Fraternal birth order and sexual orientation in pedophiles

Carving the Biodevelopment of Same-Sex Sexual Orientation at Its Joints

Sexual orientation is a core aspect of human experience and understanding its development is fundamental to psychology as a scientific discipline. Biological perspectives have played an important role in uncovering the processes that contribute to sexual orientation development. Research in this field has relied on a variety of populations, including community, clinical, and cross-cultural samples, and has commonly focused on female gynephilia (i.e., female sexual attraction to adult females) and male androphilia (i.e., male sexual attraction to adult males). Genetic, hormonal, and immunological processes all appear to influence sexual orientation. Consistent with biological perspectives, there are sexual orientation differences in brain development and evidence indicates that similar biological influences apply across cultures. An outstanding question in the field is whether the hypothesized biological influences are all part of the same process or represent different developmental pathways leading to same-sex sexual orientation. Some studies indicate that same-sex sexually oriented people can be divided into subgroups who likely experienced different biological influences. Consideration of gender expression in addition to sexual orientation might help delineate such subgroups. Thus, future research on the possible existence of such subgroups could prove to be valuable for uncovering the biological development of sexual orientation. Recommendations for such future research are discussed.

The fraternal birth-order effect as a statistical artefact: convergent evidence from probability calculus, simulated data, and multiverse meta-analysis

The fraternal-birth order effect (FBOE) is a research claim which states that each older brother increases the odds of homosexual orientation in men via an immunoreactivity process known as the maternal immune hypothesis. Importantly, older sisters supposedly either do not affect these odds, or affect them to a lesser extent. Consequently, the fraternal birth-order effect predicts that the association between the number of older brothers and homosexual orientation in men is greater in magnitude than any association between the number of older sisters and homosexual orientation. This difference in magnitude represents the main theoretical estimand of the FBOE. In addition, no comparable effects should be observable among homosexual vs heterosexual women. Here, we triangulate the empirical foundations of the FBOE from three distinct, informative perspectives, complementing each other: first, drawing on basic probability calculus, we deduce mathematically that the body of statistical evidence used to make inferences about the main theoretical estimand of the FBOE rests on incorrect statistical reasoning. In particular, we show that throughout the literature researchers ascribe to the false assumptions that effects of family size should be adjusted for and that this could be achieved through the use of ratio variables. Second, using a data-simulation approach, we demonstrate that by using currently recommended statistical practices, researchers are bound to frequently draw incorrect conclusions. And third, we re-examine the empirical evidence of the fraternal birth-order effect in men and women by using a novel specification-curve and multiverse approach to meta-analysis (64 male and 17 female samples, N = 2,778,998). When analyzed correctly, the specific association between the number of older brothers and homosexual orientation is small, heterogenous in magnitude, and apparently not specific to men. In addition, existing research evidence seems to be exaggerated by small-study effects.

Validating the Screening Scale of Pedophilic Crime Scene Behavior

The Screening Scale of Pedophilic Crime Scene Behavior (SSPC) is a seven-item structured rating scale assessing pedophilic sexual arousal. In the current study, we cross-validated the scale's convergent validity using multiple measures of sexual interest in children (clinical diagnosis of pedophilia, the high fixation/low social competence type of the MTC:CM4, and phallometric assessment of sexual interests toward children) in two independent samples (USA and Canada). In both samples and in relation to all three criteria, the SSPC showed acceptable (phallometry) to excellent (clinical assessment) diagnostic accuracy. Furthermore, the SSPC showed incremental validity in relation to the Screening Scale for Pedophilic Interest and at times outperformed it in convergent validity analyses. The current study also provides psychometric information that can help users choose an appropriate SSPC cutoff score.

New Data on Birth Order in Homosexual Men and Women and a Reply to Vilsmeier et al. (2021a, 2021b)

The fraternal birth order effect (FBOE) is the repeated finding that older brothers increase the odds of homosexuality in later-born males. It has been our working assumption, based on the majority of previous studies, that a similar FBOE does not occur in females. In an elaborate quantitative review posted last year to a preprint server, Vilsmeier et al. (2021a) concluded that there is no valid evidence for an FBOE in men or women. Ablaza et al. (2022) subsequently published a study of population-level data from the Netherlands with conclusions completely opposite to those of Vilsmeier et al., namely, that there is robust evidence of an FBOE in both men and women. The present research was initially undertaken to refute the assertion of Vilsmeier et al. that there is no proof of an FBOE in men and to investigate how they obtained such a discrepant conclusion. We found evidence that the discrepancy may relate to Vilsmeier et al.'s use of the large and demonstrably unreliable sample published by Frisch and Hviid (2006). After the publication by Ablaza et al., we expanded our article to address their finding of an FBOE in women. We argue that our preferred explanation of the FBOE in men-that it reflects the progressive immunization of some mothers to Y-linked antigen by each succeeding male fetus and the concomitantly increasing effects of anti-male antibody on sexual differentiation in the brain in each succeeding male fetus-could plausibly be extended to female homosexuality.

Are Sibship Characteristics Predictive of Same Sex Marriage? An Examination of Fraternal Birth Order and Female Fecundity Effects in Population-level Administrative Data from the Netherlands

Despite historical increases in the number of individuals engaging in same-sex relations and entering same-sex unions, the causes of sexual orientation remain an open question. Two biological processes that have received some degree of empirical validation are the fraternal birth-order effect (FBOE) and the female-fecundity effect (FFE). Respectively, these processes posit that having a greater number of older brothers and being part of larger sibships independently increase the odds of male homosexuality. Nevertheless, previous studies have relied on suboptimal data and methods, including underpowered and selected samples, and models that fail to fully disentangle the two processes. In addition, they have rarely analyzed samples of women. We address these limitations using high-quality, population-level linked register data from the Netherlands (n = 9,073,496). Applying a novel multivariable approach, we jointly examine the FBOE and FFE by comparing the sibship characteristics of men (n = 26,542) and women (n = 33,534) who entered a same-sex union against those who did not (n = 4,607,785 men and 4,405,635 women). Our analyses yield robust evidence of an FBOE on both male and female homosexuality, but no support for the FFE. Additionally, we find that individuals' birth order affects the probability of entering a same-sex union, regardless of the sex of older siblings.

Birth order revelations about managers

Purpose

This paper aims to reveal the effects of birth order in decision-making style, conflict handling style and propensity for participative decision-making. The intention is to open the perspective of birth order research in organizational studies, as an important individual difference of managers.

Design/methodology/approach

A survey was conducted with 230 managers from different industries in Kosovo. Self-report measures were used for decision-making style, conflict handling style and participatory decision-making constructs.

Findings

Results indicate that only children are more avoidant and spontaneous decision-makers. Firstborns are rational in decision-making and prefer problem-solving in conflict handling. Middleborns are intuitive decision-makers and use compromising in conflict handling. Lastborns make decisions rationally and use both compromising and problem-solving in conflicting situations. In addition, lastborns appeared to have a more positive attitude toward participative decision-making, followed by middleborns, firstborns and only children.

Research limitations/implications

Birth order affects managers’ behaviors in decision-making and conflict situations. Relationship dynamics in sibships are reflected in organizational settings, affecting how people behave in decision-making and conflict handling.

Originality/value

To the best of the authors’ knowledge, this is the first study to attest how birth order influences the ways managers make decisions, handle conflicts and involve others in decision-making. As birth order cannot be changed, such knowledge is critical.

Meta-Analyses of Fraternal and Sororal Birth Order Effects in Homosexual Pedophiles, Hebephiles, and Teleiophiles

This study investigated the relations between numbers of older brothers, numbers of older sisters, and the odds of homosexuality in later-born males, including males who are most attracted sexually to prepubescent or early pubescent children (pedohebephiles) and males who are most attracted sexually to adults (teleiophiles). The authors meta-analyzed data from 24 samples of homosexual and heterosexual men, originally reported in 18 studies, and totaling 18,213 subjects. The results confirmed that older brothers increase the odds of same-sex preference in pedohebephiles as they do in teleiophiles. They also replicated the recent finding that older sisters have a similar but weaker statistical association with the odds of homosexuality. These findings have two theoretical implications. First, the findings for older brothers and older sisters indicate some commonality in the factors that influence sexual preference in teleiophiles and those that influence sexual preference in pedohebephiles. Second, the finding for older sisters confirms a prediction stemming from the hypothesis that male fetuses stimulate maternal antibodies that increase the odds of homosexuality in later-born males. Such immunization could result from miscarried as well as full-term fetuses, and number of older sisters should correlate with number of male fetuses miscarried before gestation of the subject.

Are There Early Risk Markers for Pedophilia? A Nationwide Case-Control Study of Child Sexual Exploitation Material Offenders

Although prior research suggests associations between parental characteristics and later sexual offending in offspring, possible links between early pregnancy-related factors and sexual offending remain unclear. Early risk markers unique to sexual offending, however, may be more prominent among sexual offenders with atypical sexual interests, such as individuals involved with child sexual exploitation material (CSEM; also referred to as child pornography). We examined the prospective association between parental and pregnancy-related risk markers and a behavioral indicator of pedophilic interest, CSEM offending. All 655 men born in Sweden and convicted of CSEM offending between 1988 to 2009 were matched 1:5 on sex, birth year, and county of birth in Sweden to 3,928 controls without sexual or nonsexual violent convictions. Paternal age (adjusted odds ratio [AOR] = 1.3, 95% confidence interval [CI] [1.1, 1.7]), parental education (AOR = 0.8, 95% CI [0.6, 0.9]), parental violent criminality (AOR = 2.9, 95% CI [2.2, 3.8]), number of older brothers (AOR = 0.8, 95% CI [0.6, 0.9] per brother), and congenital malformations (AOR = 1.7, 95% CI [1.2, 2.4]) all independently predicted CSEM convictions. This large-scale, nationwide study suggests parental risk markers for CSEM offending. We did not, however, find convincing evidence for pregnancy-related risk markers, with the exception of congenital malformations and having fewer older brothers.

Neural correlates of moral judgment in pedophilia

Pedophilia is a sexual preference that is often associated with child sex offending (CSO). Sexual urges towards prepubescent children and specifically acting upon those urges are universally regarded as immoral. However, up until now, it is completely unknown whether moral processing of sexual offenses is altered in pedophiles. A total of 31 pedophilic men and 19 healthy controls were assessed by using functional magnetic resonance imaging (fMRI) in combination with a moral judgment paradigm consisting of 36 scenarios describing different types of offenses.

Scenarios depicting sexual offenses against children compared to those depicting adults were associated with higher pattern of activation in the left temporo-parietal-junction (TPJ) and left posterior insular cortex, the posterior cingulate gyrus as well as the precuneus in controls relative to pedophiles, and vice versa. Moreover, brain activation in these areas were positively associated with ratings of moral reprehensibility and negatively associated with decision durations, but only in controls. Brain activation, found in key areas related to the broad network of moral judgment, theory of mind and (socio-)moral disgust - point to different moral processing of sexual offenses in pedophilia in general. The lack of associations between brain activation and behavioral responses in pedophiles further suggest a biased response pattern or dissected implicit valuation processes.

Fraternal Birth Order, Family Size, and Male Homosexuality: Meta-Analysis of Studies Spanning 25 Years

The fraternal birth order effect is the tendency for older brothers to increase the odds of homosexuality in later-born males. This study compared the strength of the effect in subjects from small versus large families and in homosexual subjects with masculine versus feminine gender identities. Meta-analyses were conducted on 30 homosexual and 30 heterosexual groups from 26 studies, totaling 7140 homosexual and 12,837 heterosexual males. The magnitude of the fraternal birth order effect was measured with a novel variable, the Older Brothers Odds Ratio, computed as (homosexuals' older brothers ÷ homosexuals' other siblings) ÷ (heterosexuals' older brothers ÷ heterosexuals' other siblings), where other siblings = older sisters + younger brothers + younger sisters. An Older Brothers Odds Ratio of 1.00 represents no effect of sexual orientation; values over 1.00 are positive evidence for the fraternal birth order effect. Evidence for the reliability of the effect was consistent. The Older Brothers Odds Ratio was significantly >1.00 in 20 instances, >1.00 although not significantly in nine instances, and nonsignificantly <1.00 in 1 instance. The pooled Older Brothers Odds Ratio for all samples was 1.47, p < .00001. Subgroups analyses showed that the magnitude of the effect was significantly greater in the 12 feminine or transgender homosexual groups than in the other 18 homosexual groups. There was no evidence that the magnitude of the effect differs according to family size.

Leg Length Versus Torso Length in Pedophilia: Further Evidence of Atypical Physical Development Early in Life

Adult men's height results from an interaction among positive and negative influences, including genetic predisposition, conditions in utero, and influences during early development such as nutritional quality, pathogen exposure, and socioeconomic status. Decreased height, reflected specifically as a decreased leg length, is strongly associated with increased risk of poorer health outcomes. Although prior research has repeatedly shown that pedophiles are shorter than nonpedophiles, the largest study to date relied on self-reported height. In the present study, pedophiles demonstrated reduced measured height and reduced leg length as compared with teleiophiles. Given the prenatal and early childhood origins of height, these findings contribute additional evidence to a biological, developmental origin of pedophilia. In addition, the magnitude of this height difference was substantially larger than that found in children exposed to a variety of early environmental stressors, but similar to that seen in other biologically based neurodevelopmental disorders.

Independent Component Analysis of Resting-State Functional Magnetic Resonance Imaging in Pedophiles

INTRODUCTION

Neuroimaging and other studies have changed the common view that pedophilia is a result of childhood sexual abuse and instead is a neurologic phenomenon with prenatal origins. Previous research has identified differences in the structural connectivity of the brain in pedophilia.

AIM

To identify analogous differences in functional connectivity.

METHODS

Functional magnetic resonance images were recorded from three groups of participants while they were at rest: pedophilic men with a history of sexual offenses against children (n = 37) and two control groups: non-pedophilic men who committed non-sexual offenses (n = 28) and non-pedophilic men with no criminal history (n = 39).

MAIN OUTCOME MEASURE

Functional magnetic resonance imaging data were subjected to independent component analysis to identify known functional networks of the brain, and groups were compared to identify differences in connectivity with those networks (or "components").

RESULTS

The pedophilic group demonstrated wide-ranging increases in functional connectivity with the default mode network compared with controls and regional differences (increases and decreases) with the frontoparietal network. Of these brain regions (total = 23), 20 have been identified by meta-analytic studies to respond to sexually relevant stimuli. Conversely, of the brain areas known to be those that respond to sexual stimuli, nearly all emerged in the present data as significantly different in pedophiles.

CONCLUSION

This study confirms the presence of significant differences in the functional connectivity of the brain in pedophilia consistent with previously reported differences in structural connectivity. The connectivity differences detected here and elsewhere are opposite in direction from those associated with anti-sociality, arguing against anti-sociality and for pedophilia as the source of the neuroanatomic differences detected.

Parental and perinatal risk factors for sexual offending in men: a nationwide case-control study

BACKGROUND

Prior studies suggest parental and perinatal risk factors are associated with later offending. It remains uncertain, however, if such risk factors are similarly related to sexual offending.

METHOD

We linked socio-demographic, family relations, and perinatal (obtained at birth) data from the nationwide Swedish registers from 1973 to 2009 with information on criminal convictions of cases and control subjects. Male sex offenders (n = 13 773) were matched 1:5 on birth year and county of birth in Sweden to male controls without sexual or non-sexual violent convictions. To examine risk-factor specificity for sexual offending, we also compared male violent, non-sexual offenders (n = 135 953) to controls without sexual or non-sexual violent convictions. Predictors included parental (young maternal or paternal age at son's birth, educational attainment, violent crime, psychiatric disorder, substance misuse, suicide attempt) and perinatal (number of older brothers, low Apgar score, low birth weight, being small for gestational age, congenital malformations, small head size) variables.

RESULTS

Conditional logistic regression models found consistent patterns of statistically significant, small to moderate independent associations of parental risk factors with sons' sexual offending and non-sexual violent offending. For perinatal risk factors, patterns varied more; small for gestational age and small head size exhibited similar risk effects for both offence types whereas a higher number of older biological brothers and any congenital malformation were small, independent risk factors only for non-sexual violence.

CONCLUSIONS

This nationwide study suggests substantial commonalities in parental and perinatal risk factors for the onset of sexual and non-sexual violent offending.

'Chronophilia': Entries of Erotic Age Preference into Descriptive Psychopathology

A scientific nomenclature of erotic age preferences informed the mid- through late nineteenth century joint appearance of homosexuality and sexual abuse of minors on the medico-legal scene. Yet, even in the twenty-first century, legal, psychiatric and culture-critical dimensions of related terms are rarely cleanly distinguished. Review of primary sources shows the ongoing Western suspension of notions of 'sick desire', alongside and beyond the medicalisation of homosexuality, between metaphor, legal interdiction and postulated psychopathology. Virtually all early attention to erotic age preference occurred in the context of emergent attention to erotic gender preference. Age of attraction and age difference centrally animate modern homosexuality's pre-modern past; its earliest psychiatric nomenclature and typologies (1844-69); its early aetiologies stipulating degrees of sexual differentiation (1890 s); its concomitant sub-classification (1896-1914); its earliest psychophysiological tests (1950s); and, finally, its post-psychiatric, social scientific typologies (1980s). Several identifications of 'paedophilia' were seen throughout the 1890 s but as a trope it gained cultural momentum only during, and as a seemingly intriguing corollary of, the progressive depsychiatricisation of homosexuality across the Anglo-European world (late 1950s through 1980s). Early twentieth century sources varied in having it denote (1) a distinct perversion, thus possible 'complication' of sexual inversion (2) a discrete corollary of psychosexual differentiation akin to gender preference (3) a distinct subtype of fetishism, thus a likely imprint of early seduction (4) a more intricate expression of erotic symbolism or psychosexual complex or (5) a taste answering to culture, a lack of it, or a libertine disregard for it.

Detecting and correcting for family size differences in the study of sexual orientation and fraternal birth order

The term "fraternal birth order effect" denotes a statistical relation most commonly expressed in one of two ways: Older brothers increase the odds of homosexuality in later born males or, alternatively, homosexual men tend to have more older brothers than do heterosexual men. The demonstrability of this effect depends partly on the adequate matching of the homosexual and heterosexual study groups with respect to mean family size. If the homosexual group has too many siblings, relative to the heterosexual group, the homosexual group will tend to show the expected excess of older brothers but may also show an excess of other sibling-types (most likely older sisters); if the homosexual group has too few siblings, it will tend not to show a difference in number of older brothers but instead may show a deficiency of other sibling-types (most likely younger brothers and younger sisters). In the first part of this article, these consequences are illustrated with deliberately mismatched groups selected from archived data sets. In the second part, two slightly different methods for transforming raw sibling data are presented. These are intended to produce family-size-corrected variables for each of the four original sibling parameters (older brothers, older sisters, younger brothers, and younger sisters). Both versions are shown to render the fraternal birth order effect observable in the deliberately mismatched groups. In the third part of the article, fraternal birth order studies published in the last 5 years were surveyed for failures to find a statistically significant excess of older brothers for the homosexual group. Two such studies were found in the nine examined. In both cases, the collective findings for older sisters, younger brothers, and younger sisters suggested that the mean family size of the homosexual groups was smaller than that of the heterosexual comparison groups. Furthermore, the individual findings for the four classes of siblings resembled those for the present experimentally mismatched groups in which the mean family size of the homosexual group was significantly smaller. This illustrates the necessity of comparing groups on measures of mean family size and removing this confound in some way when those means are markedly different.

Elevated rates of atypical handedness in paedophilia: theory and implications

Multiple factors determine handedness including genetics, prenatal stress and post-natal environmental conditions. Atypical handedness, whether manifest as increased sinistrality or decreased strength of lateral preference, has been noted in a wide variety of populations with neuropathology. Those with atypical sexual preferences, specifically paedophilia, also manifest reduced rates of right-handedness. This paper uses the largest sample of phallometrically assessed men to date to establish the pattern of atypical handedness in paedophilia. Specifically, whereas prior research has largely characterized participants dichotomously as right-handed or non-right-handed and/or used self-report of writing hand, this paper expands upon such reports by using the Edinburgh Handedness Inventory's laterality quotient. Participants' handedness and phallometrically assessed sexual preference were analyzed both as continuous and categorical variables, and the responses of those scoring in the range of ambiguous-handedness were evaluated to ascertain whether they were ambiguously handed or more accurately described as mixed-handed. Results indicated those producing scores in the range of ambiguous-handedness demonstrated response patterns consistent with ambiguous-handedness, rather than mixed-handedness. Paedophiles demonstrated high rates of non-right-handedness primarily manifested as sinistrality, whereas those who had a sexual preference for pubescent children evidenced increased ambiguous-handedness. Results support a view of ambiguous-handedness as less pathological than previously hypothesized, and of a neurodevelopmental origin of paraphilic sexual preferences.

Potential implications of research on genetic or heritable contributions to pedophilia for the objectives of criminal law

In recent years, there has been increasing scientific research on possible genetic or heritable influences to the etiology of pedophilia, driven by national and public concerns about better understanding the disorder in order to reduce children's vulnerabilities to pedophilic and child sex offenders. This research has corresponded to growing academic dialogue on how advances in genetic research, especially concerning the causes and development of particular mental disorders or behaviors, may affect traditional practices of criminal law and how the justice system views, manages, and adjudicates different types of criminal behavior and offenders. This paper strives to supplement this dialogue by exploring several of the many possible effects and implications of research surrounding genetic or heritable contributions to pedophilia for the five widely accepted objectives that enforce and regulate the punishment of criminal law. These include retribution, incapacitation, deterrence, rehabilitation, and restoration. Although still currently in early stages, genetic and heritability research on the etiology of pedophilia may have the potential moving forward to influence the current and established punitive methods and strategies of how the justice system perceives, adjudicates, regulates, and punishes pedophilic and sex offenders, as well as how to best prevent sexual offending against children by pedophilic offenders in the future.

Juvenile homosexual homicide

Limited information exists on juvenile homosexual homicide (JHH), that is, youths who perpetrate sexual homicides against same-sex victims. Only a handful of cases from the United States and internationally have been described in the literature. This study, the first of its kind, examines the epidemiology, victimology, victim-offender relationship, and weapon-use patterns in JHH offenders using a large U.S. database on homicide spanning three decades. The data for this study were derived from the Federal Bureau of Investigation's Supplementary Homicide Reports (SHRs) for the years 1976 through 2005. A total of 93 cases of JHH were identified. On average, three of these crimes occurred annually in the U.S., and there was a marked decline in its incidence over the study period. Ninety-five percent were male offender-male victim cases and 5% were female offender-female victim cases. JHH offenders were over-represented amongst all juvenile sexual murderers, similar to their adult counterparts. The majority of these boys were aged 16 or 17 and killed adult victims. They were significantly more likely to kill adult victims than other age groups, to be friends or acquaintances of the victims, and to use contact/edged weapons or firearms. Most offenders killed same-race victims, although Black offenders were significantly more likely than White offenders to kill interracially. A case report is provided to illustrate JHH. Further research is needed to promote our understanding of the pathogenesis, etiology, and associated risk factors for this aberrant form of murder by children.

Is homosexuality a paraphilia? The evidence for and against

Whether homosexuality should be described as one among many paraphilic sexual interests or an altogether different dimension of sexual interest has long been discussed in terms of its political and social implications. The present article examined the question instead by comparing the major correlates and other features of homosexuality and of the paraphilias, including prevalence, sex ratio, onset and course, fraternal birth order, physical height, handedness, IQ and cognitive neuropsychological profile, and neuroanatomy. Although those literatures remain underdeveloped, the existing findings thus far suggest that homosexuality has a pattern of correlates largely, but not entirely, distinct from that identified among the paraphilias. At least, if homosexuality were deemed a paraphilia, it would be relatively unique among them, taxonometrically speaking.

Feederism: an exaggeration of a normative mate selection preference?

Quinsey and Lalumière (1995) suggested that some, if not most, paraphilias are exaggerated manifestations of more normative and functional mate selection preferences. The present study tested whether Feederism, a fat fetish focused on erotic eating, feeding, and gaining weight, is an exaggeration of a sexual arousal pattern commonly seen in the general population. Thirty participants (15 men and 15 women) recruited from the general population were assessed using penile plethysmography and vaginal photoplethysmography, respectively. None of the participants were self-identified Feeders or Feedees. Participants were shown sexual, neutral, and feeding still images while listening to audio recordings of sexual, neutral, and feeding stories. Participants did not genitally respond to feeding stimuli. However, both men and women subjectively rated feeding stimuli as more sexually arousing than neutral stimuli. We discuss the discordance between physiological and self-reported sexual arousal in the context of sex differences in sexual concordance and implications for future research.

Executive function profiles of pedophilic and nonpedophilic child molesters

There is increasing evidence of neurocognitive dysfunction among child molesters, supporting the notion of brain anomalies among pedophiles. However, approximately half of child molesters are not pedophilic (i.e., are not primarily attracted to children), and neurocognitive differences between pedophilic (PED) and nonpedophilic (NPED) child molesters are not well understood. The purpose of this study was to assess neurocognition, specifically executive functioning (EF), among phallometrically defined PED and NPED child molesters, relative to nonsexual offenders (NSO). Participants (N = 89) were compared on seven EF domains. Results revealed that (a) child molesters exhibited an overall executive profile that was different from that of NSOs, with PEDs differing from NSOs but not from NPEDs; (b) child molesters on the whole performed better than NSOs on abstract reasoning and more poorly on inhibition; and (c) PEDs performed better than NPEDs on planning and exhibited better overall performance accuracy relative to NPEDs. These results suggest that PEDs exhibit a more deliberate, planful response style characterized by greater self-monitoring; whereas NPEDs appear to respond more impulsively. The current report further elucidates neurocognition among child molesters and highlights the need for future research examining subtypes of child molesters.

Child sex tourism: extending the borders of sexual offender legislation

Child sex tourism, the act of traveling to engage in sexual acts with minors, plagues developing nations worldwide. Several laws have been passed internationally in recent years designed to curtail this practice. Government entities and human rights organizations have driven these efforts. United States citizens represent a significant proportion of participants in child sex tourism. The PROTECT Act of 2003 prohibits United States citizens from participating in sexual acts with minors while traveling, and establishes extraterritorial jurisdiction. The case of Michael Lewis Clark, the first United States citizen convicted under this legislation, is highlighted. Child sex tourism poses unique issues to courts that will require ongoing clarification as challenges arise. This article discusses potential future challenges, describes strategies to address this problem, and relates this issue to psychiatry. Mental health providers may have the role of evaluating both the victims and perpetrators of child sex tourism. The authors propose a classification system for offenses and an initial list of topics to discuss with victims. The authors also describe the proper mechanism for reporting United States citizens suspected of participating in child sex tourism.

The DSM diagnostic criteria for pedophilia

This paper contains the author's report on pedophilia, submitted on June 2, 2008, to the work group charged with revising the diagnoses concerning sexual and gender identity disorders for the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). The author reviews the previously published criticisms and empirical research concerning the diagnostic criteria for pedophilia and presents criticism and relevant research of his own. The review shows that the DSM diagnostic criteria for pedophilia have repeatedly been criticized as unsatisfactory on logical or conceptual grounds, and that published empirical studies on the reliability and validity of these criteria have produced ambiguous results. It therefore seems that the current (i.e., DSM-IV-TR) diagnostic criteria need to be examined with an openness to major changes in the DSM-V.

Etiology of pedophilia from a neurodevelopmental perspective: markers and brain alterations

DEVELOPMENT

Distinct signs have been associated with a wide range of neurodevelopmental disorders and warning signs of neural developmental problems have also been observed in pedophiles. Continuing this line of research, several neuroimaging studies have found neural alterations in this disorder.

CONCLUSIONS

Pedophilia has been related to distinct indicators of neurodevelopmental alterations such as low intelligence quotient, left-handedness and smaller stature, among others. In addition, pedophiles show several neural alterations and a predominantly subcortical pattern of cerebral activation to sexual stimuli. The results of these studies suggest that the origin of pedophilia may partly lie in brain alterations due to problems during neural development, although these alterations do not absolve these persons of responsibility for their actions.

Pedophilia, hebephilia, and the DSM-V

The term pedophilia denotes the erotic preference for prepubescent children. The term hebephilia has been proposed to denote the erotic preference for pubescent children (roughly, ages 11 or 12-14), but it has not become widely used. The present study sought to validate the concept of hebephilia by examining the agreement between self-reported sexual interests and objectively recorded penile responses in the laboratory. The participants were 881 men who were referred for clinical assessment because of paraphilic, criminal, or otherwise problematic sexual behavior. Within-group comparisons showed that men who verbally reported maximum sexual attraction to pubescent children had greater penile responses to depictions of pubescent children than to depictions of younger or older persons. Between-groups comparisons showed that penile responding distinguished such men from those who reported maximum attraction to prepubescent children and from those who reported maximum attraction to fully grown persons. These results indicated that hebephilia exists as a discriminable erotic age-preference. The authors recommend various ways in which the DSM might be altered to accommodate the present findings. One possibility would be to replace the diagnosis of Pedophilia with Pedohebephilia and allow the clinician to specify one of three subtypes: Sexually Attracted to Children Younger than 11 (Pedophilic Type), Sexually Attracted to Children Age 11-14 (Hebephilic Type), or Sexually Attracted to Both (Pedohebephilic Type). We further recommend that the DSM-V encourage users to record the typical age of children who most attract the patient sexually as well as the gender of children who most attract the patient sexually.

Cerebral white matter deficiencies in pedophilic men

The present investigation sought to identify which brain regions distinguish pedophilic from nonpedophilic men, using unbiased, automated analyses of the whole brain. T1-weighted magnetic resonance images (MRIs) were acquired from men who demonstrated illegal or clinically significant sexual behaviors or interests (n = 65) and from men who had histories of nonsexual offenses but no sexual offenses (n = 62). Sexual interest in children was assessed by participants' admissions of pedophilic interest, histories of committing sexual offenses against children, and psychophysiological responses in the laboratory to erotic stimuli depicting children or adults. Automated parcellation of the MRIs revealed significant negative associations between pedophilia and white matter volumes of the temporal and parietal lobes bilaterally. Voxel-based morphometry corroborated the associations and indicated that the regions of lower white matter volumes followed, and were limited to, two major fiber bundles: the superior fronto-occipital fasciculus and the right arcuate fasciculus. No significant differences were found in grey matter or in cerebrospinal fluid (CSF). Because the superior fronto-occipital and arcuate fasciculi connect the cortical regions that respond to sexual cues, these results suggest (1) that those cortical regions operate as a network for recognizing sexually relevant stimuli and (2) that pedophilia results from a partial disconnection within that network.

Neurodevelopmental correlates of paraphilic sexual interests in men

The etiology of anomalous, or paraphilic, sexual preferences in men is unclear although a growing literature points to their prenatal neurodevelopmental ontogenesis. The present study explored whether this was also apparent in a community sample of 200 heterosexual men by examining their sexual fantasies using the Wilson Sex Fantasy Questionnaire (WSFQ) and several demographic and somatic neurodevelopmental markers, including sibling sex composition, handedness, maternal and paternal age at birth, second to fourth finger length ratios, and fluctuating asymmetry of finger lengths and wrist widths. Responses to the WSFQ were used to quantify the extent of paraphilic interest by computing a variance-quotient (or VQ) previously shown to differentiate paraphilic from conventional heterosexual males. High paraphilic scorers had a significantly greater number of older brothers, higher right-hand 2D:4D, and a trend for lower Edinburgh Handedness Inventory (EHI) scores compared to low-paraphilic scorers. Correlational analysis revealed a significant positive association of VQ scores with number of older brothers and significant negative associations with number of younger brothers and EHI scores (elevated paraphilic interests were correlated with elevated non-right handedness). Correlations between VQ scores and other variables were not significant. It is suggested that processes such as developmental instability and maternal immunity may play a role in variant sexual preferences among otherwise healthy heterosexual men.

A comparison of criminal sexual conduct defendants based on victim age

This study compared defendants charged with Criminal Sexual Conduct whose victims were <6 years of age with defendants whose victims were 12 or more years of age. The study included 163 men referred to the evaluation unit of a state center for forensic psychiatry. Thirty-eight men had younger victims (YVs) and 125 men had older victims (OVs). The variables of comparison were defendant demographic and psychiatric variables frequently identified in the sex offender literature. Controlling for other demographic and psychiatric variables by use of logistic regression modeling, elderly defendants (60 years or greater), and incest offenders were three times more likely to have YVs (Odds Ratio [OR] 3.08 and 3.11, respectively). Unlike previous studies defendants with serious psychiatric pathology (psychosis or mania) were no more likely to have YVs (OR 0.66) than were defendants without psychosis.

Physical height in pedophilic and hebephilic sexual offenders

Adult men's height reflects, not only their genetic endowment, but also the conditions that were present during their development in utero and in childhood. We compared the adult heights of men who committed one or more sexual offenses and who were erotically interested in prepubescent children (pedophilic sexual offenders; n=223), those who were erotically interested in pubescent children (hebephilic sexual offenders; n=615), and those who were erotically interested in adults (teleiophilic sexual offenders; n=187), as well as men who had no known sexual offenses and who were erotically interested in adults (teleiophilic nonoffender controls; n=156). The pedophilic and the hebephilic sexual offenders were significantly shorter than the teleiophilic nonoffender controls. The teleiophilic sexual offenders were intermediate in height between the nonoffenders and the pedophilic and hebephilic sexual offenders and not significantly different from any of the other groups. This suggests that-regardless of whatever psychological sequelae might also have followed from the conditions present during early development-pedophilic and hebephilic sexual offenders were subject to conditions capable of affecting their physiological development.

Review of medical reports on pedophilia

The present report is a review of all 554 papers published on Medline on pedophilia. The first discussion is the history of the disorder from ancient Greece to the present time, especially the influence of the liberal country of the Netherlands, the North American Man-Boy Love Association, and the sexual crisis in the Catholic Church. One important question is the relationship between homosexual pedophilia and adult homosexuality. Evidence for and against this relationship is presented. Next discussed are the characteristics of the victim and the long lasting serious effects of sexual abuse. Laboratory correlations are included, especially phallometric tests in order to objectively measure the physical responses to sexual stimuli. Electrophysiological and radiographic tests are also mentioned, including electroencephalography, computed tomography, magnetic resonance imaging, and positron emission tomography scans. An important section is the characterization of pedophiles with emphasis on their frequent previous sexual abuse, their past, their present, and their anticipated future. The final topic is treatment of this disorder with surgery, medication, behavioral therapy and the combination of medication and behavioral therapy.

IQ, handedness, and pedophilia in adult male patients stratified by referral source

This study investigated whether the previously observed association of pedophilia with lower IQs is an artifact of heterogeneity in referral source. The subjects were 832 adult male patients referred to a specialty clinic for evaluation of their sexual behavior. The patients' erotic preferences for prepubescent, pubescent, or adult partners were assessed with phallometric testing. Full scale IQ was estimated using six subtests from the WAIS-R. The results showed that the relations between pedophilia and lower IQ, lesser education, and increased rates of non-right-handedness were the same in homogeneous groups referred by lawyers or parole and probation officers as they were in a heterogeneous group referred by a miscellany of other sources. Those results, along with secondary analyses in the study, supported the conclusion that the relation between pedophilia and cognitive function is genuine and not artifactual. The findings were interpreted as evidence for the hypothesis that neurodevelopmental perturbations increase the risk of pedophilia in males.

Family size, birth order, and parental age among male paraphilics and sex offenders

A sample of 1823 male paraphilics, sex offenders, and non-sex offender controls were compared on family size, birth order, and parents' ages at the time of the probands' births. Sample data were also compared to population data from Statistics Canada. The men in all groups were from larger than average Canadian families and they tended to be later born. Paraphilics and sex offenders had even larger families than offender controls. Their parents tended to be older at their birth with 34.2% of mothers and 51.3% of fathers over 30 years of age, but there were no statistically significant subgroup differences. There were also significantly more multiparous teenage mothers than expected and more paraphilics' fathers who were younger than the mothers, both factors associated in the literature with increased risk of perinatal complications and abnormalities. The confounding influences of parental age, birth order, and family size were examined and indicated the need for large samples and multivariate analysis in evaluating the role of family variables associated with paraphilics and sex offenders.

A profile of pedophilia: definition, characteristics of offenders, recidivism, treatment outcomes, and forensic issues

Pedophilia has become a topic of increased interest, awareness, and concern for both the medical community and the public at large. Increased media exposure, new sexual offender disclosure laws, Web sites that list the names and addresses of convicted sexual offenders, politicians taking a 'get tough' stance on sexual offenders, and increased investigations of sexual acts with children have increased public awareness about pedophilia. Because of this increased awareness, it is important for physicians to understand pedophilia, its rate of occurrence, and the characteristics of pedophiles and sexually abused children. In this article, we address research that defines the various types and categories of pedophilia, review available federal data on child molestation and pornography, and briefly discuss the theories on what makes an individual develop a sexual orientation toward children. This article also examines how researchers determine if someone is a pedophile, potential treatments for pedophiles and sexually abused children, the risk of additional sexual offenses, the effect of mandatory reporting laws on both physicians and pedophiles, and limitations of the current pedophilic literature.

Grade failure and special education placement in sexual offenders' educational histories

A sample of 701 adult men underwent assessment following illegal or clinically significant sexual behaviors or interests. Patients were categorized on the basis of phallometric (penile) responses in the laboratory to erotic stimuli depicting adults, pubescent children, and prepubescent children; histories of sexual offenses; and self-reported sexual interests. Comprising the categories were men sexually interested in prepubescent children (pedophiles; n = 114), men sexually interested in pubescent children (hebephiles; n = 377), men sexually interested in adults and who had committed a sexual offense against an adult (teleiophilic offenders; n = 139), and men sexually interested in adults and who had no known history of any sexual offenses (teleiophilic nonoffenders; n = 71). Patients' assessments included IQ testing and self-reported academic history, which included any grade failures and assignment to special education classes. Relative to the teleiophilic offenders, both the pedophilic and the hebephilic groups showed approximately double the odds of failing a grade or being enrolled in special education, both before and after covarying IQ. No significant differences were detected between the teleiophilic offenders and the teleiophilic nonoffenders. These data are consistent with the hypothesis that an erotic age preference for children sometimes results from a perturbation of neurodevelopment occurring early in life.

Interaction of fraternal birth order and handedness in the development of male homosexuality

The present study investigated evidence for an interaction between two of the best established etiologic factors, or markers of etiologic factors, in the literature on male homosexuality: fraternal birth order and hand preference. By combining five samples, the authors produced study groups of 1774 right-handed heterosexuals, 287 non-right-handed heterosexuals, 928 right-handed homosexuals, and 157 non-right-handed homosexuals. The results showed a significant (P = 0.004) handedness by older brothers interaction, such that (a) the typical positive correlation between homosexuality and greater numbers of older brothers holds only for right-handed males, (b) among men with no older brothers, homosexuals are more likely to be non-right-handed than heterosexuals; among men with one or more older brothers, homosexuals are less likely to be non-right-handed than heterosexuals, and (c) the odds of homosexuality are higher for men who have a non-right hand preference or who have older brothers, relative to men with neither of these features, but the odds for men with both features are similar to the odds for men with neither. These findings have at least two possible explanations: (a) the etiologic factors associated with non-right-handedness and older brothers-hypothesized to be hyperandrogenization and anti-male antibodies, respectively-counteract each other, yielding the functional equivalent of typical masculinization, and (b) the number of non-right-handed homosexuals with older brothers is smaller than expected because the combination of the older brothers factor with the non-right-handedness factor is toxic enough to lower the probability that the affected fetus will survive.

Phallometric comparison of pedophilic interest in nonadmitting sexual offenders against stepdaughters, biological daughters, other biologically related girls, and unrelated girls

This study compared the mean levels of sexual response to children produced by four groups of men with sexual offences against prepubescent girls and two comparison groups with other offences or no offences. All groups (N = 291) consisted of patients referred for clinical assessment of their sexual behavior or interests. Group assignment was determined by the victim's age and her relation to the patient: biological daughter; stepdaughter; other biologically related girl (e.g., sister, niece, granddaughter); unrelated girl; adult woman; and no known victim. The men with sexual offences had precisely one known victim each. The patients with offences may or may not have denied the act of which they were accused, but all patients denied an erotic preference for children. Sexual response to children was assessed by means of phallometric testing, a psychophysiological technique in which the individual's penile blood volume is monitored while he is presented with a standardized set of laboratory stimuli depicting male and female children and adults. The results indicated that the mean level of pedophilic response in men with offences against daughters or stepdaughters is intermediate between that in men with offences against otherwise-related or unrelated girls and that in men with no offences against girls at all.

The strength of sexual arousal as a function of the age of the sex offender: comparisons among pedophiles, hebephiles, and teleiophiles

Previous research has shown that sexual arousability in human males declines from its peak in early adolescence until old age. This study compared the rates of decline in three groups of males: those most attracted sexually to prepubescent children (pedophiles), those most attracted to pubescent children (hebephiles), and those most attracted to physically mature persons (teleiophiles). The participants were 2,028 patients referred to Toronto's Centre for Addiction and Mental Health from 1995 to 2004 for evaluation of criminal or otherwise disturbing sexual behavior, but not for erectile or ejaculatory problems. All underwent phallometric assessment for erotic age-preference. This is a psychophysiological technique in which an individual's penile blood volume is monitored while he is presented with a standardized set of laboratory stimuli depicting male and female children, pubescents, and adults. The experimental measure of sexual arousability was the average of the participant's three greatest penile responses to any stimulus category, expressed in cubic cm of blood volume increase. The results showed that sexual arousability was an inverse function of age, and that there were no differences between the pedophiles, hebephiles, and teleiophiles in the rate at which arousability declined.

Handedness in pedophilia and hebephilia

A sample of 404 adult men underwent assessment following illegal or clinically significant sexual behaviors or interests. Patients' assessments included: administration of a modified version of the Edinburgh Handedness Inventory; recording of patients' phallometric (penile) responses to erotic stimuli depicting adults, pubescent children, and prepubescent children of both sexes; and a tabulation of the numbers of patients' victims, ages 0-11, 12-14, 15-16, and 17 and older, of both sexes. In Study 1, patients' right-handedness scores correlated negatively with their phallometric responses to stimuli depicting prepubescent children and positively with stimuli depicting adults, replicating the pattern described in a previous report (Cantor et al., 2004). Unlike the previous study, however, patients' handedness scores did not significantly correlate with their numbers of prepubescent victims. To explore this discrepancy, Study 2 combined the patients from this replication sample with those in the previously reported sample, categorizing them by the sex and age group of greatest erotic interest to them. The odds of non-right-handedness in men offending predominantly against prepubescent children were approximately two-fold higher than that in men offending predominantly against adults and three-fold higher after eliminating those men with intrafamilial (i.e., incest) offenses. Handedness differences between men erotically interested in males versus females were not statistically significant. These results indicate that the rates of non-right-handedness in pedophilia are much larger than previously suggested and are comparable to the rates observed in pervasive developmental disorders, such as autism, suggesting a neurological component to the development of pedophilia and hebephilia.

Are over a third of foster parent molestations homosexual?

50% of foster parent abuse in a general population survey and 34% of abuse as determined by the Illinois DCFS was homosexual. In news stories in the 50 largest newspapers and wire services 1980-2003, 175 foster parents sexually abused 351+ charges. For the 169 whose sex of victim could be determined: 149 (88%) were men; 76 (53%) victimized homosexually; and 85 (50%) were unmarried. Men assaulted 319 (91%) victims, homosexual practitioners 222 (63%), and the unmarried 164 (47%). From 1980-1994 57% of the victims were girls; after 1994 56% were boys. In 21 group homes, the molestation was homosexual in 15 (71%) and 31 of the 32+ perpetrators were male and at least 334 of 349+ victims were boys.

Quantitative and theoretical analyses of the relation between older brothers and homosexuality in men

Meta-analysis of aggregate data from 14 samples representing 10,143 male subjects shows that homosexuality in human males is predicted by higher numbers of older brothers, but not by higher numbers of older sisters, younger brothers, or younger sisters. The relation between number of older brothers and sexual orientation holds only for males. This phenomenon has therefore been called the fraternal birth order effect. Research on birth order, birth weight, and sexual orientation suggests that the developmental pathway to homosexuality initiated by older brothers operates during prenatal life. Calculations assuming a causal relation between older brothers and sexual orientation have estimated the proportion of homosexual men who owe their sexual orientation to fraternal birth order at 15% in one study and 29% in another. The maternal immune hypothesis proposes that the fraternal birth order effect reflects the progressive immunization of some mothers to male-specific antigens by each succeeding male fetus and the increasing effects of such immunization on sexual differentiation of the brain in each succeeding male fetus. There are at least three possible mechanisms by which the mother's immune response could influence the fetus: the transfer of anti-male antibodies across the placenta from the maternal into the fetal compartment, the transfer of maternal cytokines across the placenta, and maternal immune reactions affecting the placenta itself. This hypothesis is consistent with recent studies showing that the quantity of fetal cells that enter the maternal circulation is greater than previously thought, and that the number of male-specific proteins encoded by Y-chromosome genes is greater than previously thought.

Intelligence, Memory, and Handedness in Pedophilia

A sample of 473 male patients with pedophilia (assessed by the patients' sexual history and penile response in the laboratory to standardized, erotic stimuli) or other problematic sexual interests or behaviors received brief neuropsychological assessments. Neuropsychological measures included a short form of the Wechsler Adult Intelligence Scale--Revised (D. Wechsler, 1981), the Hopkins Verbal Learning Test--Revised (R. H. B. Benedict, D. Schretlen. L. Groninger. & J. Brandt, 1998), the Brief Visuospatial Memory Test--Revised (R. H. B. Benedict, 1997), and the Edinburgh Handedness Inventory (S. M. Williams, 1986). Pedophilia showed significant negative correlations with IQ and immediate and delayed recall memory. Pedophilia was also related to non-right-handedness even after covarying age and IQ. These results suggest that pedophilia is linked to early neurodevelopmental perturbations.

The etiology of anomalous sexual preferences in men

People discover rather than choose their sexual interests. The process of discovery typically begins before the onset of puberty and is associated with an increase in the secretion of sex hormones from the adrenal glands. However, the determinants of the direction of sexual interest, in the sense of preferences for the same or opposite sex, are earlier. These preferences, although not manifest until much later in development, appear to be caused by the neural organizational effects of intrauterine hormonal events. Variations in these hormonal events likely have several causes and two of these appear to have been identified for males. One cause is genetic and the other involves the sensitization of the maternal immune system to some aspect of the male fetus. It is presently unclear how these two causes relate to each other. The most important question for future research is whether preferences for particular-aged partners and parts of the male courtship sequence share causes similar to those of erotic gender orientation.

Fraternal birth order and birth weight in probably prehomosexual feminine boys

The purpose of this study was to confirm a previous finding that homosexual males with older brothers weigh less at birth than do heterosexual males with older brothers. The subjects comprised 250 feminine boys referred to a child psychiatry service because of extreme cross-gender wishes or behavior and assumed, on the basis of previous research, to be prehomosexual, plus 739 control boys and 261 control girls referred to the same service for reasons unrelated to sexual orientation or gender identity disorder and assumed, from base-rate probabilities, to be preheterosexual. The feminine boys with two or more older brothers weighed 385 g less at birth than did the control boys with two or more older brothers (P = 0.005). In contrast, the feminine and control boys with fewer than two older brothers did not differ in birth weight. This finding suggests that the mechanism by which older brothers increase the odds of homosexuality in later-born males operates prior to the individual's birth. We hypothesize that this mechanism may be immunologic, that antimale antibodies produced by human mothers in response to immunization by male fetuses could decrease the birth weight of subsequent male fetuses as well as increase their odds of homosexuality.

Fraternal birth order and the maternal immune hypothesis of male homosexuality

In men, sexual orientation correlates with an individual's number of older brothers, each additional older brother increasing the odds of homosexuality by approximately 33%. It has been hypothesized that this fraternal birth order effect reflects the progressive immunization of some mothers to Y-linked minor histocompatibility antigens (H-Y antigens) by each succeeding male fetus and the concomitantly increasing effects of such maternal immunization on the future sexual orientation of each succeeding male fetus. According to this hypothesis, anti-H-Y antibodies produced by the mother pass through the placental barrier to the fetus and affect aspects of sexual differentiation in the fetal brain. This explanation is consistent with a variety of evidence, including the apparent irrelevance of older sisters to the sexual orientation of later born males, the probable involvement of H-Y antigen in the development of sex-typical traits, and the detrimental effects of immunization of female mice to H-Y antigen on the reproductive performance of subsequent male offspring. The maternal immune hypothesis might also explain the recent finding that heterosexual males with older brothers weigh less at birth than heterosexual males with older sisters and homosexual males with older brothers weigh even less than heterosexual males with older brothers.

Sensitivity and specificity of the phallometric test for pedophilia in nonadmitting sex offenders

The specificity of phallometric testing for pedophilia has been calculated using sex offenders against adult women. Does the offender's actual number of prior sexual contacts with women affect such estimates? To answer this, the authors' studied 82 male sex offenders against adult women, 172 offenders against unrelated children, and 70 offenders against their own biological children or stepchildren. Phallometric testing included visual and auditory depictions of prepubescent, pubescent, and adult males and females. The results for offenders against women showed that those who had had sexual contact with the greatest number of women (consenting or nonconsenting) had the lowest probability of being diagnosed as pedophilic. Specificity, calculated for those who had sexual contact with the most women and thus the most evidence of attraction to them, was 96%. Sensitivity, calculated analogously for men with the most offenses against children, was 61%.