Treating sexual offenders with intellectual limitations in the community

Non-pharmacological treatment for individuals with autism spectrum conditions who display harmful sexual behaviour

Background: Specific treatment and interventions for individuals with Autism Spectrum Conditions who display harmful sexual behaviour have yet to be widely evaluated. This review aims to consolidate and assess the quality of research exploring non-pharmacological interventions for individuals with Autism Spectrum Conditions who display harmful sexual behaviour. Method: A systemic search of electronic databases was conducted. Articles were considered for inclusion, according to identified inclusion and exclusion criteria. At the end of the search, ten papers were deemed suitable for inclusion. Results: Ten studies were considered eligible for review, including a study of follow-up data of one of the original studies. Quality assessment indicated that the majority of papers provided weak research evidence, with only two papers receiving an "adequate" rating. A consistent methodological flaw was the lack of control groups for group interventions. Conclusions: There is currently a very small research base exploring non-pharmacological interventions for individuals with Autism Spectrum Conditions who display harmful sexual behaviour. The current research is littered with methodological flaws, however reveals some useful information regarding the use of functional behaviour assessment and individualised treatment planning, as well as some of the limitations of using adapted group CBT interventions. Suggestions for future research include; studies evaluating the effectiveness of behavioural interventions for individuals with Autism Spectrum Conditions who display harmful sexual behaviour, studies which include female participants, studies which utilise control groups where appropriate, and an evaluation of interventions for those with Autism Spectrum Conditions without Intellectual Disabilities.

Community intervention programs for sex offenders: A systematic review

Sexual violence is a phenomenon that negatively impacts the victims' physical and psychological health and well-being. Sex offenders tend not to take responsibility for their actions, have difficulties in emotion regulation and impulse control, paraphilias or other disorders, so they are a difficult group to treat. In addition, the available psychological treatment programs tend to have inconsistent and, sometimes, undesirable results. This systematic review aimed to analyse the recidivism rates of sex offenders treated in community settings. According to the PRISMA guidelines, a systematic search in three databases, EBSCOhost, PubMed, and Web of Science, and a manual search was performed. A total of 319 empirical studies using quantitative methodologies were identified, 27 of which were selected for full-text analysis. In the end, 15 studies were included, published between 1996 and 2020. The objectives, intervention approach, instruments used, and the main results and conclusions were extracted from each study. The studies explored different types of sex offenders, such as: violent sex offenders (e.g., rapists), child abusers, and child abusers with pedophilia (and/or other paraphilias). Results showed that most of the programs had a cognitive-behavioral approach (n = 13). Overall, the interventions appear to be effective in reducing recidivism rates, and some of them led to improvements in other outcomes, such as cognitive distortions, accepting responsibility, victim awareness and empathy, emotional regulation, and offense supportive attitudes. Limitations and implications for future studies were discussed.

How effective are interventions at enhancing empathy for service users with an intellectual disability who engage in sexually abusive behaviour? A review of the literature

BACKGROUND

Sexual offending has been attributed to empathy deficits, implicating interventions targeting empathy as a potential mechanism for reducing sexually harmful behaviour. However, there is less known about how appropriate and effective interventions are for individuals with intellectual disabilities. This review aims to provide a comprehensive synthesis of research findings in this area.

METHOD

Four databases were searched, yielding 13 studies meeting the inclusion criteria which were appraised using the CCAT.

RESULTS

CBT group treatments adapted from mainstream treatment programmes for people with intellectual disabilities were widely used, demonstrating improvements in empathy and reductions in sexually abusive behaviour overall.

CONCLUSIONS

Studies are limited by sample sizes, lack of control groups and inconsistent definitions of intellectual disabilities and sexually abusive behaviour. Future research should include evaluation of models other than CBT, further assessment of empathy-specific interventions and understanding of the mechanism underpinning empathy change.

The effectiveness of cognitive-behavioural therapy group-based interventions for men with intellectual disabilities and sexual offending histories: a meta-analysis

BACKGROUND

Data from sex offender treatment programmes (SOTP) on the re-offending of convicted sex offenders from the prison service in England and Wales was recently reviewed and found to be associated with no change in sexual reoffending. While this result is at variance with a number of other reviews it does give rise to concern as most programmes for individuals with intellectual disabilities adopt similar treatment methods. It is therefore important to consider the treatment outcomes for this client group by conducting a meta-analysis to examine treatment effects.

METHOD

A systematic search of PsychINFO, EMBASE, MEDLINE and CINAHL was conducted in February 2019 using specific inclusion and exclusion criteria. Eighteen papers were identified, and their quality was assessed using a risk of bias framework. Scores on cognitive distortions, sexual knowledge and victim empathy measures as well as reports of further sexually abusive behaviour were pooled together to run a meta-analysis which yielded effect sizes for each outcome.

RESULTS

A large treatment effect was found for reducing cognitive distortions and increasing victim empathy, with a moderate effect found for improvements in sexual knowledge. This meta-analysis also found that 11.5% of individuals with intellectual disabilities who have completed these programmes will go on to display further sexually abusive behaviours.

CONCLUSIONS

The findings suggest that cognitive distortions are significantly reduced following treatment, there are also significant improvements in sexual knowledge and victim empathy. A rate of 11.5% for further reported sexually abusive behaviour during follow up periods was found, which is higher than the rate found for mainstream SOTP completers. Problems regarding the recording of sexually abusive behaviour are considered.

Examining the questionnaire on attitudes consistent with sexual offending

BACKGROUND

The Questionnaire on Attitudes Consistent with Sexual Offending (QACSO) is an assessment developed by Lindsay, Whitefield, Carson, Broxholme and Steptoe (2004). The QACSO was designed to assess cognitive distortions relating to sexual offending in males with intellectual disabilities (ID). Cognitive distortions form part of the offence chain in sexual offending and as such require effective assessment and treatment.

METHOD

The QACSO manual and studies utilizing the QACSO were examined.

RESULTS

An overview of characteristics of the QACSO is outlined. The strengths and limitations of the measure are discussed, including validity and reliability of the measure and normative samples.

CONCLUSIONS

The QACSO is a valuable tool in assessing cognitive distortions in intellectual disability sexual offenders. Whilst there are some concerns about validity and reliability which it would be beneficial to address, overall the measure has utility in forensic practice and research, and is unique for being developed specifically for intellectual disability offenders.

Risk Assessment of Adolescents with Intellectual Disabilities Who Exhibit Sexual Behavior Problems or Sexual Offending Behavior

Adolescents with intellectual disabilities are known to engage in various sexual behavior problems or sexual offending behaviors. This article provides a review of important aspects of risk assessment within the context of a broader, more comprehensive and holistic assessment of these individuals. Pertinent risk and sexual interest assessment tools are identified along with their strengths and limitations. Issues that are often unattended to are addressed, including consideration of the behavioral implications of the young person's diagnosis and level of cognitive functioning, need for sexual knowledge and sexual interest assessment, and issues related to making a mental health diagnosis. Recommendations for future research are also offered.

A Systematic Review of Behavioral Health Interventions for Sex Offenders With Intellectual Disabilities

This article reviews evaluation studies of programs designed to treat sex offenders with intellectual and developmental disabilities (IDD) published in peer-reviewed journals between 1994 and 2014. The design of this study is mirrored after PRISMA (Preferred Reporting of Items for Systematic Reviews and Meta-Analyses) recommendations for conducting a systematic literature review. The study design, study setting, characteristics of participants, type of treatment, and intervention procedures comprise areas of focus for evaluating the implementation of treatment programs. Therapeutic outcomes include changes in attitudes consistent with sex offending, victim empathy, sexual knowledge, cognitive distortions, and problem sexual behaviors. Eighteen treatment evaluation studies were identified from the United States, the United Kingdom, Australia, and New Zealand. Cognitive-behavioral treatments were the most commonly delivered treatment modality to sex offenders with IDD. Other less common treatments were dialectical behavioral therapy, problem solving therapy, mindfulness, and relapse prevention. No randomized controlled trials were identified. The most common designs were multiple case studies and pre- and post-treatment assessments with no control and repeated measures follow-up. Small sample sizes, no control groups, and wide variation in treatment length and follow-up time complicate the qualitative synthesis of study findings. Short follow-up times introduce the potential for bias in conclusions surrounding treatment efficacy for many of the studies reviewed in this analysis. The overall quality of studies examining treatments for sex offenders with IDD is poor and requires further development before rendering firm conclusions about the effectiveness of interventions for this population.

Individuals with developmental delay and problematic sexual behaviors

The field of sex offenders with intellectual and developmental disabilities (IDD) has attracted a significant amount of research in the last 5 to 10 years. This research has included theoretical work on the reasons why men with IDD might engage in problematic sexual behaviours, work on the assessment of risk for future incidents, research investigating the pathways into and through services for sex offenders with IDD and a considerable amount of work developing and evaluating effective treatments. This paper will review the recent research on each of these areas in turn.