenders found that the mean IQ of sex offender samples was approximately five points lower than that found in non-sex offender samples (Cantor et al., 2005). ...
Research indicates that individuals with intellectual disabilities (ID) are overrepresented among sexual offenders, and that those with ID might differ from those without ID in terms of the etiology of offending behavior. Despite this, few studies have explored ID using incarcerated U.S. samples. The present study sought to identify relevant characteristics of this population by comparing individuals with and without ID who are incarcerated in the U.S. for sexual offenses. Archival records for 3,066 participants were used to determine demographic, historical, and offense-related characteristics. Participants with ID, including those with borderline ID, comprised 19.1% of the sample and displayed elevated rates of adverse childhood experiences and psychopathology. Contrary to previous research, participants with ID were no more likely to offend against children than those without ID. These findings help to elucidate the etiology of offending behavior among those with ID and inform on potential targets for intervention.
... Day 60 found that 32% of the sexual delinquents with ID in the study sample had suffered psychiatric illnesses as adults, while Lindsay indicated that a third had a significant mental illness, including psychotic disorders, bipolar disorders and major depression (with a percentage similar to non-sexual delinquents). 6,55 Substance abuse in individuals that commit crimes has been described to be less common in subjects with ID than in those that do not have this diagnosis. 4,19,27,40,42,61---63 Along the same line, the consumption of toxic substances has been reported to be less frequent in offenders with an IQ under 85. ...
... Their problems go back to early childhood and they can have numerous mental health needs. 6,55 Crocker and Hodgins 39 indicated that such subjects received sentences earlier (before the age of 30); 71% of the males and 43% of the females had been convicted before the age of 18, with important behavioural problems in early childhood. However, it has also been stated that these subjects might be a bit older, with parental supervision a possible protective factor against antisocial behaviours while the parents live (which could also apply to institutionalisation). ...
... 72 Lindsay describes 3 areas of forensic assessment for subjects with ID that commit crimes: evaluations in the courts, risk assessment and evaluations for treatment planning. 6 When the courts assess accountability, the causal relationship stems from the subject's diagnosis of ID. The courts attempt to minimise subjectivity, turning to IQ figures, which require appropriate interpretation. ...
Intellectual disability is of maximum interest in the forensic field. This review includes an electronic search of articles in English or Spanish registered in the Medline database with the terms FORENS* and INTELLECTUAL DISABILITY in the Title or Abstract, up until January 1, 2018, selecting those that addressed issues related to the condition's historical background and legal consideration, criminality and criminal typology, comorbidity in offenders, risk factors and recidivism, and forensic assessment, excluding articles on treatment or treatment outcomes.
We identified 80 articles that fulfilled criteria for inclusion, which highlighted the special consideration historically given by the law to subjects affected by intellectual disability, their high rates of imprisonment, which discussed their relationship with violence, including sexual violence, which describe high rates of comorbidity with other psychiatric disorders, with discrepancies regarding toxic-related disorders, and lastly which reviewed these subjects’ risk factors and recidivism, as well as the forensic assessment methods. We also outline the limitations of the literature review, especially in relation to the research criteria that define intellectual disability.
... However, results of studies comparing individuals with and without ID/BIF are inconsistent, with some studies indicating diminished accuracy for static instruments (Blacker et al., 2011) or higher scores (Stephens et al., 2018) for those with ID/BIF relative to those without ID/BIF despite similar recidivism rates. Of note, existing studies have used differing criteria to determine ID/BIF (i.e., IQ cut-offs, inclusion of BIF; Lindsay, 2002). The criteria used to determine recidivism may also influence results: one study of individuals with ID/ BIF found that the Static-99R was predictive of sexually problematic behavior (which included both sexual offenses and non-illegal inappropriate behavior such as obscene comments and gestures); however, estimates of predictive accuracy fell short of statistical significance when only illegal sexual offenses were considered (Pouls & Jeandarme, 2022). ...
... This also prevented analysis of how the severity of intellectual deficits might influence risk assessment. Previous studies have used various clinical diagnoses and IQ score cutoffs, resulting in widely varied estimates of prevalence (Lindsay, 2002). Most studies regarding sexual recidivism risk assessment have used liberal cutoff scores between 75 and 85 (Blacker et al., 2011;Delforterie et al., 2019;Fedoroff et al., 2016;Lofthouse et al., 2013;Stephens et al., 2018;Wilcox et al., 2009), though studies have differed with respect to the inclusion of those with BIF as well as the extent to which adaptive deficits are considered. ...
While studies indicate that individuals with intellectual disabilities (ID) and borderline intellectual functioning (BIF) are overrepresented among those incarcerated for sexual offenses, there is a paucity of research with respect to risk assessment for this population, particularly among incarcerated U.S. samples. This gap is concerning given that individuals perceived as high risk may be denied bail, given harsher sentences, or subject to civil confinement. The present study examined the predictive validity of the Static-99 and Static-99R, which rely on historical predictors, and the MnSOST-R, which includes a dynamic subscale. Archival records were used to compare individuals with ( n = 459) and without ( n = 459) ID/BIF released from New Jersey state prisons between 1996 and 2007, with an average follow-up period of 5.7 years. All three instruments demonstrated good predictive validity for those without ID/BIF, while only the MnSOST-R produced a significant AUC value for those with ID/BIF. Reincarceration rates for those with ID/BIF within high-risk groups ranged from 0% to 8%, similar to the overall recidivism base rate of 4%. Results highlight the need for additional research to determine which risk factors should be considered for those with ID/BIF.
... Beneath the fragile surface of the intersection of desire and intellectual disability in psychological literature lurks the unfounded and ancient fear of this label harboring ignorant sexual deviants. Studies claim that there is an increase in incidents of sexual crimes among populations with intellectual disabilities (Lindsay, 2002). Some authors have claimed as much as a doubling of incidents between the years of 1973 and 1983 (Lund, 1990). ...
... Some authors have claimed as much as a doubling of incidents between the years of 1973 and 1983 (Lund, 1990). In light of deinstitutionalization, whereby these individuals are incorporated into the larger community, the question of the prevalence of proper assessment and treatments of sexual deviance in intellectual disabilities has led to an increase in research on these topics in psychology (Lindsay, 2002). Among a slew of characteristics of offenders with intellectual disabilities found within research, including neglect and parental separation, sexual naiveté stands out (Day, 1993). ...
This article untangles the social representation of people with intellectual disabilities by calling attention to a recent story tucked in the shadowy crevices of American newspapers. These articles found on the Internet are not static presentations of facts, but rather dynamic sites of interactions where people respond, dispute, and elaborate on the content. This work traces the social origins and locations of everyday knowledge, drawing on Serge Moscovici’s social representation theory that considers knowledge to be a process that is communally enacted, socially embedded, and ongoing. An analysis of the language used by journalists and commentators on published internet articles related to the case found that individuals oppressed by the label of intellectually disabled are often prevented from defining themselves, this task is deferred to professionals and families. When a relationship is established with someone else, it is therefore assumed to be a clinical relationship. Characteristics such as inaccessibility to verbal communication lead to infantilization, which makes consent inconceivable. Finally, lurking behind these themes is the implication that people who are oppressed by the label of intellectually disabled are less than human and therefore do not have the privilege of inalienable human rights, such as the right to feel desire.
... DISABILITY AND OFFENDING: Both adults and young people with intellectual disabilities are over-represented in the population of child sex offenders identified by the criminal justice system (Hackett, 2014;Lindsay, 2002;Marotta, 2017). In the US for example, the prevalence of intellectual disability among the general population was stated as being between 1 to 3% but there are between 4-10% of the sex offender prison population with intellectual disabilities (Marotta, 2017). ...
... Intellectually disabled males with sexually aggressive behaviour may be more visible to professionals and therefore more likely to be sent for assessment. Although screening rates for intellectual disability among young offenders have increased, adults with intellectual disability may confess more readily and not be assessed (Lindsay, 2002;Marotta, 2017) MENTAL HEALTH ISSUES: Mental health and victimisation: Mental health problems are risk factors for sexual victimisation in childhood (Assink et al, 2019) and may increase children's social isolation, so that they are more likely to be singled out by perpetrators and as a result be re-victimized (Cuevasa et al. 2010;Jones et al. 2012). ...
This evidence review aims to address these specific issues documenting what we know about the extent, nature and consequences of child sexual abuse and exploitation for children in different contexts and the evidence on effective interventions and strategies to prevent and respond to it.
... Het percentage van forensische cliënten dat een VB heeft varieert van 3 tot 50% (Craig, 2018;Hellenbach, Karatzias, & Brown, 2017;Kaal, Overvest & Boertjes, 2014;Uzieblo, Winter, Vanderfaeillie, Rossi, & Magez, 2012). Diverse studies tonen aan dat deze daders vaker worden veroordeeld voor zedendelicten, met percentages oplopend van 21 tot 40%, dan voor andere delicten (Lindsay, 2002; Van den Bogaard, Embregts, Hendriks, & Heestermans, 2013). Hoewel in het afgelopen decennium een duidelijke toename wat betreft het aantal studies die zich op forensische-gerelateerde onderwerpen bij personen met een VB merk-baar is, blijft het probleem van zedendelicten in deze doelgroep nog relatief onderbelicht. ...
... Diverse studies bevestigen bijvoorbeeld dat zedenplegers met een VB doorgaans seksueel naïever zijn ten aanzien van seksuele handelingen en seksuele relaties dan hun normaal begaafde tegenhangers (o.a. Lindsay, 2002;Rice, Hariss, Lang, & Chaplin, 2008). Er zijn echter ook onderzoeken die wijzen op het tegenovergestelde (Lunsky, Frijters, Griffith, Watson, & Williston, 2007) of aantonen dat er geen verschillen zijn tussen zedenplegers met en zonder een VB (Talbot & Langdon, 2006). ...
Diverse studies tonen aan dat forensische cliënten met een verstandelijke beperking (VB) relatief vaak zijn veroordeeld voor het plegen van zedendelicten in vergelijking tot andere delictentypen. De accuraatheid van prevalentiecijfers is echter lastig in te schatten, aangezien het diagnosticeren van een VB geen eenvoudige opgave is en afhankelijk is van het gekozen instrument. Bovendien is er risico op over- of onderschatting, en is de pakkans wellicht groter dan voor andere diagnostische groepen. In deze literatuurstudie schetsen wij eerst belangrijke aandachtspunten bij het diagnosticeren van een VB. Vervolgens beogen wij te informeren over de meest invloedrijke verklarende modellen voor seksueel grensoverschrijdend gedrag bij plegers met een VB, over de bruikbaarheid van risicotaxatie-instrumenten
bij plegers met een VB, over de verschillende behandelmogelijkheden en over de effectiviteit van de bestaande behandelprogramma’s bij plegers met een VB. Meer inzicht ten aanzien van deze doelgroep kan leiden tot een betere inzet van middelen.
In Tijdschrift voor Seksuologie
... Alexander (2010) registró que un poco menos de la mitad de los sujetos con DI que habían delinquido tenía una enfermedad grave mental (psicosis, trastornos bipolares o trastornos depresivos), alrededor de un tercio tenían un trastorno generalizado del desarrollo y más de un cuarto realizaba un uso nocivo o tenía dependencia de alcohol u otros tóxicos 47 . Day (1994) informó que el 32% de los delincuentes sexuales con DI de su muestra había sufrido enfermedades psiquiátricas en la edad adulta 60 , mientras que Lindsay informa que un tercio tenía una enfermedad mental significativa incluyendo trastornos psicóticos, trastornos bipolares y depresión mayor (con un porcentaje similar en los delincuentes no sexuales) 6,55 . ...
... Lindsay describe 3 áreas de evaluación forense para los sujetos con DI que delinquen: evaluaciones en los tribunales, evaluación del riesgo y las evaluaciones para la planificación del tratamiento 6 . ...
Resumen
La discapacidad intelectiva resulta del máximo interés en el ámbito forense. La presente revisión comprende la búsqueda electrónica de artículos en inglés o castellano registrados en la base de datos Medline con los términos FORENS* e INTELLECTUAL DISABILITY en el «Título» o «Resumen», hasta el 1 de enero de 2018, seleccionándose aquellos que abordaban cuestiones relativas a los antecedentes históricos y consideración jurídica, la criminalidad y tipología delictiva, la comorbilidad en sujetos que delinquen, los factores de riesgo y reincidencia y la evaluación forense, excluyendo los artículos sobre tratamiento o resultados del mismo.
Se identificaron 80 artículos que cumplían criterios de inclusión, que subrayaban la consideración especial históricamente dispensada por la justicia a los sujetos afectos de discapacidad intelectiva, las elevadas tasas descritas en prisión, discuten su relación con la violencia, incluida la sexual, describen tasas elevadas de comorbilidad con otros trastornos psiquiátricos, con discrepancias respecto a los trastornos relacionados con tóxicos y, por último, repasan los factores de riesgo y la reincidencia en estos sujetos, así como los métodos de evaluación forense de la discapacidad. Asimismo, se explicitan las limitaciones de la bibliografía revisada especialmente en relación con los conceptos que definen la discapacidad intelectiva en investigación.
... The main reason for this is thought to be the limitations of individuals with intellectual disabilities in cognitive and social skills (Chave-Cox, 2014). In addition, individuals with intellectual disabilities seem to have difficulties understanding the complexity of sexuality and controlling their sexual behaviour (Lindsay, 2002). ...
The aim of this study is to reveal the perspectives of non-disabled siblings regarding the sexuality of individuals with intellectual disabilities. The research was designed as phenomenology, one of the qualitative research models. Siblings of individuals between the ages of 18-33 and those with intellectual disabilities participated in the study. While collecting the data, a demographic information form and a semi-structured interview form created by the researchers were used. Content analysis steps were followed in the analysis of the data. According to the results obtained from the research, three main themes have been identified: the sexuality and sexual development of individuals with intellectual disabilities through the eyes of their non-disabled siblings, the views of non-disabled siblings on the sexual life of individuals with intellectual disabilities, and the reflections of the sexuality of individuals with intellectual disabilities on their non-disabled siblings’ sexuality and social participation. In light of the results obtained, studies on the sexuality of individuals with intellectual disabilities were discussed and parallel results were reached; however, it was seen that more research is needed due to the limited number of studies that included evaluations from the eyes of siblings without disabilities.
... The following responsivity issues must be considered in developing psychological intervention programs for offenders with ID. These issues this client group include: (a) The need to allow time to work with the participants to build their motivation to address their offending issues; (b) Problems with emotion dysregulation and high rates of co-morbidity can also present as a responsivity factor and may also lead to increased risk of non-completion (Lippoid, 2016); (c) The need for participants to develop coping skills first before they deal with their offending issues; and (d) The need to also address issues around vulnerabilities given that offenders with cognitive impairment are likely to have extensive histories of physical, emotional, and sexual abuse and neglect (e.g., Lindsay, 2002;Lindsay, Steptoe, et al., 2012, etc.) ...
A review of the current literature on evidence-based violence prevention programs developed for individuals with an intellectual disability (ID) reveals a paucity of direct evidence for this population. In addition, the existing offence-specific programs are primarily grounded in adapted cognitive behaviour therapy (CBT) programs designed for the mainstream offender population, which may not be suitable for offenders with co-morbid mental health and personality disorders. The current paper discusses the development of a violence rehabilitation program for offenders with an ID. The focus of the article is on the exploration of the empirically supported risk factors associated with violent offending and the incorporation of these dynamic risk factors into the program modules. A case study example was utilized to examine the process of VRP-ID and how the modules targeted the offenders' treatment needs. Responsivity issues are addressed by identifying cognitive difficulties experienced by this cohort and the implications for treatment. The Risk/Need/Responsivity (RNR) model and the good lives Model (GLM) are widely used offender rehabilitation models that can be considered the guiding principles in developing this program. Furthermore, it utilizes contemporary therapeutic frameworks such as motivational interviewing (MI), cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), and GLM reconceptualization and skills. The program is grounded in trauma-informed principles, which acknowledge this client group's high prevalence of victimization.
... Research and reports on this subject also support the findings (Normand & Sallafranque-St-Louis, 2016;Pan American Health Organisation, 2022;Reiter et al., 2007;Roden et al., 2020;Tomsa et al., 2021;United Nations, 2012). therefore, they could be pushed to crime (Brookbanks & Freckelton, 2018;Freckelton, 2016;Lindsay, 2002;Lindsay et al., 2007;Salekin et al., 2010;Taylor & Lindsay, 2018). These findings demonstrated that training courses should be organised to raise the awareness of the related staff and social policies should be adopted for individuals in Turkey to ensure their equality with their peers, access to available services, and prevent abuse or traumatization during the legal interviews. ...
Background:
Increased social integration of individuals with intellectual disabilities or autism could may raise their likelihood of interacting with justice system and legal staff.
Aims:
The present article aimed to determine the perceptions of the legal support staff about the individuals with intellectual disabilities or autism.
Materials and methods:
In the study, conducted with the phenomenological method, the views of 15 legal support staff were obtained. The study reported what participants perceived and examined whether participants had an accurate understanding of the experiences/support needs of people with intellectual disabilities/autism. The data were analysed with content analysis.
Results:
Three themes were determined: (1) Experience of interview with an individual with intellectual disabilities/autism, (2) attitudes of judges, lawyers and other staff, and (3) abuse/trauma.
Discussion:
Findings are consistent with literature. Individuals with intellectual disabilities/autism have problems in expressing themselves, also staff do not know them, do not know their features. Studies show that staff often do not know what to do in these interviews.
Conclusion:
Based on the participant perspectives, it was determined that individuals with intellectual disabilities/autism experienced self-expression problems, interviewees did not understand children/individuals with intellectual disabilities or autism and could exhibit negative attitudes, the children could be abused and traumatised during judicial processes, they were more prone to abuse when compared to their peers, they could be involved in certain events more frequently and could be pushed to crime.
... The other concern clinicians have is that the existing assessment tools don't have enough pictures to enable them to accurately determine the person's knowledge in the area being assessed. Some studies [29,30] found that many of the existing assessments are too linguistically complicated; thus they suggest either creating new assessments or revising existing assessments to meet the needs of people with ID. In addition, Frawley and Wilson [9] found that young men and women with ID face different challenges when dealing with sexuality and relationships within social and private life. ...
The aim of this study was to develop a pictorial scale for use in assessing the sexual knowledge of male high school students with intellectual disabilities studying at special education schools in Taiwan. A pictorial scale with 40 multiple-choice items was developed to assess the participants' relevant knowledge. Each item consisted of a written question and corresponding illustrations. A total of 181 male high school students in Taiwan participated in the study. Construct validity using exploratory factor analysis generated 26 items formatted into six subscales: puberty and physiology, body boundaries, proper touching, proper relationships, sexually transmitted diseases, and sex and the law. The variance explained for the six subscales was between 6.93 and 11.34%, and the variance explained for the whole scale was 53.99%. The reliability of Cronbach’s alpha was between .58 and .78, and the whole scale’s alpha value was .87. The participants demonstrated a relatively high level of knowledge on the body boundaries and proper relationships subscales, followed in descending order by proper touching, sex and the law, puberty and physiology, and sexually transmitted diseases.Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.Yes, I confirm that the author and affiliation have been correctly identified.
... As far as it concerns perpetrators, studies on the prevalence of sex offenders with an intellectual disability within the judicial system has led to divergent results. 39 However, research in The Netherlands and abroad has shown a relation between low intelligence and committing sexual offences. Perpetrators of sexual offences are more likely to be less intelligent or to have been diagnosed with a mild intellectual disability than other types of perpetrators. ...
Objectives:
To explore characteristics of sexual abuse within residential settings for people with an intellectual disability and to map out measures undertaken and improvement plans made by healthcare organisations after sexual abuse.
Design:
Descriptive analysis of reports about sexual violence against persons with an intellectual disability submitted to the Dutch Health and Youth Care Inspectorate by healthcare organisations.
Setting:
Residential settings for people with an intellectual disability in The Netherlands.
Selection:
186 incident reports submitted to the Inspectorate between January 2017 and December 2019 were included.
Results:
125 incident reports concerned sexual abuse by fellow clients and 61 reports concerned sexual abuse by professionals. Client perpetrators were predominantly male whereas almost 30% of the abusing professionals were female. The majority of the perpetrating professionals were unlicensed professionals. Clients who committed sexual abuse were mostly relocated to another residential setting. Most healthcare organisations invested in education and training for employees instead of improving the sexual education programme for clients after an incident of sexual abuse. If there was a strong suspicion of sexual abuse by a professional, resignation followed in most cases. In just two cases, the perpetrating professional was reported to a warning registry.
Conclusions:
A small amount of the perpetrating professionals held a licensed profession, which makes it challenging to address this form of sexual abuse through healthcare regulation. It raises the question why warning registries are not engaged more often after alleged sexual abuse. Constantly relocating abusing clients might endanger the (sexual) safety of clients in these new environments. Previous literature suggests that adequate sexual education regarding social skills and sexual behaviour is very effective for the majority of clients who commit sexual abuse. Healthcare organisations could take up a more prominent role in this to ensure safety for their own clients and for clients residing elsewhere.
... After implementation of the measure in practice, researchers advocate that ongoing psychometric evaluation is carried out to evaluate the quality and structure of the measure (Finlay & Lyons, 2001;Lindsay, 2002;Stancliffe et al., 2014). Developers should not assume that the adapted version holds the same structure for varying subpopulations and the psychometric properties of the adapted version should be re-evaluated as if it were a new measure (Blasingame et al., 2011;Zabalia, 2013). ...
Background
Persons with intellectual disabilities (ID) may have difficulties providing reliable and valid accounts of their personal experiences through self-report measures. The aim of the current study was to systematically review the peer-reviewed research literature on the adaptations needed to develop ‘ID-inclusive’ self-report measures.
Method
A search of PsycINFO, PubMed, Web of Science and Google Scholar identified 49 studies that met inclusion criteria. A GRADE-CERQual assessment was performed to determine the level of confidence in the review findings.
Results
161 recommendations for the development of ‘ID-inclusive’ self-report measures were extracted from 49 included studies. Recommendations were presented in a GRADE-CERQual Summary of Findings table, according to a 5-stage model of instrument development.
Conclusions
This review offers much-needed practical guidance for clinicians and researchers on how to develop ‘ID-inclusive’ self-report measures. Recommendations for future research about self-report instrument development for use with people with ID are presented.
... Much has been written on the challenges of researching those with an intellectual disability in the criminal-justice system (Clare, 1993;Lindsay, 2002;Simpson & Hogg, 2001). Difficulties in assessing adaptive functioning in custody, the impact of custodial environments on intelligence testing, the imprecise nature of intelligence tests, and the inability to acquire childhood records means it is often impossible to confirm a diagnosis of intellectual disability for those in the criminal-justice system. ...
This chapter reviews the literature on the treatment of sexually abusive behavior with respect to both the general and cognitively disabled populations, and provides recommendations for a model of treatment and support for those with a disability. Developments in the psychological treatment of sexual offending in the general population has followed a path paralleling that of other psychological issues, transitioning from psychodynamic to behavior therapy and then cognitive-behavioral therapy (CBT). The literature and practice have become divergent, with a shift toward the use and evaluation of CBT in offender populations while studies of the general population appear to continue to employ behavioral interventions. The self-regulation model proposes pathways to offending. Offending may occur due to an inability to control behavior (underregulation), a desire to not offend but a use of ineffective strategies (misregulation), or a desire to offend in an individual whose self-regulation is intact but who has inappropriate goals
... Lindsay et al., compared 48 sex offenders and 50 intellectually impaired non-sex offenders, finding a significantly higher incidence of sexual abuse in the group who committed a sexual offense (38% x 12.7%) and a significantly higher incidence of physical abuse in the group who committed the offense (14% x 36%) [32], [42], [43], [44]. According to those authors, this finding consolidates the hypothesis that the type of abuse suffered during childhood may be linked to the type of offenses committed in adult life. ...
Sex offenders are clearly a heterogeneous group of individuals both in terms of the type of criminal behaviour (e.g., child molestation, rape, exhibitionism, frotteurism) and in terms of characteristics subsumed to each type. Many treatment programs are guided, quite explicitly, through very detailed manuals in which each client insists on fully participating in each stage of treatment. In these manual programs, the steps are presented in a fixed order and each step is allocated a fixed period of time. Treatment should be adjusted to the needs of each client, despite considerable evidence of heterogeneity and the allocation of sex offenders to specific treatment programs. Therefore, this paper address psychological approached used with sexual offenders diagnosed with paraphilic disorders.
... Eight of the studies involved group therapy interventions which were found to yield mixed outcomes, with reported recidivism rates ranging between 0-40%. Based on this review and that by Lindsay (54), it appears that most treatment approaches show some promise, but the studies were quite limitedinvolving small, heterogeneous samples, utilising measures with limited reliability and validity, using poorly defined outcomes, and incorporating treatment interventions that were often described poorly. The main methodological shortcoming, however, is the absence of any controlled studies. ...
Offending behaviour and intellectual disability has long been—erroneously—associated in the literature and this misattribution has shaped services for this population. In this chapter, the relationship between intellectual disability and criminality is described along with the impact on the care and treatment of people in this population. Developments in the assessment of risk are outlined and clinical interventions for fire setting, sexually aggressive and violent behaviour are detailed, along with consideration of service level outcomes. Over the last 20 years or so there have been significant developments in clinical assessment and treatment approaches for people with intellectual disabilities who offend, however more rigorous and larger scale research is required to support further advances.
... The majority of the studies evaluating interventions for offenders with intellectual disabilities have found statistically significant improvements on cognitive outcome measures at the end of treatment (Taylor & Lindsay, 2018). However, intervention studies have focused exclusively on clinical samples without including non-offending intellectual disability comparison groups (Lindsay, 2002). Inclusion of control groups of people with intellectual disabilities who have not committed offences would help to determine whether, prior to treatment, there are any differences between people with intellectual disabilities who have and have not offended on the aspects of cognition under evaluation. ...
Background
Interventions for offenders with intellectual disabilities (ID) have used cognitive variables as measures of treatment outcome. However, the relevance of cognitive variables to offending in people with intellectual disabilities is unclear. This review aimed to evaluate the evidence for a relationship between cognitive variables and offending in people with intellectual disabilities.
Method
A systematic search identified studies comparing offenders and non‐offenders with intellectual disabilities on an aspect of cognition. Seven cognitive variables were found and compared across 15 studies. These were appraised for their quality using an adapted quality appraisal checklist. The reliability and validity of cognitive measures were also considered.
Results and conclusions
Other than for cognitive distortions, the evidence for a relationship between cognitive variables and offending in people with intellectual disabilities is currently limited due to methodological weaknesses and the small number of studies assessing each variable. Clinicians are advised to focus on cognitive distortions until better evidence is available.
... Once risk has been identified, the purpose of the ARMIDILIO-S is to help develop strategies to reduce risk of reoffending. There are unique risk factors for people with IDs and these factors are important to determine treatment strategies (Lindsay, 2002); in addition, care providers and community supports can have a significant impact on risk of sexual reoffense (Boer et al., 2012). ...
Individuals with intellectual disabilities (IDs) - and specifically those with genetic disorders - are more prone to medical and psychological challenges that affect their sexual development, experiences, and fertility. In this review paper we first provide an overview of the biopsychosocial (BPS) model and then explain how the model can guide and improve the assessment and treatment of challenging sexual behaviors by persons with IDs. We discuss two genetic conditions - fragile X syndrome and 22q11.2 deletion syndrome - in case studies, showing how the BPS model can be used to assess and treat the sexual problems of individuals with various types of ID. We conclude with BPS-formulated treatment considerations in three key domains: biomedical treatment (e.g., medication side effects; stopping or changing medications), psychological treatment (e.g., providing psychological therapies), and socio-environmental interventions (e.g., providing socio-sexual education and staff training). Together, these treatment interventions can aid clinicians to prevent and/or treat problematic sexual behaviors of people with IDs.
... Furthermore, if an individual with IDD reports abuse to a family member or a support staff, that person may be reluctant to report, or confused as to how to report the allegation to the appropriate channel (Equip for Equality, 2008). Additionally, biases regarding the sexual expression of individuals with IDD may lead to consensual sexual activities being seen as deviant (Lindsay, 2002), thus over-representing the reports of suspected abuse perpetrated by individuals with IDD. There are likely different processes underlying the perpetration of sexual violence of individuals with and without IDD (Keeling & Rose, 2005) which leads to different strategies for addressing microsystem vulnerabilities. ...
Current research on sexual violence perpetrated against individuals with intellectual and developmental disabilities (IDD) focuses on rates of victimization and individual risk factors. This research suggests that individuals with IDD are at a greater risk for sexual violence compared with the general public. At this time, there is no comprehensive theoretical framework to explain sexual abuse risk factors for individuals with IDD. This article describes such a framework by examining how an ecological perspective can be used to understand why individuals with IDD are at increased risk as well as provide a roadmap for how to prevent sexual abuse. An ecological framework, first introduced by Bronfenbrenner in 1979, examines individuals at multiple contextual levels. Current research on sexual violence and adults with IDD is reviewed through an ecological lens. We argue that an ecological approach is necessary for examining the nature of sexual violence and IDD, understanding why individuals with IDD are at a greater risk for sexual violence, and providing insight into how to prevent sexual violence.
... Nicht zuletzt haben Beschuldigte mit Beeinträchtigungen behinderungsbedingte Schwierigkeiten, ihre Interessen zu wahren (Inclusion Europe, 2003). Ohne die nötige Unterstützung haben sie geringere Chancen auf Verfahrensgerechtigkeit als Beschuldigte ohne Beeinträchtigungen, erhalten beispielsweise seltener einen juristischen Beistand (Lindsay, 2002). ...
Menschen mit einer Autismus-Spektrum-Störung (ASS) sind eine vulnerable Personengruppe für diverse Opfererfahrungen und kommen auch als Tatverdächtige eher mit Ermittlungsbehörden in Kontakt als Menschen ohne entsprechende Diagnose. Da das Wissen über Autismus in der Allgemeinbevölkerung wie auch bei Fachpersonen teilweise noch sehr lückenhaft zu sein scheint, stellt sich die Frage, inwieweit autismusspezifische Besonderheiten der sozialen Interaktion im Strafverfahren berücksichtigt werden. Während internationale Studien auf eine mögliche Benachteiligung dieser Personengruppe in Strafverfahren hinweisen, fehlt es im deutschsprachigen Raum an empirischen Erkenntnissen zu Erfahrungen dieser Personengruppe mit Ermittlungs- und Gerichtsbehörden sowie zu handlungsrelevantem Wissen und diesbezüglichen Einstellungen der am Verfahren beteiligten Fachpersonen.
... For example, a commonly used treatment programme for sex offenders with ID is the Sex Offender Treatment Services Collaborative-ID cognitive behavioural treatment, which includes components focussed on sex education and sexual offending behaviour in particular. Whilst these are important treatment targets for sex offenders with ID (Lindsay, 2002), they might not be relevant to all fire setters. Existing programs for violent offenders, that generally adopt a cognitive behavioural approach (Taylor, Novaco, Gilmer and Thorne, 2002), on the other hand, may be more relevant and useful given the concepts addressed in these programs include those identified as relevant to fire setters through the current study, such as anger management. ...
Purpose
Fire setters who have an intellectual disability (ID) are often identified as posing a particular danger to the community although relatively little is known about their characteristics, treatment and support needs. The paper aims to discuss this issue.
Design/methodology/approach
This study describes the characteristics of 134 residents of low, medium and high security ID facilities in the UK who have either an index offence of arson, a violent index offence or a sexual index offence.
Findings
Index arson offenders who had an ID had multiple prior convictions, a history of violent offending and a high likelihood of having a comorbid mental disorder. There were many shared characteristics across the three groups.
Practical implications
The current study suggests that offenders who have ID who set fires have treatment needs that are similar to those of violent and sex offenders. It follows that fire setters who have an ID may also benefit from participating in more established offending behaviour treatment programs, such as cognitive behaviour therapy programs, developed for other types of offender.
Originality/value
This study is one of the few which has investigated the characteristics and treatment needs of persons who have an ID who set fires. In particular, it is one of the first to compare the characteristics and treatment needs for persons with ID who set fires, to those who have committed violent and sexual offences.
... In secure settings, the process of structured risk assessment is an established part of routine clinical practice, whereas in the community the process is often sporadic (Yacoub & Latham, 2012). The absence of policy and protocol specific to managing risk, difficulty with cross-agency liaison and ownership of management plans, and a lack of standardized risk measures for this population (Boer, Tough, & Haaven, 2004;Lindsay, 2002;Lindsay & Beail, 2004) are likely barriers to conducting risk assessment in community settings. ...
Background:
Structured assessments have been shown to assist professionals to evaluate the risk of aggression in secure services for general offender populations and more recently among adults with intellectual disabilities. There is a need to develop intellectual disability sensitive measures for predicting risk of aggression in community samples, especially tools with a focus on dynamic variables.
Methods:
The study prospectively followed 28 participants for up to 2 months to test whether the Current Risk of Violence (CuRV) and Short Dynamic Risk Scale (SDRS) were able to predict verbal and physical aggression in a community sample of adults with intellectual disability.
Results:
CuRV and SDRS ratings significantly predicted verbal and physical aggression over a 2-month period.
Conclusions:
The current study supports the use of the CuRV with adults with intellectual disability living in community settings. The CuRV and SDRS are worthy of future development and evaluation in independent investigations.
... Despite the high prevalence of SA in individuals with ID and the devastating effects on psychological and physical well-being (Gil-Llario et al., 2018, 2019, there is a lack of instruments to estimate their vulnerability to sexual victimization. Available measures assessing SA in people with disabilities are focused on people with ID as perpetrators of the abuse (rather than on the factors that increase the likelihood of sexual victimization; Boer, Tough, & Haaven, 2004;Embregts et al., 2010;Lindsay, 2002;Lindsay, Elliot, & Astell, 2004). After an in-depth review of academic databases, only one scale emerged that assesses people with ID as potential victims of SA: the scale developed by Liou (2014). ...
People with intellectual disability (ID) are more vulnerable to being victims of sexual abuse (SA) because, in most cases, they are not able to detect the warning signs that abuse could occur. However, there is a lack of appropriate assessment tools to determine their vulnerability. To address this limitation, the current study tests the psychometric properties of the Detection of Sexual Abuse Risk Screening Scale (DSARss), a new scale developed to assess the ability of individuals with mild or moderate ID to detect the risk of SA. In all, 246 individuals with mild or moderate ID (55.3% males) completed the DSARss, along with other scales assessing related dimensions (e.g., psychopathological symptoms, quality of live). Exploratory factor analysis (EFA) yielded a four-factor structure explaining 65.34% of the total variance in the DSARss. Two independent EFAs in males and females were also performed to confirm the suitability of this four-factor structure according to gender. The reliability of the total score and subscales ranged between .70 and .93. Likewise, correlations with other related scales were positive and significant. Temporal stability 6 months after the first application was .47. Finally, we explored the criterion-related validity of the DSARss across different SA indicators. These results, along with the absence of sound questionnaires to assess the risk of SA in people with ID, justify the use of the DSARss to assess this construct in both men and women.
... ID is far more prevalent in this group than in the general population (Hayes & Farnill, 2003;Holland, 2004), ranging from 1.5-19.1% and averaging 6.2% (Denkowski & Denkowski, 1985). Studies of the prevalence of ID in prison populations suffer from methodological limitations (Holland & Persson, 2011) such as variability in the definition of ID (Fazel, Xenitidis, & Powell, 2008;Holland & Persson, 2011), variability in the sample inclusion and exclusion criteria (Morgan, Leonard, Bourke, & Jablensky, 2008), variability in the assessment tools used (Søndenaa, Rasmussen, & Nøttestad, 2008), use of non-standardized tools (Holland & Persson, 2011), and absence of a Control group for comparison purposes (Lindsay, 2002). ...
While the prevalence of mental disorders in people with intellectual disabilities (ID) is well
documented, there is less specific literature in the forensic domain. This study sought to
clarify the psychiatric and criminological characteristics among Belgian French-speaker forensic inpatients with low IQ and mental health illnesses. To this end, we compared a low IQ group with mental health illnesses (n¼69), low IQ group (n¼56), and control group
(n¼165). Compared with controls, proportionally more inpatients low IQ with Mental
Health Illnesses presented a psychiatric illness, particularly a mood disorder, and proportionally fewer presented a cluster C personality disorder. The findings highlight the specificity and heterogeneity of the psychiatric profile of this subgroup of patients. He also demonstrated that forensic patients with ID are not a homogeneous group. This emphasizes the importance of considering in the management of forensic ID patients the specific needs with regard to their psychopathological profile.
... Offenders with ID are likely to have different risks factors than offenders without ID, such as greater frequency of certain items like past behavior difficulties, difficulty forming lifelong relationships, and challenging behaviors in childhood (Green et al., 2002). Furthermore, offenders with ID have a greater likelihood of co-morbid psychiatric disorders and sexual naïveté, both of which are assessed in standard risk assessment instruments, potentially leading to over-endorsement of these items in offenders with ID (Lindsay, 2002). Although studies have reported moderate predictive accuracy for risk among sex offenders with ID using the VRAG, Psychopathy Checklist-Screening Version (PCL-SV; Hart, Cox, & Hare, 1995), HCR-20, (Gray, Fitzgerald, Taylor, MacCulloch, & Snowden, 2007) and the Sex Offender Risk Appraisal Guide (SORAG; Quinsey et al., 1998) (Federoff et al., 2016), research efforts over the past decade have produced sex offender risk assessment scales specifically designed for intellectually disabled offenders. ...
Over the past four decades, ongoing research in the field of forensic psychology has evolved and expanded the domains of forensic evaluation, such as risk assessment and personality assessment, and treatment and care of offending populations and those involved with the criminal justice system. This chapter will review research advances in two of the most important areas of forensic psychology: (1) Forensic assessment; and (2) Therapeutic intervention. Forensic clinicians performing evaluations and administering treatment to individuals involved in the criminal justice system rely on constant empirical advancement of diagnostic tools, testing scales, and treatment programs in order to ensure ethical care. This chapter will discuss these empirical advances in the context of violence risk assessment, sex offender risk assessment, and personality assessment, and treatment of offenders. The chapter will conclude with a discussion of policy implications for forensic research highlighting the necessity of continued empirical advancement in the psycholegal arena.
... ID is far more prevalent in this group than in the general population (Hayes & Farnill, 2003;Holland, 2004), ranging from 1.5-19.1% and averaging 6.2% (Denkowski & Denkowski, 1985). Studies of the prevalence of ID in prison populations suffer from methodological limitations (Holland & Persson, 2011) such as variability in the definition of ID (Fazel, Xenitidis, & Powell, 2008;Holland & Persson, 2011), variability in the sample inclusion and exclusion criteria (Morgan, Leonard, Bourke, & Jablensky, 2008), variability in the assessment tools used (Søndenaa, Rasmussen, & Nøttestad, 2008), use of non-standardized tools (Holland & Persson, 2011), and absence of a Control group for comparison purposes (Lindsay, 2002). ...
While the heterogeneity of psychiatric illness among persons with intellectual disability (ID) is well documented, there is very little in the literature regarding forensic inpatients with dual diagnosis (DD). This study sought to specify the psychiatric and criminological characteristics of a French-speaking Belgian population of forensic inpatients with DD. To this end, three groups were compared: DD group (n = 69), Low IQ group (n = 56) and control group (n = 165). IQ was measured with the WAIS-III. Psychiatric disorders were diagnosed with the MINI and the SCID-II. Offenses were garnered from forensic records. Age, length of stay and social characteristics were also considered. Compared with controls, proportionally more inpatients with DD presented a psychiatric illness, particularly a mood disorder, and proportionally fewer presented a cluster C personality disorder. The results highlight the need to study this subgroup of patients in terms of their specific psychopathological profile.
... Indeed, Craig and Hutchinson (2005) calculated that the reconviction rate for ID offenders convicted of a sexual offence was 6.8 times, at two years follow up, and 3.5 times, at four years, that of non-ID offenders convicted of similar sexual offences. It must be acknowledged however, that the research on this group of individuals is extremely flawed, with methodological differences between the studies being so great that con- clusions regarding the true prevalence of sexual offences by men with ID are difficult to state (Craig & Hutchinson, 2005;Lindsay, 2002). With regard to elderly individuals who commit sexual offences, the decrease in societal tolerance, along with a greater readiness for the police and pros- ecutors to pursue and secure more 'late-in-life' convictions for non-recent sexual offences, has seen a growth in the amount of elderly individuals in prison for a sexual offence (Crawley & Sparks, 2005;Hart, 2008). ...
Circles of Support and Accountability (CoSA) are growing in popularity on an international scale. To ensure that CoSA projects continue to grow in both success and public confidence, a solid research base is essential. The body of literature on the effectiveness of CoSA, particularly from Canada, US, UK and the Netherlands, is in fact growing. However, it has been argued that there is still not yet enough evidence to determine whether CoSA significantly reduces sexual recidivism by the Core Member (Elliott, Zajac, & Meyer, 2013). The following chapter includes an overview of this debate along with the key CoSA efficacy studies carried out to date. In addition, more qualitative explorations of the psychosocial implications of being involved are considered.
... Indeed, Craig and Hutchinson (2005) calculated that the reconviction rate for ID offenders convicted of a sexual offence was 6.8 times, at two years follow up, and 3.5 times, at four years, that of non-ID offenders convicted of similar sexual offences. It must be acknowledged however, that the research on this group of individuals is extremely flawed, with methodological differences between the studies being so great that conclusions regarding the true prevalence of sexual offences by men with ID are difficult to state (Craig & Hutchinson, 2005;Lindsay, 2002). With regard to elderly individuals who commit sexual offences, the decrease in societal tolerance, along with a greater readiness for the police and prosecutors to pursue and secure more 'late-in-life' convictions for non-recent sexual offences, has seen a growth in the amount of elderly individuals in prison for a sexual offence (Crawley & Sparks, 2005;Hart, 2008). ...
The barriers to successful reintegration that those convicted of sexual offences face, often lead to social isolation and prevent desistance from crime being achieved (Tewksbury & Mustaine, 2009). Of those who commit these offences, the elderly and intellectually disabled face even greater barriers, often finding the transition from prison to community the most difficult. In 2014, a prison-model of Circles of Support and Accountability (CoSA) was established to support these individuals specifically. A qualitative evaluation was commenced at the same time, involving interviews with the Core Members to explore their personal experience of the prison-based model. This chapter will explore some of the key themes derived from the data in relation to the support the prison-based model of CoSA provided the Core Members during their transition from prison to community.
Purpose
The purpose of this paper is to explore three main areas in relation to the interface between challenging behaviour and offending.
Design/methodology/approach
The first aim is to explore the labelling of behaviours as challenging or offending behaviour in the light of legal definitions, staff knowledge and beliefs and the mental capacity and mental health acts. The second is to explore challenging behaviour as a risk factor for offending in people with Intellectual Disability (ID).The third aim is to discuss the challenging behaviour as a barrier to discharge from secure services.
Findings
There is limited research suggesting that challenging behaviour such as physical aggression can lead to longer stay in forensic services, and this warrants further research.
Originality/value
This paper aims to promote discussion about the interface of offending and challenging behaviour in people with IDs and to promote best practice.
The purpose of this study was to better understand the risk factors and personality characteristics of men with intellectual disability convicted of sexual offences (MIDSOs) with sexual preoccupation. The sample consisted of two groups taking medication to address sexual preoccupation: those with average IQ and above and those with borderline IQ and below. Differences between the groups were explored on age, static risk, sexual compulsivity, clinical and personality factors. Both groups were compared to clinical samples/general population to ascertain presence and level of problematic traits. Whilst MIDSOs report significantly higher levels of cognitive distortion, there were more similarities than differences between the groups. When comparing scores to the clinical/general populations, MIDSOs reported higher levels of clinical and personality factors. Implications for findings are discussed.
This chapter describes the historical context of sexual crimes committed by those with extreme intellectual functioning. Following definitions of intellectual functioning, it will explore historical understandings of sexual violence perpetrated by those with low intellectual functioning and, uniquely, high intellectual functioning. Indeed, whilst there is a growing body of literature concerning sexual violence committed by those with low intellectual functioning (encompassing those with intellectual disabilities), little attention has been paid to those with high intellectual functioning who commit sexual offences, or comparisons between these two groups. The chapter will offer some discussion as to why this has been the case, as well as considering theoretical links between extremes of intellectual functioning and the commission of sexual crime.
Few populations are as widely misunderstood as sex offenders. Community fear of sex offenders has led to extreme punitive responses to this type of offense. While the phrase “sex offender” conjures images of rape in dark alleys and kidnapping, the largest proportion of sex offenses are actually between people that know one another, whether through friendship, family, or previous dating relationships. Research using penile plethysmographs has provided some answers to help us understand the lives and realities of sex offenders. Of note, sex offenders are not simply seeking sex wherever they can get it. Rather, sex offenders tend to be more attracted to violent sexual fantasies. Feminist perspectives argue that rape and sexual assault are the products of desires for power and control. Most correctional workers, however, acknowledge that while power and control are important, the sexual element is also a present and important consideration. Using this understanding, correctional counselors can redirect these fantasies toward legal and consensual acts. Contrary to popular opinion, sex offenders can be successfully rehabilitated.
This chapter reviews the literature on the treatment of sexually abusive behavior with respect to both the general and cognitively disabled populations, and provides recommendations for a model of treatment and support for those with a disability. Developments in the psychological treatment of sexual offending in the general population has followed a path paralleling that of other psychological issues, transitioning from psychodynamic to behavior therapy and then cognitive‐behavioral therapy (CBT). The literature and practice have become divergent, with a shift toward the use and evaluation of CBT in offender populations while studies of the general population appear to continue to employ behavioral interventions. The self‐regulation model proposes pathways to offending. Offending may occur due to an inability to control behavior (underregulation), a desire to not offend but a use of ineffective strategies (misregulation), or a desire to offend in an individual whose self‐regulation is intact but who has inappropriate goals.
The desire for intimate relationship and sexual well-being in closely tied, and characterizes all human-beings. Intimate relationships, and healthy sexual life that come with it, can promote the life the individual, and create a “calling-card” to enter society. Nevertheless, social standards and norms that can help the establishment of romantic and sexually characterized relationships may make them challenging for people on the Autism Spectrum Disorder (ASD). This chapter opens with a description of the importance of sexuality as a central aspect of adult life in general, followed by an exploration of the link between sexuality and aspects of quality of life among people, especially females, with ASD, being a minority within a minority, through contemporary literature review. The differences in ASD symptomology between males and females directs to key issues regarding sexuality among females with ASD including: interest and attraction, behavior, and orientation, and the impacts each of these have on sexuality and sexual functioning in this population. Findings regarding greater diversity in the gender identity and greater flexibility in sexual attraction among people with ASD that is more pronounced among females than males, as well as higher vulnerability and risk of abuse, raise a concern regarding the link between sexuality and victimization among females with ASD. The chapter addresses some relevant recommendations for professional staff and therapists.
Despite the awareness that children with severe and complex difficulties experience child sexual abuse (CSA), the development of research in this area is still in its infancy. This call for relevant research seeks to identify the main gaps in knowledge in order to inform future debate, potential research questions, and raise issues for practice. Themes are identified relevant to researchers and practitioners globally. These include the complexity and duality of definition: recognition of CSA; barriers to communication with children and between services; diversity of segregated and inclusive settings; interaction of age and gender; adult and peer abuse in institutions; sexuality and disability; and intrusive care and medical practices. Recommendations for future research and practice in creating safe environments are provided.
National and economic benefits of mobile phone use in developing countries has been a well-articulated research domain over an extended period. This can be attributed to the ubiquitous nature of mobile phones and their increased penetration in developing nations. However, the potential benefits of mobile phones for empowerment and well-being of people with disability (PWD) has been ignored. This paper focuses on the well-being of the physically challenged in Nigeria and how mobile phones can be employed to empower them. The link between ICT and human development has been well researched, but minimal research has attempted to link ICT, mobile phone and disability using the Capability Approach as a theoretical lens. The critical realist ethnographic study approach is employed in this study to show how mobile phones can be used to empower and impact on the well-being of the physically challenged. Data were collected from the Adamawa skill acquisition center for persons with disability, Nigeria. It is argued that mobile phones have the capabilities to empower and impact on the well-being of the physically challenged. Thus, the findings illustrate that mobile phones play significant roles in the well-being and empowerment of the physically challenged.
In this chapter, the authors review some of the key ethical issues encountered when working with offenders who have an intellectual or developmental disability (IDD). First, the ethics of interpreting prevalence rates of persons with IDD in the judicial system is discussed. The chapter then provides elaboration on the emerging issues related to the rights of persons with IDD including issues relating to treatment, access and responsibility, and the balancing of rights with responsibility. Additionally, ethics involving offenders with IDD will be explored in the final segment of the chapter. The authors have focused primarily on the ethical challenges faced when supporting a controversial offender group; persons who have sexually offended.
Zusammenfassung
Pflege und Pflegeroboter zielen darauf ab, Menschen mit Pflegebedarf zu betreuen, Krankheiten zu verhüten und Gesundheit zu fördern. Das umfasst die ganzheitliche Sorge um das Wohlbefinden und schließt auch das sexuelle Wohlbefinden als wichtigen Gesundheitsfaktor und als Menschenrecht mit ein. Der Beitrag behandelt zunächst den Stellenwert des sexuellen Wohlbefindens und konkretisiert die sexuellen Anliegen von Menschen mit Pflegebedarf. Die bisherigen Angebote der Sexualassistenz für Menschen mit Pflegebedarf werden beschrieben. Auf dieser Grundlage plädiert der Beitrag dafür, im Sinne einer besseren Förderung sexuellen Wohlbefindens von Menschen mit Pflegebedarf in Zukunft auch Konzepte der robotischen Sexualassistenz zu entwickeln und zu evaluieren. Dabei werden drei Entwicklungspfade aufgezeigt, nämlich die Nutzung von Sexrobotern und Sexpuppen, die Ausstattung von multifunktionalen Pflegerobotern mit sexuellen Assistenzfunktionen sowie der Einsatz spezialisierter sexueller Assistenzgeräte. In allen drei Szenarien sollte robotische Sexualassistenz jeweils durch professionelle Sexualberatung begleitet werden. Angesichts der Tatsache, dass in der Allgemeinbevölkerung das Interesse an und die Nutzung von sexuellen Artefakten wie Sexspielzeugen und Sexmaschinen weit verbreitet und positiv mit sexueller Gesundheit verknüpft ist, sind Menschen mit Pflegebedarf von dieser Entwicklung nicht auszuschließen. Möglichen Gefahren robotischer Sexualassistenz gilt es im Zuge einer interdisziplinär informierten Entwicklung der Technik und ihrer Einsatzszenarien entgegenzuwirken.
The article presents an analysis of the general characteristics of negative psychosocial experiences and their possible impact on the psychosexual sphere of children and adolescents with intellectual disabilities and with autism spectrum disorders. Seeking such factors, the focus was on the family environment. Particular attention was paid to parental attitudes towards the child with indicated developmental disabilities and the child's sexuality. The tasks essential for the development of sexuality during childhood and adolescence were described. Possible problems and difficulties that may arise in this sphere in persons with developmental disabilities in the context of negative experiences were analyzed. General guidelines important for supporting parents were outlined, which are important from the perspective of limiting the adverse psychosocial experiences of children.
Fully revised, this new edition reviews the most up-to-date and clinically relevant information on the mental health and behavioral problems of people with intellectual, developmental and learning disabilities, also previously known as mental retardation. Providing the latest evidence base from the literature and embracing clinical experience, it covers the essential facts and concepts relating to coexisting medical and psychiatric disorders, with new and updated chapters on mental health and epilepsy, schizophrenia spectrum disorders, personality disorders, and mental health problems in people with autism and related disorders. The disorder-based chapters are complemented by chapters on carer and family perspectives, possible future developments and contributions highlighting the principles of assessment, management and services from global and historical perspectives. This is essential hands-on practical advice for psychiatrists, psychologists and all other mental health professionals including nurses, therapists, social workers, managers, service providers and commissioners.
• Studies of criminality among patients in psychiatric hospitals and of mental disorder among incarcerated offenders have suggested an association between the major mental disorders (schizophrenia and major affective disorders) and crime. However, these investigations are characterized by notable methodological weaknesses, and, consequently, this conclusion has remained tentative. Little is known about the criminality of intellectually handicapped people. The present study examined the relationship between crime and mental disorder and crime and intellectual deficiency in an unselected Swedish birth cohort followed up to age 30 years. It was found that men with major mental disorders were 21/2 times more likely than men with no disorder or handicap to be registered for a criminal offense and four times more likely to be registered for a violent offense. Women with major disorders were five times more likely than women with no disorder or handicap to be registered for an offense and 27 times more likely to be registered for a violent offense. These subjects committed many serious offenses throughout their lives. The criminal behavior in over half these cases appeared before the age of 18 years. Intellectually handicapped men were three times more likely to offend than men with no disorder or handicap and five times more likely to commit a violent offense. Intellectually handicapped women were almost four times more likely to offend than women with no disorder or handicap and 25 times more likely to commit a violent offense. The results of this investigation confirm and extend previous findings indicating that individuals with major mental disorders and those with intellectual handicaps are at increased risk for offending and for violent offending. However, in the United States, where rates of crime overall and crime by substance abusers are very high, the mentally disordered and intellectually handicapped would account for only a small proportion of these offenses.
The psychological assessment and treatment of male sex offenders has been of increasing interest in recent years, and a substantial literature, primarily cognitive-behavioural in orientation, now exists. However, there is little information about the application of this literature to men with mild learning disabilities (previously known as mild ‘mental handicap’), who have impaired intellectual and social functioning and are at increased risk of additional difficulties. This paper uses the cognitive-behavioural approach as a framework for presenting preliminary guidance on the assessment and treatment of men with mild learning disabilities. It should be emphasized that, at present, almost nothing is known about the outcome of attempts to intervene in the sex offending of this population.
Groups of individuals with or without mental retardation, all of whom were currently on probation, were tested with measures of comprehension of Miranda rights and of suggestibility. As in previous work, participants with mental retardation were found to be less able to comprehend their Miranda rights. In addition, they were significantly more likely to respond to suggestive questioning and to change their answers. Significant correlations were found between measures of comprehension of Miranda rights and measures of suggestibility. Implications of these results were discussed.
Intellectual functioning, parental age, and sexual orientation in 991 male sexual offenders were investigated. Sources of data included semistructured interviews, clinical charts, phallometric tests, and self-administered questionnaires. The results suggest two main conclusions: (i) Among pedophiles in general, erotic preference moves away from adult women along two dimensions: age and sex. The extent of this movement is greater, along both dimensions, for pedophiles with lower levels of intellectual functioning. (ii) High maternal age (or some factor it represents) increases the likelihood of exclusive sexual interest in boys. Intellectual deficiency (or some factor it represents) decreases the likelihood of exclusive sexual interest in girls. These two factors summate, so that a pedophile with both factors is more likely to be sexually interested in boys than a pedophile with only one.
The limited literature from the 1970's to the present that specifically addresses the pharmacologic treatment of sexually offending behavior in people with mental retardation/developmental disabilities (MR/DD) is reviewed within the larger context of the pharmacologic treatment of sexual offending behaviors. The significance of comorbid conditions, both in the assessment and treatment of MR/DD individuals and also in the assessment and treatment of sexual offending behaviors is reviewed. The problem of sexual offending behaviors is also considered within the larger context of the behavioral difficulties and unique vulnerabilities of the MR/DD populations. Several illustrative clinical cases are discussed. The efficacy and potential side effects associated with the use of hormonal agents medroxyprogesterone and cyproterone acetate in the treatment of sexual offending behaviors is reviewed. The theoretical basis for the use of selective serotonin reuptake agents is discussed as well as a review of clinical trials and case reports of the use of these agents. The problems and possible benefits from the appropriate use of antipsychotic agents is also briefly reviewed.
Discussion is given to relevant behavioral issues in the treatment of sexual offending, with specific emphasis on issues related to persons with developmental disabilities. Recommendations for quality behavioral programming are made, and a review of the relevant literature illustrates several major approaches in the clinical management of inappropriate sexual arousal and behavior. It is concluded that quality behavioral programming in the area of sexual offending comprises the following domains: (1) implementation of therapeutic behavior change regimens in sexual offending tailored to each individual in all sexual and general curriculum areas; (2) behavioral responses directly measured; (3) behavior patterns charted (e.g., graphed using a standard celeration charting system); (4) functional and descriptive definitions of behavior used in the implementation of behavior change regimens; (5) an emphasis on building new and appropriate sexual behaviors as well as general behavioral skills; and (6) a behavior analytic investigation of the impact of environmental influences on each individual's behavior.
Paraphilias are clinical disorders that encompass atypical sexual urges, fantasies, and behaviors, cause significant maladjustment, and frequently, involve criminal activity. Despite increased interest in the sexual functioning of people who have mental retardation, little is known about the presence of paraphilias among this population. This paper discusses diagnostic criteria and treatment considerations relative to paraphilias and paraphilia-related disorders, including two case profiles of young adults with mental retardation. These profiles highlight the clinical presentation of each adult and demonstrate differences in diagnostic screening and treatment formulation. Pertinent issues are discussed.
Persons with developmental disabilities (DD) who have committed sexual offenses pose a special challenge in assessment and treatment. Accurate diagnosis is an important precursor to development of appropriate treatment interventions. This article describes commonly seen types of sexual offenders with DD. The variety of frequently seen skill deficits, and their implication for re-offense risk are presented. The article concludes with a presentation of issues that should be the focus of an assessment, and a survey of useful procedures and instruments used in evaluating sex offenders with DD.
The most appropriate means of dealing with offenders with an intellectual disability has become a contentious issue of postdeinstitutionalisation. Proponents of normalisation argue that offenders should be held accountable and responsible for their actions in the same way as nondisabled citizens. Critics argue that such an approach fails to recognise the multiple disadvantages under which most offenders labour. Unfortunately, much of this debate is carried out at the level of rhetoric only because comparatively little is known about the experiences of offenders within the system. This study examines the characteristics and experiences of two groups of offenders with an intellectual disability held in custody: one within the mainstream prison system, the other within a secure facility on the grounds of an institution. Although not without its disadvantages, the secure facility appears better equipped to meet the multiple and complex needs of this grossly disadvantaged group of offenders.
This study surveys a quarter of a century of continuous opera tion of the Psychiatric Clinic of the Court of General Sessions of New York County.
The statistical findings are based on some 71,000 examinations of approximately 57,000 persons involved in felonies.
Most of these persons are not significantly psychotic, neurotic, or even intellectually deficient in the ordinary clinical sense. Approximately 1.5 per cent are psychotic; less than 1 per cent are significantly neurotic; about 2.5 per cent are mental defec tives. Thus, only about 5 per cent of all persons convicted of felonies need to be considered for special treatment for psychotic, neurotic, or mentally deficient states. The remaining 95 per cent of serious offenders—at least in our jurisdiction—tend to show more or less severe character disorders.
Over the 26-year period of this study, the only significant fluc tuation in incidence of major character disorders occurs in the group psychiatrically designated as pathologic (or sociopathic) personalities. The percentage of pathologic personalities appre hended for felonious crimes tends to fluctuate in accordance with sociologic, economic, and legal factors, rather than as a result of any significant variation in the personality configuration of the delinquency-prone population.
The personality classifications developed by the Clinic are listed and described in two categories: Major Character and Behavior Disorders (seven subgroups), and Lesser Character and Behavior Disorders (twelve subgroups).
¹ Walter Bromberg and Charles B. Thomp son, "The Relation of Psychosis, Mental Defect and Personality Types to Crime," Journal of Criminal Law and Criminology, May-June, 1937, pp. 70-89.
² John H. Cassity, "Personality Study of 200 Murderers," Journal of Criminal Psycho pathology, Jan., 1941, pp. 296-304.
³ The words psychoneurosis and neurosis are used interchangeably—a standard psychi atric practice. They refer to degrees of nerv
ous disorder which do not significantly im pair an individual's contact with, or appre ciation of, reality.
This paper reviews the classification of the sex offence of stalking and describes two men with an intellectual disability who have been convicted of offences consistent with stalking. Treatment issues are outlined and a treatment method described. One man was seen in a group for sex offenders and the other was seen in individual sessions. The man seen in a group had a successful outcome while the other participant reoffended after 9 months. The processes of cognitive change for both men are outlined and compared by assessing attitudes across the offending areas of rape, voyeurism, exhibitionism and dating abuse. The outcomes are discussed in terms of both individual participants and the population of sex offenders with an intellectual disability.
This paper, the first of a three-part series, describes the philosophy and establishment of the Mental Impairment Evaluation and Treatment Service. It explains how the service operates, the kinds of people referred to the unit during its first 18 months of operation, and the quality of life it has provided for its service users.
Substantial numbers of sex offenders have a history of learning difficulties which may lead to resistance to treatment (a learning situation) and to problems processing information in therapy. Some ways of dealing with the learning disabled client are discussed, including a focus on their strengths and being open initially about the learning problems.
This study established a current average national estimate of the prevalence of mental retardation among state prison inmates, and gathered information regarding their adjustment to incarceration and rehabilitative services provided them. It was determined that an average of 2% or about 7,600 inmates are mentally retarded, and that the number presently confined in all types of correctional settings is approximately 12,640. That relatively low figure was attributed to the emergence of various diversion processes and improved psychometric practice, and it was expected that these ongoing trends would reduce this prevalence rate even further in the future. It was also concluded that the mentally retarded do not adjust well to prison life, and that the mentally retarded do not adjust well to prison life, and that supplemental rehabilitation services for them at those sites had not expanded appreciably over the past two decades.
This article describes the case of a ‘mentally handicapped’ man who confessed falsely to a double murder during police interviewing. The confession was video-recorded and superficially appeared genuine and convincing. A psychological framework is provided to explain the process and mechanism which resulted in the false confession. It shows how such emotions as fear and shame can be misinterpreted by detectives as an indication of guilt. The case highlights the risk of a miscarriage of justice when vulnerable suspects are spoken to about a crime by police officers outside the setting of tape-recorded interviews, and the potential dangers of refusing private access to a solicitor and an appropriate adult prior to police interviews.
People with learning disabilities are typically over-represented in Western criminal justice systems. They are vulnerable during police questioning, and may not comprehend their right to silence; they may confess, or acquiesce to the police version of events. They may have a long history of challenging behaviour which has never been appropriately addressed until the behaviour brings them into contact with the criminal justice system. It is important for service providers to have a working knowledge of the criminal justice system, and a clear idea of their role in relation to the client, especially during police interviews.
A descriptive study was conducted on male, mentally retarded offenders referred to a state hospital for a psychological evaluation. Results suggest that such individuals represent a specialized group of offenders primarily distinguished by their mild retardation and crimes against persons. (Author)
This paper reports on the use of a problem-solving approach to intervention with 13 adult male sex offenders with an intellectual disability. This approach facilitates interventions which target the participant's internal control over offending behaviour as well as addressing the social and environmental context of the behaviour. Most participants were able to respond to strategies developed for the non-disabled offender. As a result of individual assessment and intervention most participants achieved more community access. Characteristics of the participants are described, issues related to intervention are discussed and suggestions for future research are given.
A descriptive study was conducted of the recidivism of 75 offenders with intellectual disability who had served a sentence in the segregated unit at the Melbourne Metropolitan Reception Centre. The study aimed to determine the factors which influence recidivist rates, and thereby identify prisoners who are most at risk of reoffending. The results showed a recidivist rate of 41.3% with the variables of unemployment, substance abuse and a psychiatric history being important antecedents of recidivism.
Trailing behind the recent acknowledgement of the high incidence of sexual abuse amongst people with intellectual disabilities is a recognition of men with intellectual disabilities as perpetrators of sexual abuse. This paper reviews the North American, Australian and British literature published in this area. It demonstrates that both theoretical understandings and clinical interventions with men with intellectual disabilities are often discordant with wider perspectives of work with sexual abusers. The effect of this is shown to be common discriminatory practice received by men with intellectual disabilities which at times shows poor regard for their rights.
The growing interest in forensic risk assessment in intellectual disability services reflects the perception that deinstitutionalization has exposed more people to a greater risk of offending. However, ‘risk’ and the related idea of ‘dangerousness’ are problematic concepts because of connotations of dichotomous definition, stability and predictability. Assessment instruments in mainstream forensic psychiatry often combine actuarial and clinical data, and increasingly stress the dynamic nature of risk as well as the importance of situational and accidental triggers. Despite this increasing sophistication of research in mainstream forensic psychiatry, the ability to predict future offending behaviour remains very limited. Furthermore, actuarial predictors developed in studies of psychiatric or prison populations may not be valid for individuals with intellectual disabilities. Offending behaviour among people with intellectual disabilities is also hard to circumscribe because it often does not invoke full legal process or even reporting to the police. In order to discover how such problems were reflected in practice, a survey of providers in the North-west Region of England was undertaken. Seventy out of 106 providers identified as possibly relevant to this inquiry responded to a short postal questionnaire. Twenty-nine (42%) respondents – mainly in the statutory sector – reported operating a risk assessment policy relating to offending. The number of risk assessments completed in the previous year varied from none to ‘several hundred’. Providers reported three main kinds of problems: (1) resources or service configuration; (2) interagency or interdisciplinary cooperation or coordination; and (3) issues relating to the effectiveness, design and content of assessment.
The identification, assessment and treatment of the mentally retarded sex offender presents a dilemma for not only professional evaluators and departments of developmental disabilities, but also for law enforcement agencies, criminal justice systems and, in some cases, the correctional system. The paucity of information on the mentally retarded sex offender leads many professionals to offer patchwork types of treatments and treatment planning which does nothing to alleviate the problem. This article will provide professionals with a framework which can be modified and used to justify treatment. The presentation seeks to integrate information gathering and clinical knowledge into a comprehensive treatment plan that takes into account specific interventions as well as accountability for the rights of the mentally retarded.
This paper reviews work on the treatment of men convicted of exhibitionism or indecent exposure. Recidivism is extremely high after treatments, with true figures on recidivism unavailable until 4 years after conviction. It is extremely difficult to control for treatment effects because of the ethical issues surrounding withholding of treatment, but cognitive techniques provide a promising treatment approach. The present study attempted to address all these issues for men with a learning disability. A cognitive treatment is presented and data are available for at least 5 years after conviction. An AB design was used and treatment effects were monitored carefully. Treatment dealt with the issues of accepting that the offense took place, taking responsibility for the offense, accepting the intention of the offending behavior, victim awareness, and behavior consistent with offending for four offenders. All the men responded to treatment, although one offender with only 1 year of probation responded less convincingly than others. Beliefs relating to indecent exposure being fun or not causing harm to women seemed most open to alteration. The beliefs in which the perpetrator thought that the victim shared responsibility for the offense and that women may take a long while to recover from such an incident, seemed the most difficult to alter. Individual characteristics of the case examples are discussed in terms of these general trends.
This paper describes a cognitive therapy for men with a learning disability convicted of sex offences against children. Methods are described which focus the session, emphasize confidentiality, ensure that the patient accepts responsibility for the offence, and deal with issues of intent, harm done to the victim and sequences of offending behaviour. Methods for producing cognitive change are described. Patients were assessed regularly and data are presented in detail. While all six men showed improvement, there were several variables which interfered with the course of treatment. The study attempts to address two major problems in work with sex offenders: the difficulty of employing a controlled treatment design and the importance of a long follow-up period.
Although sex education programmes are thought to be useful in teaching people with intellectual disabilities, there is very little evidence that the material taught is retained by clients. This paper reports data which has been collected routinely on a sex education programme. Forty-six subjects were assessed on their level of sexual knowledge in seven areas: parts of the body, masturbation, male puberty, female puberty, intercourse, pregnancy and childbirth, and birth control and venereal disease. They were retested after a 9-month sex education programme and tested again at a 3-month follow-up. A control group of 14 subjects were tested on two occasions, 4 months apart. There were significant and substantial increases in sexual knowledge on all areas for the experimental group. The control group showed no corresponding increases in knowledge.
Sexual offenses, particularly paraphilias, although infrequent, are committed by people with mental retardation. Their management poses clinical and ethical dilemmas. Available treatments were reviewed, especially the literature on the most effective agent, medroxyprogesterone acetate (MPA). A case history was presented of a young man with mild mental retardation who was successfully treated with MPA. The role of antiandrogen treatments of paraphilias among the mentally retarded population includes a consideration of informed consent and ethical aspects of treatment.
Based on data from the Danish Central Criminal Register, the total number of mentally retarded offenders serving statutory care orders on a census day decreased from 290 in 1973 to 91 in 1984. The reduction was caused by shorter sentences and a dramatic decrease in the number of sentenced borderline retarded offenders: the total number of sentences per year slightly decreased, and the number of first-time sentences was stable. Crimes of property are decreasing among this population, while violence, arson, and sexual offences are increasing. Behaviour disorder was found in 87.5% of 91 offenders serving care orders in 1984. Offensive behaviour was significantly predicted by early institutionalisation, having retarded or divorced parents of low socio-economic status, and behaviour disorder of social-aggressive type. Independent significant effects were attributed to behaviour disorder and low socioeconomic background. All predictors were closely correlated. Biological factors did not have any significant predictive value.
A minority of people with mental retardation have sexual behaviour which is socially unacceptable or which brings them into conflict with the law. Such behaviour may be the result of ignorance about sexual matters, often best managed by counselling or by a behavioural approach. There are a small number of men with mental retardation and aberrant sexual behaviour who benefit from the prescription of an antilibidinal drug. Treatment with an antilibidinal drug alone reduces the intensity of sexual drive but does not alter its direction; concurrent sexual counselling or psychotherapy is often indicated. The various antilibidinal medications available are reviewed, with particular attention to reports which have described the treatment of people with mental retardation. Of the antilibidinals currently used, medroxyprogesterone acetate and cyproterone acetate are those for which there is most evidence of efficacy. Cyproterone acetate is preferable because it has a specific antiandrogenic action and fewer adverse effects.
There is a need for controlled studies of antilibidinal drugs, with clearly defined inclusion criteria and adequate measures of both behavioural and attitudinal change.
Ninety-nine mild to severely mentally retarded adults were evaluated on a variety of measures. The battery included the Peabody Picture Vocabulary Test-Revised (PPVT), the Psychopathology Instrument for Mentally Retarded Adults, the Social Performance Survey Schedule, Hamilton Rating Scale of Depression, the Beck Depression Inventory and Zung Self-Rating Depression Scale. Depression and social skills measures correlated significantly with each other on self-report and informant reports. Receptive vocabulary did not significantly correlate with depression or social skills measures, irrespective of self or other report format. Additionally, demographic variables such as intellectual level were not significant. The PPVT mean scores differed significantly by level of mental retardation as might be expected. The significance of these data and their implication for further study are reviewed.
The offenders committed to local hospitals in 1962 and 1964 under a hospital order with restriction of discharge were followed up for 15 years with regard to subsequent court appearances, hospital admissions, and death. One hundred and forty-six were traced. Of these, 49 per cent had been diagnosed as mentally ill: most of this group were committed for violent offences. Thirty-five per cent were mentally subnormal: they were frequently committed for sexual offences, arson and property offences. Twelve per cent were diagnosed psychopathic: this group had a wide variety of committal offences.
Fourteen per cent of the mentally ill and 17 per cent of the mentally subnormal were still in hospital after 15 years, but 51 per cent of the mentally ill and 36 per cent of the mentally subnormal were released within three years. Sixty-one per cent of the psychopaths were released within two years. Few of the subsequent offences were serious in any of the diagnostic groups.
Since 1973 there has been a dramatic fall in restriction orders, especially for mentally subnormal patients.
Depression and psychopathology were assessed in 110 adult patients (ages 18-71 years) classified as borderline, mildly, moderately, or severely mentally retarded. Patients completed modified versions of the Beck Depression Inventory, the Zung Self-Rating Depression Scale, the MMPI depression scale, the Thematic Apperception Test, and the Psychopathology Instrument for Mentally Retarded Adults. Clinicians and ward personnel rated the patients on the Hamilton Rating Scale for Depression and an informant version of the Psychopathology Instrument for Mentally Retarded Adults. The measures correlated significantly with each other and were consistently related to the diagnosis of depression.
A minority of individuals with mental retardation engage in offensive sexual behavior (e.g., child molestation, genital exposure, rape). Many of these individuals may benefit from the adjunctive administration of antilibidinal drugs. The two most widely used are the antiandrogens, medroxyprogesterone acetate (MPA) and cyproterone acetate (CPA). In the present paper the efficacy, cautions, side effects, and mode(s) of action of these substances were reviewed and medico-legal issues surrounding their use discussed. Controlled studies of antilibidinal agents with adequate numbers of patients using clearly defined (e.g., cognitive abilities) and valid and reliable outcome measures are needed.
Sex offences are overrepresented in the mentally handicapped, but information about the characteristics and offence behaviour of this group is limited.
A retrospective case note survey was made of 47 male patients referred for antisocial sexual behaviour.
Of 191 offences and/or incidents committed, 55.5% were heterosexual, 24% indecent exposure, 12.4% homosexual, 13.6% serious and 3.6% involved physical assault. Average age of the offenders was 23.9 years, with a mean IQ of 59.5, and there was a high prevalence of family psychopathology, psychiatric illness, minor physical disabilities, sexual experience, impaired relationship skills and sexual recidivism. Recidivists showed a low specificity for offence type and age and sex of victim. Categorical analysis differentiated a 'sex offences only' group from a 'sex plus other offences' group in the key areas of psychopathology, offence behaviour and outcome; this was supported by factor analysis.
The finding of two subgroups of mentally handicapped male sex offenders has important implications for prevention, assessment and treatment.
Dissatisfied with more traditional approaches to behavior management, psychology staff in a community-based residential treatment program for offenders with mental retardation developed and instituted a peer Jury System to deal with inappropriate resident behaviors. Behaviors were divided into eight major areas and analyzed for 5 months subsequent to the institution of the Jury System, with statistically significant improvement noted in 7 of the 8 areas and for 11 of the 12 subjects. Implications must be viewed as provisional due to the AB design, but results suggest that the system warrants serious consideration for expanded use with offenders with mental retardation.
Sixty-seven subjects with mild or moderate intellectual disability were assessed on a variety of measures of emotion. All of the measures were self-report measures and all of the data is based on reports by the subjects' themselves. The battery included the Zung Self-Rating Anxiety Scale, the Zung Depression Inventory, the General Health Questionnaire and the Eysenck-Withers Personality Test. The results reveal an impressive amount of convergent validity in the subjects' emotional systems.
Eighty-four incarcerated child molesters and 95 nonoffender comparison subjects were interviewed. All of the nonoffenders and 93% of the child molesters had been sexually abused in childhood. The prisoners were more socially disadvantaged as children and had received more verbal and physical abuse. The prisoners were more accepting of their abuse in the sense of not understanding or accepting that it was aberrant behavior but rather thinking that it was a commonplace, inevitable, and consequently a normal part of childhood. Liking some aspect of the initial abuse also differentiated prisoners from the nonoffenders. Prisoners were abused by a larger number of people than were nonoffenders. Prisoners did not use the fact of their own abuse as an excuse for their own offenses. Abuse by a female was more common in the prisoner group. It is possible to see what constitutes sexual abuse to an outsider being construed positively by some victims, especially where the sexual acts occur in a context that includes affection and attention. This factor seems important to remember when trying to understand the replication of abuse across generations. The men who were least damaged by abuse were those abused by strangers in "one-off" offenses, which they recognized as wrong and from which they escaped without accepting responsibility for the adults behavior.
The present study compares the responses to treatment of sex offenders with intellectual disability receiving 1- and 2-year probationary sentences. There were seven subjects in each group. There were no differences between subjects with regard to age, IQ or previous offences. All subjects received group treatment which addressed issues of: denial, minimization and responsibility for the offence; harm done to the victim; behaviour consistent with offending; and victim awareness and confidentiality. The subjects were assessed on a standard questionnaire designed to assess attitudes consistent with sex offending. All subjects were convicted of either indecent exposure or offences against children. There was a significant difference between the groups at the end of the probation period with subjects sentenced to 2 years' probation showing greater improvement. Subjects receiving 1 years' probation retained a number of attitudes consistent with denial and minimization of their offence. Furthermore, follow-up data underlined the poorer response to treatment for the 1-year probation group in terms of re-offending rates and assessment of attitudes consistent with sex offending. The authors recommend that a court order for a 1-year period of probation with treatment is of little value when dealing with sex offenders with intellectual disability. Rather, a period of at least 2 years' probation with a treatment recommendation is suggested.
Following the closure of the large mental handicap hospitals in the UK, the majority of people with intellectual disability (ID) are currently living in the community. However, people with ID who also exhibit challenging behaviour (CB) have been the most difficult-to-place group and use a large amount of service resources. A variety of service options have been proposed for the assessment and treatment of CBs, but there is little information on the effectiveness of these alternatives. The Mental Impairment Evaluation and Treatment Service (MIETS) is one of these service options and the aim of the present study is to describe and evaluate this service. The present authors studied the first 64 patients admitted to MIETS following its opening. A within-subject comparison research design was used. Demographic and clinical data were obtained from case records and the effectiveness of MIETS interventions was evaluated by comparing the number of incidents of challenging behaviour, the use of seclusion, and the place of residence before and after the MIETS intervention. Only 10 (17.5%) of the patients had been admitted from community facilities, but 48 (84.2%) of the patients were discharged to community placements (P < 0.000 I1). The MIETS also significantly reduced the frequency and severity of challenging behaviours (P < 0.0001). It is concluded that the MIETS is an effective treatment model for people with ID and CB, and that there is no place for therapeutic nihilism in this difficult-to-place group of patients.
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.
To review patterns of physical and sexual abuse in cohorts of sexual offenders and nonsexual offenders with intellectual disability.
Forty-six sexual offenders were compared with 48 male nonsexual offenders in relation to their experiences of sexual and physical abuse in childhood. Comprehensive assessments were taken over a period of at least one year, and were conducted independently by a range of professionals.
Thirty-eight percent of the sexual offenders and 12.7% of the nonsexual offenders had experienced sexual abuse, while 13% of the sexual offenders and 33% of the nonsexual offenders had experienced physical abuse.
Sexual abuse seems a significant variable in the history of sexual offenders, while physical abuse seems a significant variable in the history of nonsexual offenders. The results support the view that the "cycle of abuse" is neither inevitable nor an adequate explanation of future offending.
) Persons at Risk During Interviews in Police Custody: The Identification of Vulnerabilities
- G H Gudjonsson
- I C H Clare
- S Rutter
- J Pearse
Gudjonsson G. H., Clare I. C. H., Rutter S. & Pearse J. () Persons at Risk During Interviews in Police Custody: The Identification of Vulnerabilities. Research Study No. , The Royal Commission on Criminal Justice, HMSO, London.
) Toward an epidemiol-ogy of relevant attributes
- Noble J H Conley
- R W R W Conley
- R Luckasson
- G Bouthilet
Noble J. H. & Conley R. W. () Toward an epidemiol-ogy of relevant attributes. In: The Criminal Justice System and Mental Retardation (eds R. W. Conley, R. Luckasson & G. Bouthilet), pp. –.
Treating Intellectually Disabled Sex Offenders: A Model Residential Programme
- J Haaven
- R Little
- D Petre-Miller
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Haaven J., Little R. & Petre-Miller D. () 'Treating Intellectually Disabled Sex Offenders: A Model Residential Programme. Safer Society Press, Orwell, VT. Hayes S. () Sex offenders. Australia and New Zealand Journal of Developmental Disabilities (Journal of Intellec-tual and Developmental Disabilities) , –.
) Detect-ing counterfeit deviance: differentiating sexual deviance from sexual inappropriateness
- D Hingsburger
- D Griffiths
- V Quinsey
Hingsburger D., Griffiths D. & Quinsey V. () Detect-ing counterfeit deviance: differentiating sexual deviance from sexual inappropriateness. Habilitation Mental Health Care Newsletter , –.
) Defendants with mental retardation in the forensic services system
- R C R W Petrella
- R Conley
- G Luckasson
- Bouthilet
Petrella R. C. () Defendants with mental retardation in the forensic services system. In: The Criminal Justice System and Mental Retardation (eds R. W. Conley, R. Luckasson & G. Bouthilet), pp. –.
- Brown B. S.
- Langevin R.