Male mentally handicapped sex offenders

The Impact of Mental Illness and Intellectual Disability Information on General Public Perceptions of a Person Convicted of a Child Sex Offence

A person convicted of sex offences (PCSO) is confronted with several challenges upon re-entry to the community, often facing difficulties accessing housing and employment, and experiencing stigmatisation, hostility and harassment from community members. Given the importance of community support for successful reintegration, we examined differences in public (N = 117) attitudes toward a PCSO against a child (PCSO-C) with mental illness or intellectual disability compared to a neurotypical PCSO-C in an online survey. At present, differences in attitudes towards these groups has not been explored. Results indicated the PCSO-Cs with intellectual disability or mental illness were seen to pose less risk of sexual reoffending and prompted higher levels of reintegration comfort than the neurotypical PCSO-C. Participants' prior personal exposure to mental illness or intellectual disability was unrelated to attitudes, but those who believed that PCSOs in general have a low capacity for change attributed greater risk of sexual reoffending, greater risk of future harm to children, higher levels of blame and lower reintegration comfort, regardless of MI and ID information. Female participants also perceived greater risk of future harm to adults, and older participants estimated higher risk of sexual reoffending than younger participants. Findings have implications for community acceptance of PCSO-Cs and jury decision-making processes and highlight the importance of public education regarding neurodiverse PCSO-Cs and PCSO capacity for change to encourage knowledge-based judgements.

Crimes and sentences in individuals with intellectual disability in a forensic psychiatric context: a register-based study

Aims

To study associations between intellectual disability (ID) and sexual and violent offending among individuals subject to pre-trial forensic psychiatric assessment. To investigate sentences following pre-trial forensic psychiatric assessment in offenders with and without ID.

Methods

A population-based observational study using data from pre-trial forensic psychiatric assessments in Sweden (1997–2013), the Swedish National Crime Register and several other Swedish national registers. The study population consisted of 7450 offenders (87% men, 13% women) who were subject to forensic psychiatric assessment in 1997–2013, of whom 481 (6.5%) were clinically assessed as having ID.

Results

ID offenders were more likely than non-ID offenders to have a sexual crime as an index crime [26.2 v. 11.5%, adjusted odds ratio (OR) 2.7, 95% confidence interval (CI) 2.02–3.58] as well as previous convictions regarding sexual offending (10.4 v. 5.6%, adj OR 2.3, 95% CI 1.70–3.12). These associations were restricted to male offenders; sexual offending was uncommon among women. Comorbid attention-deficit hyperactivity disorder reduced the association between ID and sexual offending (adj OR 2.7 v. 3.1, p = 0.017), while comorbid autism spectrum disorder had no significant influence on the association (adj OR 2.7 v. 3.0, p = 0.059). Violent crime was equally common among ID and non-ID offenders. Offenders with ID were more likely than non-ID offenders to be sentenced to forensic psychiatric care or community sanctions and measures (such as probation, conditional sentences or fines) than to prison; however, 15% of individuals who received an ID diagnosis during the forensic psychiatric assessment were sentenced to prison. Previous criminal convictions, concurrent antisocial personality disorders and substance use disorders were associated with a higher probability of a prison sentence among offenders with ID.

Conclusions

Sexual crime is overrepresented among offenders with ID compared to offenders with other mental disorders than ID in forensic psychiatric contexts. ID offenders become subject to forensic psychiatric care and forensic psychiatric services need evidence-based treatment programmes for offenders with ID. In addition, there is a need for early intervention strategies suitable for disability services and special education schools, in order to address the complex needs of individuals with ID and prevent sexual and violent offending.

Risk Factors for Sexual Offenses Committed by Men With or Without a Low IQ: An Exploratory Study

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.

Similarities and Differences Between Youth Who Engaged in Intrafamilial and Extrafamilial Sexually Abusive Behavior: An Exploratory Study

This study examined differences between youth who engaged in intrafamilial (ISAB) and extrafamilial sexually abusive behavior (ESAB) on various characteristics covering the sociodemographic, offense-related, psychological, and environmental domains. A total of 85 Dutch male youth participated in this study. Information was obtained through self-report questionnaires and systematic screening of the case files. Youth who engaged in ISAB, compared with ESAB, came from larger families, were enrolled in higher levels of secondary education and started sexual offending at a younger age. Youth who engaged in ESAB were more frequently diagnosed with attention-deficit hyperactivity disorder (ADHD) and intellectual disabilities (ID) and primarily received longer treatment in the context of residential care. The findings are discussed in connection to the literature on (adult) sexual offending. The risk factors and criminogenic needs that distinguish youth who engaged in ISAB and ESAB appear different from those found in adult populations.

Crime Scene Behaviors and Characteristics of Offenders with Mental Illness: A Latent Class Analysis

The current study aimed to identify distinct types of crime scene behaviors based on the criminal planning and motivation of offenders with mental illness in South Korea. Furthermore, our study examined the relationships between the identified types of crime scene behaviors in terms of the offenders' sociodemographic characteristics, modus operandi, and types of mental illness. Utilizing latent class analysis, the associations between crime scene behavior types and offender characteristics such as demographic factors, crime scene actions, and criminal information were empirically investigated. In particular, based on a sample obtained from a national police database of offenses committed between 2006 and 2014, four offense groups were identified: (i) instrumental-planned, (ii) instrumental-unplanned, (iii) expressive-unplanned, and (iv) hybrid. Additionally, significant relationships were found between offense styles and offender characteristics as well as criminal backgrounds. The findings suggest that mental disorders influence the types of actions exhibited by offenders during the commission of their crime. The results are discussed in terms of their theoretical and practical utility to criminal investigation.

Forensic psychiatry for people with learning disability

The forensic psychiatry of learning disability is a subspeciality which exists on the ‘borderlines’ between other areas. It takes in information from forensic psychiatry, learning disability, child and adolescent psychiatry, psychology, genetics and pharmacology to name but a few.

Crime sexual e retardo mental

Apresentamos o caso de um homem que cometeu estupro de menino de cinco anos de idade. A perícia psiquiátrica concluiu que o mesmo apresentava retardo mental moderado, sendo inimputável. Atualmente ele cumpre medida de segurança em Hospital de Custódia e Tratamento Psiquiátrico do Rio de Janeiro. São discutidos fatores motivadores desse comportamento sexual, bem como as questões subjetivas do paciente que contribuíram para esse comportamento.

Organic Approaches to the Treatment of Paraphilics and Sex Offenders

Emphasizing the power and fundamental nature—comparable to the basic mammalian drive for food—of sex drives and urges in almost everybody, including paraphilics and sex offenders, this article gives an overview of biologically-based, or “organic” approaches to the treatment of paraphilics and sex offenders.

Organic treatment approaches for this population may be divided into surgical and pharmacotherapeutic categories. Surgical approaches include castration (orchiectomy), sterotactic (brain) surgery and estrogen implants, the latter two approaches are not used in the United States (U.S.). All surgical approaches act hormonally, in reducing or blocking the amount of circulating androgens in the subject. Pharmacotherapeutic approaches include: (1) Indirect-acting and direct-acting antiandrogen hormones, also intended to reduce or block the amount of circulating androgens in the subject. (2) Psychotropic medications for primary treatment of male aggressive hypersexuality, for treatment of co-occurring psychiatric symptomatology, or for both. (3) An experimental pharmacologic approach to the treatment of this population consists of the use of antiepileptic drugs, or “AED's” to stabilize the impulsivity/compulsivity of these subjects, in reducing the hypothesized “kindling” that may occur during impulsive/compulsive periods in these individuals.

Whatever organic approach may be used for paraphilics and sex offenders, such an approach alone is not sufficient treatment for this population. Psychotherapeutic and cognitive/behavioral approaches must also be included in these individuals' treatment regimens. A companion piece to this article, giving an overview of psychotherapeutic and cognitive/behavioral treatment approaches to this population will be published in a future issue of this Journal.

Crime and Legal Issues among Intellectually Disabled Individuals

Intellectual Disability (ID) can be caused by a variety of factors, which may lead to a variety of signs and symptoms. Individuals with ID are living in societies where during the past decade there is a steady increase in the amount of research focused on civil law, criminal law and mental health. In this chapter, there will be a theoretical presentation of the research on ID regarding criminal law and the different forms of aggressive behavior such as sexual violence, homicide, theft, arson and alcohol-drug abuse. There will be information on research regarding civil law and the most common problems for individuals with ID, such as financial capacity and capacity for medical consent. Finally, there will be a section for the most important issues regarding the trial and conviction for individuals with ID and a presentation of a recent research on attitudes toward ID and legal issues. The above will be examined through the prism of current neuropsychological data, while cross-cultural restrictions will be discussed.

Persons with intellectual disabilities and problematic sexual behaviors

Persons with intellectual disabilities who have been identified because they committed a sexual offense may have done so because of a sexual paraphilia. However, special consideration in assessment is required to determine whether the offense is caused by a paraphilia alone or whether other factors relating to the individual's intellectual disabilities may be especially significant. This article reviews some factors that have been identified as significant and provides an overview of treatment approaches from multiple perspectives.

Why do some people with intellectual disability engage in offending behaviour and what can we do about it? Editorial

BACKGROUND

The field of forensic intellectual disabilities has been developing rapidly over the last 15 years. Much of the work has been built on research in mainstream criminality but more recently studies have emerged that reveal issues specific to offenders with intellectual disability.

METHOD

Research on pathways into offending is reviewed with reference to its relevance to the field of intellectual disability. We also summarize some findings on pathways into and through services for offenders with intellectual disability.

FINDINGS

Studies reveal that developmental adversity is an important risk variable. Previous and recent aggression are potent risk factors. New evidence suggests that immediate, proximal risk factors may be more important in this client group. The studies in this issue add to the knowledge on pathways into offending, important areas for assessment and effective treatments as well as advancing knowledge in the academic literature on general criminality.

Comparison of intellectually disabled offenders with a combined history of sexual offenses and other offenses versus intellectually disabled offenders without a history of sexual offenses on dynamic client and environmental factors

Sexually offensive behavior is prevalent among individuals with intellectual disabilities (ID) and many sex offenders also commit other offenses such as vandalism or assault. We examined the differences between sex offenders with ID and a history of combined sex and other types of offenses (mixed sex offenders) versus offenders with no history of sexual offenses (non-sex offenders). Dynamic client and environmental factors were measured using the Adult Behaviour Checklist (ABCL) and the Risk Inventarization Scale on Sexually Offensive Behavior of Clients with intellectual disabilities (RISC-V). Item, subscale, and total scores were then compared for the two groups. Most of the comparisons did not reveal significant differences between the two groups. The findings call for a general theory of offending behavior to explain the absence of differences between the mixed sex offenders and non-sex offenders with ID.

An evaluation and 20-year follow-up of a community forensic intellectual disability service

BACKGROUND

Since the middle of the 20th century, there have been several heterogeneous studies of recidivism by offenders with intellectual disabilities (ID) who have been in specialist mental health services after an index offence. Although some were long term, as befits a chronically needy group, laws and services have changed in that time. It may no longer be appropriate to rely on findings from the 1960s and 1970s.

AIMS

To compare mental health presentations and recidivism between male sex offenders, men convicted of other offences and female offenders from a 1986-2008 cohort of offenders referred to specialist forensic ID services in Scotland.

METHOD

A 20-year follow-up of an assessment and treatment service for 309 offenders with ID (156 sex offenders, 126 non sexual male offenders and 27 women) was conducted.

RESULTS

Sex offenders were more likely to be referred from the courts and had lower anger levels. Women were more likely to be diagnosed with mental illness. There was a split between groups with sex offenders committing few nonsexual offences and the other groups showing few sexual offences. During the study period, 16% of sexual offenders, 43% of male nonsexual offenders and 23% of women committed at least one further offence. Following assessment and treatment there was a 90-95% reduction in offending incidents.

CONCLUSIONS

Although recidivism rates are disappointing, harm reduction data suggests that assessment and treatment for offenders with ID can be highly successful in terms of public safety.

Maltreatment and depression in adolescent sexual offenders with an autism spectrum disorder

This study examined the self-reported presence and severity of abuse, neglect, and depressive symptoms for 43 adolescents adjudicated delinquent due to a sexual offense. Twenty-seven of the adolescent sexual offenders were also diagnosed with an autism spectrum disorder, and 16 did not carry an autism spectrum disorder diagnosis. Both groups reported moderate to high levels of abuse and neglect. Adolescent sexual offenders with an autism spectrum disorder reported significantly higher depressive symptoms than those without an autism spectrum disorder. Furthermore, of the group with an autism spectrum disorder, those reporting severe levels of emotional abuse and/or emotional neglect were more likely to also have depressive symptoms. Results suggest a need to tailor treatment programs to match the unique needs of sexual offenders.

Physical conditions and challenging behaviour in people with intellectual disability: a systematic review

BACKGROUND

Challenging behaviour is a major problem among people with intellectual disabilities. Physical factors may be an important cause. The aim of the present systematic review was to determine the physical conditions associated with challenging behaviour.

METHODS

A literature search was conducted in PubMed and the Cochrane systematic review database for empirical studies published between 1990 and 2008. The quality of all the studies that met the inclusion criteria was assessed using the SIGN-50 methodology checklists.

RESULTS

The search identified 45 studies, which looked at general medical conditions, motor impairment, epilepsy, sensory impairment, gastrointestinal disease, sleep disorders, dementia and others. There were four high-quality observational studies, seven well-conducted observational studies, 21 observational studies of low methodological quality and 13 non-analytical studies. There were significant and independent associations between challenging behaviours and urinary incontinence, pain related to cerebral palsy and chronic sleep problems, and between self-injurious behaviour and visual impairment. No association was found with hearing impairment, bowel incontinence, mobility impairment or epilepsy. Many other physical conditions were not addressed at all.

CONCLUSION

Medical conditions can play a role in challenging behaviour, and this should be evaluated in the clinical setting. So far, the level of evidence is generally low, and longitudinal studies are completely lacking. We recommend a systematic approach to research examining the role of physical conditions in challenging behaviour, the ultimate aim being to establish a basis for the development of clinical guidelines.

Pharmacological management of inappropriate sexual behaviours: a review of its evidence, rationale and scope in relation to men with intellectual disabilities

BACKGROUND

The management of inappropriate sexual behaviours (ISB) including sexual offending is difficult, especially when the person treated has intellectual disabilities (ID). Psychological therapies are the accepted first line of treatment. Pharmacological treatments have also been advocated, particularly for people who have committed serious sexual offences. There is limited information on available drugs and evidence of their efficacy in the treatment of ISBs, in particular for people with ID.

METHODS

A literature search of electronic databases was undertaken. Pharmaceutical companies were contacted for unpublished information. Trials that included people with ID were systematically reviewed for the benefits and outcome in that population.

RESULTS

Androgen depleting drugs (cyproterone acetate, medroxyprogesterone acetate and luteinising hormone releasing hormone agonists) and psychotropic drugs (serotonin specific reuptake inhibitors and antipsychotics) are the two major categories of medications used in the treatment of ISBs. The majority of studies identified were open trials and most relied on self-report measures. Trials that included people with ID were few in number. Most trials indicated beneficial effects including reduction in sexually deviant fantasies and behaviours.

CONCLUSION

The quality of evidence base for the use of pharmacological agents in the treatment of ISBs is inadequate to justify their use in routine clinical practice. If used, they should only be a part of a comprehensive treatment programme and closely monitored. In addition, there are several clinical, ethical and legal issues to be addressed before considering pharmacological treatment of ISBs in people with ID.

Sexual preferences and recidivism of sex offenders with mental retardation

By some accounts, sex offenders with mental retardation commit sex offenses against children because the offenders lack sexual knowledge or are socially and intellectually immature rather than because of sexually deviant interests. By other accounts, these offenders exhibit pedophilic sexual interests. In this study, phallometrically determined sexual interests, recidivism, and choices of victims of 69 sex offenders with mental retardation are examined and compared with those of 69 sex offenders of average or higher IQ. Consistent with hypotheses, sex offenders with mental retardation exhibit more deviant preferences for prepubertal children, male children, and young children than do the comparison offenders. They are also more likely to have had a prepubertal victim, a prepubertal male victim, and a very young victim. They are no more likely than the comparison offenders to exhibit preferences for extremely coercive sex with children or to exhibit deviant adult activity preferences, nor are they more likely to recidivate violently. Results support the idea that pedophilia is a disorder of neurodevelopment and point to the importance of risk assessments that include assessing sexual preferences among sex offenders with mental retardation.

Are the mentally retarded and learning disordered overrepresented among sex offenders and paraphilics?

A sample of 2,286 male sex offenders and paraphilics and 241 nonsex offenders was evaluated for the prevalence of mental retardation and learning disorders, using the full Wechsler IQ scales. The sex offenders were generally of average intelligence, and the mentally retarded were not overrepresented among them, but the learning disordered were. There were no differences among sex offenders and controls in overall IQ or in the percentage of mentally retarded or learning-disordered cases, suggesting that the learning difficulties are not peculiar to sex offenders. There was a bias in referral source, with more mentally retarded, borderline-retarded, and/or learning-disordered cases being referred by the Children's Aid Society, prisons, and the Crown, suggesting that referral source may play a significant role in evaluating intelligence and mental retardation among sex offenders; but the overrepresentation of learning disorders among criminals appears to be a significant phenomenon, regardless of referral source.

Personality disorder and offending in people with learning disabilities

This article reviews the literature on personality disorder in offenders with learning disabilities, using Medline, PsychoInfo and CINAHL databases, and search terms ‘offending’, ‘personality disorder and intellectual disabilities’, ‘learning disabilities’ and related terms. Methods of defining offending population, personality disorder and learning disabilities vary greatly, and few studies focus specifically on personality disorder, learning disability and offending. The definition of learning disability often encompasses both borderline learning disability and low average intelligence. Personality disorder, especially anti‐social personality disorder, is prevalent in offenders with learning disabilities, but less than in the general population, and is associated with higher levels of security and poorer outcomes. The study concludes that there is a continuum of offenders with borderline and mild learning disabilities, reflected in learning disability forensic services.

Risk assessment in offenders with intellectual disability: a comparison across three levels of security

In mainstream offender samples, several risk assessments have been evaluated for predictive validity. This study extends this work to male offenders with intellectual disabilities. Participants from high-, medium-, and low-security settings, as well as community settings, were compared on a range of risk assessments. The Violence Risk Appraisal Guide, HCR-20-Historical Scale, the Risk Matrix 2000-C (combined risk), and the Emotional Problems Scales-Internalising discriminated between groups, with participants from high security having higher scores than those in medium security, who had higher scores than those in the community. The Violence Risk Appraisal Guide, all HCR-20 scales, the Short Dynamic Risk Scale, and the Emotional Problems Scales (Internalising and Externalising) showed significant areas under the curve for the prediction of violence. The Static-99 showed a significant area under the curve for the prediction of sexual incidents. The discussion reviews the value of these various scales to intellectual disability services.

Interventions for learning disabled sex offenders

BACKGROUND

The management of sex offenders is a major public concern. Behavioural and pharmacological interventions have been used for many years and more recently cognitive behavioural based interventions have become popular around the world. Programmes designed for the general population have been modified for those sex offenders with learning disability, to address their cognitive deficits. The efficacy of these modified programmes is unclear.

OBJECTIVES

To determine the efficacy of interventions with learning disabled sex offenders.

SEARCH STRATEGY

The reviewers searched the Cochrane Library 2006 (Issue 1), MEDLINE (1966 to Sept 2006), Embase (1980 to September 2006), CINAHL (1982 to September 2006), PsycINFO (1872 to September 2006), Biological Abstracts (1980 to September 2006).

SELECTION CRITERIA

All randomised controlled trials comparing an intervention for learning disabled sex offenders to any other, or no intervention.

DATA COLLECTION AND ANALYSIS

Data were independently extracted.

MAIN RESULTS

No randomised controlled trial was identified.

AUTHORS' CONCLUSIONS

Using the methods described the reviewers found no randomised controlled trial evidence to guide the use of interventions for learning disabled sex offenders. Until the urgent need for randomised controlled trials is met, clinical practice will continue to be guided by either extrapolation of evidence from randomised controlled trials involving sex offenders without learning disability or non-randomised trial evidence of interventions for the learning disabled sex offender.

Community management of sex offenders with intellectual disabilities: characteristics, services, and outcome of a statewide program

The state of Vermont closed its only institution for persons with intellectual disabilities in 1993 and moved to a totally community-based model of services. Here we describe the characteristics of the near exhaustive statewide sample of adult male sex offenders with intellectual disabilities (N=103) who received these services between 1993 and 2004, discuss these services, and examine the sexual recidivism rates of the sample. Over an average follow-up period of 5.8 years, 10.7% of the sample was identified as having sexually reoffended. Most reoffenses were noncontact, and most victims were staff members, relatives, or housemates of the abuser. Results are discussed in terms of their clinical, policy, and research implications.

Cognitive-behavioural treatment for men with intellectual disabilities and sexually abusive behaviour: a pilot study

BACKGROUND

Cognitive-behaviour therapy (CBT) seems to be becoming the treatment of choice for non-disabled sex offenders. Nevertheless, there have been relatively few evaluations of such treatment for men with intellectual disabilities (ID) and sexually abusive behaviour.

METHOD

A pilot study providing CBT for two groups of men with ID is described. Measures of change in sexual knowledge, victim empathy and cognitive distortions were collected, together with a log of further sexually abusive behaviour.

RESULTS

Fifteen men were offered treatment but some dropped out and some declined to take part in the research. The results for the eight men who consented to the research and completed treatment showed significant positive changes in sexual knowledge and victim empathy (two men completed both groups, making 10 sets of data in all). Cognitive distortions showed significant change on only one of the two measures. Some men showed further sexually abusive behaviour either during or after the treatment group (all had been previously diagnosed as on the autistic spectrum).

CONCLUSION

There is a need for a larger multi-site trial of treatment with a broad set of measures and the ability to analyse who benefits from such treatments and who does not.

A preliminary evaluation of the adaptation of four assessments for offenders with special needs

BACKGROUND

Appropriate assessment is an essential part of treating sexual offenders. Few assessments exist that can be used with offenders who have lower levels of intellectual functioning and/or literacy deficits.

METHOD

This study describes the adaptation of four self-report assessments for sexual offenders with special needs: (i) the Social Intimacy Scale (SIS: Miller & Lefcourt, 1982); (ii) the Relationship Scales Questionnaire (RSQ: Griffin & Bartholomew, 1994a); (iii) the Criminal Sentiments Scale (CSS: Gendreau, Grant, Leipciger, & Collins, 1979); and (iv) the Victim Empathy Distortion Scale (QVES: Beckett & Fisher, 1994). Each scale was adapted in an effort to simplify content and language and to improve readability. Preliminary data are presented on the comparability of each adapted measure to the original, as well as the internal consistency, reliability, and concurrent validity of the adapted tests.

RESULTS

The SIS and the QVES were identified as appropriate assessment measures, comparable to the original with good reliability and validity. One subscale of the RSQ had fair reliability and validity, while the remaining subscales had varied psychometric properties. The adapted CSS had poor psychometric qualities and the adaptation of this test appears not to have been successful.

CONCLUSIONS

The relevance of these findings to our understanding of offending by this population is discussed.

Sexual knowledge and attitudes of men with intellectual disability who sexually offend

BACKGROUND

Various explanations of sexual offending in men with intellectual disability (ID) have stressed sexual deviance and a lack of developmental socio-sexual knowledge.

METHOD

Using the normative dataset of people with ID from the development of the Socio-Sexual Knowledge and Attitudes Assessment Tool - Revised (SSKAAT-R: Griffiths & Lunsky, 2003), two samples of individuals with ID and a history of sexual offence were compared on sexual knowledge to matched samples of individuals with ID and no known sexual offences.

RESULTS

Offenders with ID who were identified as having engaged in sexually inappropriate behaviour, such as public masturbation or touching someone inappropriately, did not differ in terms of sexual knowledge from their matched sample of individuals with ID with no sexual offence history, whereas offenders who had committed more serious offences demonstrated greater sexual knowledge than matched non-offenders. When only those individuals who had received prior sex education were compared in terms of sexual knowledge, there were no differences between groups. However, sex offenders (serious offences) expressed more liberal attitudes than sex offenders (inappropriate behaviour) and non-offenders towards same-sex activities.

CONCLUSIONS

The study points to the dynamic effect of socio-sexual education on offenders' knowledge and attitudes, and highlights potential differences in the knowledge and attitudes of different subtypes of offenders.

Assessment of deviant arousal in adult male sex offenders with developmental disabilities

Ten individuals, residing in a treatment facility specializing in the rehabilitation of sex offenders with developmental disabilities, participated in an arousal assessment involving the use of the penile plethysmograph. The arousal assessments involved measuring change in penile circumference to various categories of stimuli both appropriate (adult men and women) and inappropriate (e.g., 8- to 9-year-old boys and girls). This approach extends the existing assessment literature by the use of repeated measurement and single-subject experimental design. Data from these assessments were analyzed to determine if clear and informative outcomes were obtained. Overall, three general patterns of results emerged. Some participants showed differentiated deviant arousal or higher levels of arousal to specific inappropriate stimuli (deviant is a term used in the existing sex-offender literature to describe this type of arousal). Other participants showed undifferentiated deviant arousal, in which case they showed nonspecific arousal to inappropriate stimuli. The remaining participants showed no arousal to inappropriate stimuli but did show arousal to appropriate stimuli. Implications for assessment, treatment, and future directions are discussed.

Treating sexual offenders with learning disabilities in the community: a critical review

This study offers a critical review of a treatment group for sexual offenders with learning disabilities. The participants were diverted from criminal proceedings due to their level of cognitive functioning and attended a 7-month treatment program comprising of four main components: sex education, cognitive distortions, offending cycle, and relapse prevention. A number of psychometric assessments were administered immediately before and after intervention. Although no significant differences were found in attitudes toward sexual offending following treatment, the trend was for improvements in sex knowledge and honesty of sexual interest. Improvements in socialization skills (leisure time and interpersonal skills) were significant. No further incidents of sexual offending have been reported during a 12-month follow-up. A number of explanations for the nonsignificant improvement in attitudes are considered and recommendations for future treatment evaluation studies are made. The development of specific questionnaires and treatment programs for sexual offenders with learning disabilities is discussed.

A test of counterfeit deviance: a comparison of sexual knowledge in groups of sex offenders with intellectual disability and controls

Several authors have suggested that lack of sexual knowledge is a primary reason for inappropriate sexual behaviour in men with intellectual disabilities. This hypothesis, counterfeit deviance, is tested in the current report with two separate cohorts comparing sex offenders and controls, both with intellectual disability. The Socio-Sexual Knowledge and Attitudes Test was completed on all participants and any significant differences between groups indicated that the sex offender cohort had a higher level of knowledge. The hypothesis has not been supported. In addition, a positive relationship was found between intellectual ability and knowledge for the control cohort but not for the sex offender cohort.

Quality of life and relationships in sex offenders with intellectual disability

BACKGROUND

Hayes (1991) and Day (1994) have developed hypotheses about the importance of social and developmental variables in the aetiology of sexual offences in offenders with intellectual disability. The present study is the first of its kind to investigate the perceived quality of life and relationships of sex offenders in comparison to an appropriate control group.

METHOD

A group of 28 sex offenders with intellectual disability (ID) were compared with 28 members of a control group of individuals with ID. All participants completed the Significant Others Scale (SOS) which assesses self-perceptions of potential and ideal support from significant others in the individual's life, and the Life Experience Checklist (LEC) which assesses experiences and opportunities across 5 living domains: home, leisure, freedom, relationships and opportunities.

RESULTS

There were no differences between the groups on age and IQ. On the SOS there were no differences between the groups on the number of times each significant other was reported. Actual and ideal levels of support from both mother and father were lower for sex offenders than the control group. On the LEC, sex offenders reported lower scores on the relationships and leisure sections.

CONCLUSIONS

Poorer relationships and little indication of any wish to change that state of affairs suggests lower levels of integration and identification with society for sex offenders compared with the control group.

A comparison of offenders with intellectual disability across three levels of security

BACKGROUND

A number of authors have described, with disparate results, the prevalence of people with intellectual disability and their characteristics, in a range of offender cohorts defined by service use. These have included high security, a range of criminal justice services and community services. There is a need for research comparing cohorts of offenders with intellectual disabilities across different settings. AIM AND HYPOTHESIS: To conduct such a comparison and test the hypothesis that severity of characteristics measured will be highest in highest levels of residential security.

METHOD

A clinical-record-based comparison a offenders with intellectual disability in high security (n = 73), medium/low security (n = 70), and a community service (n = 69).

RESULTS

Groups were similar in age and tested IQ levels. Early psychiatric service contact had been more likely in the lower security groups. In line with the hypothesis, more complex presentations, in particular comorbid personality disorder, was more likely in the highest security group. Both fatal and non-fatal interpersonal violence convictions were significantly related to group, with more in the high security group sustaining a conviction both at the index offence and prior to that. Over 50% of all groups had at least one conviction for a sexual offence. A regression model accounting for 78% of the variance was made up largely of disposal variables (Mental Health Act status and probation) and indications of antisocial traits (criminal damage, lifetime conviction for murder and ICD-10 personality disorder classification).

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The authors show that context of sampling affects most relationships between intellectual disability (ID) and offending when the methods for measuring ID are held constant. The results also present several questions on the relationship between risk, services available in an area and referral to higher security.

Personality disorders in people with learning disabilities: follow-up of a community survey

BACKGROUND

A sample of community-based service users with intellectual disability (ID) was re-examined after 5 years to determine the impact of a diagnosis of personality disorder (PD).

METHODS

Seventy-five of the original 101 participants were followed up. Of these, 21 people had a PD identified during the original study.

RESULTS

Compared with controls, people with a PD were significantly more likely to receive central nervous system (CNS) drugs, have more contact with psychiatric services, show increased offending behaviour, score higher on the Aberrant Behaviour Checklist and score above the threshold on the Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD). Participants with PD recorded were more likely to have a recorded psychiatric disorder, have contact with specialist teams, and have more hospital admissions.

CONCLUSION

People with ID and PD are able to live in the community with specialist support but improved assessment, diagnosis and support services need to be targeted more effectively to them.

Quantitative reanalysis of aggregate data on IQ in sexual offenders

General intelligence has been the most commonly studied neuropsychological characteristic of sexual offenders for over 70 years. Results, however, have been highly inconsistent. To assess whether sexual offenders score lower in IQ than nonsexual offenders and to explore which sexual offense characteristics relate to IQ, the authors reanalyzed all reports providing sufficient information. Data spanned 236 samples, comprising 25,146 sexual offenders and controls. The literature contained sufficient information to permit comparison of adult versus juvenile sexual offenders, offenders targeting children versus adults, offenders targeting their own versus unrelated children, and offenders targeting boys versus girls. Results confirm the association between IQ and sexual offending and suggest that previous discrepancies are attributable to how many pedophilic individuals were in each sample.

On intelligence and crime: a comparison of incarcerated sex offenders and serious non-sexual violent criminals

The impact of low IQ on crime has been a focus of debate for several decades now. Although sociologists have virtually removed it from the list of possible factors influencing crime, the impact of IQ on crime continues to generate a significant amount of scientific research and a substantial number of publications. The purpose of this study is to assess intellectual levels and to compare two groups of incarcerated criminals. Using MANCOVA and ANCOVA procedures, 261 sex offenders and 150 non-sexual violent criminals were compared on IQ subscales. The results show significant differences on vocabulary, comprehension, arithmetic, mental math computations, object assembly, letter-number sequencing, and perception subscales, as well as on performance IQ and total IQ. The impacts of penal filtering and sample composition are hypothesized to explain differences between the two subgroups. Theoretical and practical implications are discussed.

Sex offenders with an intellectual disability

It is only in recent years that the myth of the incorrigible and untreatable sex offender with an intellectual disability has been seriously questioned. Current assessment and treatment approaches in this area assume that such offenders are accountable for their actions and treatable with appropriately modified techniques. Even though they may be initially hard to engage in the assessment and treatment process, the use of simplified approaches that support the day-to-day reinforcement of treatment concepts is proving to be effective with this population.

Women with intellectual disability who have offended: characteristics and outcome

BACKGROUND

There have been a few reports describing the characteristics and outcomes of male offenders with intellectual disability (ID). Therefore, while we are building up a reasonable picture of this client group, there are almost no reports of female offenders with ID. This paper is a preliminary attempt to present information on a small cohort of female offenders.

METHODS

Characteristics of female offenders are presented including information on age, IQ, mental illness, referring agents, crimes committed, problems identified, sexual and physical abuse and outcome. Some comparisons are made with corresponding descriptions of male cohorts in Lindsay et al. (2004).

RESULTS

The main result is that females constitute 9% of referrals to the service. Other notable results are that: at 61% sexual abuse in the cohort of female offenders is higher than in male cohorts but at 38.5% physical abuse is no higher than in appropriate comparison groups; as with mainstream female offenders identification of mental illness is high at 67%; and total re-offending over 5 years was 22% but, excluding prostitution, was only 16.5%.

CONCLUSIONS

In some respects, this cohort of female offenders shows similar characteristics to their male counterparts. However, there are higher levels of mental illness, higher levels of sexual abuse and lower levels of re-offending. It is hypothesized that as females constitute such a low percentage of referrals, it suggests that women with ID do not show the same levels of sexually abusive behaviour or aggressive behaviour--the two most frequent reasons for male referral. Therefore, an intervening variable such as mental illness may indeed be a significant factor. Lower re-offending rates may indicate the success of interventions directed at psychological problems and mental illness.

Sexual and nonsexual offenders with intellectual and learning disabilities: a comparison of characteristics, referral patterns, and outcome

This article reports an evaluation of a community intellectual disability offender service over the period from 1990 to 2001. Men who committed sex offenses or sexually abusive incidents (n = 106) and men who committed other types of offenses and serious incidents (n = 78) are compared on personal characteristics, referral sources, forensic details, and outcome up to 7 years after referral. The cohorts are older than one would expect from the criminology literature, and, at about 33%, the incidence of mental illness is consistent with some previous studies. A greater proportion of sex offenders had criminal justice involvement and a formal disposal from court. Fire raising was not overly represented as an offense. There was a higher rate of reoffending in the nonsexual cohort, which persisted up to 7 years. Investigating only reoffenders, there was a considerable amount of harm reduction recorded up to 7 years, statistically significant up to 5 years following initial referral.

Dangerous Children: Assessment and Management of Risk

BACKGROUND

  Workers in the field of child health appear to be presented with increasing numbers of young people who exhibit behaviours that pose a potential or actual risk to the safety of others.

METHOD

  A review of the current literature on the assessment and management of these children and adolescents was conducted.

RESULTS

  A history taking check-list has been devised on the basis of what is known about current associations with background and current factors and violent acts directed to others. There is emerging evidence of interventions that may be effective in reducing long-term risks in such youths. However, these are often resource intensive and may be less effective in older children and adolescents.

CONCLUSIONS

  Faced with the challenge of assessing and managing severely conduct disordered children, child and family mental health teams should develop formalised assessment procedures and protocols for managing risk factors in a multi-agency context.

Epidemiology and treatment of juvenile sexual offending

The juvenile sex offender is defined as a youth who commits any sexual act with a person of any age against the victim's will, or in an aggressive, exploitative, or threatening manner. The term 'child molester' refers to those who choose only, or primarily, child victims. In this article, we mostly focus on adolescents aged between 13 and 18 years. To reduce sex crimes and the risk of adolescent sexual re-offending, effective treatment strategies have to be implemented for adolescent sexual offenders. Supervision and treatment recommendations for juvenile sex offenders initially emerged from the literature on adult sex offenders. Treatment must include behavioral therapy, family therapy, and psychosocial interventions. Pharmacotherapy is not always a first-line treatment. Antidepressants (especially selective serotonin reuptake inhibitors) offer promise in the treatment of adolescent sexual offending but further controlled studies are needed. In some rare situations, however, especially when severe paraphilic behaviors (such as pedophilia) are present, an hormonal intervention such as cyproterone acetate treatment may be needed.

A comparison of anxiety and depression in sex offenders with intellectual disability and a control group with intellectual disability

The aims of this study were to employ modified versions of the 21-item Beck Anxiety and Depression Inventories with a group of 16 sex offenders with mild intellectual disability and borderline intelligence and 16 control participants with similar levels of intellectual disability. Test-retest correlations found high reliability for both assessments across all participants. There was a significant differences between the scores of the 2 groups with the sex offenders reporting significantly lower levels of anxiety and depression than the control participants. The results are discussed by presenting hypotheses on the emotional stability in each group.