The contribution of psychopathic traits and substance use in the prediction of recidivism of sexual offenders.

Substance use and dependence may play an essential role in the risk of reoffending by sex offenders. Research examining the influence of substance use and dependence on the criminal behaviour of psychopathic sex offenders is limited. Alcohol and drug use have been identified as factors which promote criminal behaviour and are suspected to contribute, at least partially, to the probability of reoffending. For instance, previous research showed that elevated scores on the Michigan Alcohol Screening Test (MAST) contribute to the predictability of the Hare Psychopathy Checklist - Revised (PCL-R) on recidivism. The current study retrospectively evaluated a database of incarcerated high-risk offenders registered in the Regional Treatment Center, Sex Offender Treatment Program (RTCSOTP); in order to assess the contribution of self-disclosed histories of alcohol and substance use and dependency have, in concert with measures of psychopathic characteristics, on the predictability of recidivism. Results of the retrospective data identified PCL-R and DAST (Drug Abuse Screening Test) scores as significant predictors of sexual and violent recidivism of male inmates undergoing treatment in RTCSOTP within 5 years of their release. MAST scores, however, did not significantly contribute to the predictability of sexual and violent recidivism in this population. We conclude, drug use should be considered as an important factor when addressing recidivism in sexual offenders who demonstrate psychopathic characteristics.

To Reoffend or Not to Reoffend? An Investigation of Recidivism Among Individuals With Sexual Offense Histories and Psychopathy.

Although psychopathy is a well-established risk factor for recidivism among those who have committed sexual offenses, there are nonetheless some individuals with sexual offense histories who are high in psychopathy but do not recidivate. This population-nonrecidivating psychopathic sex offenders (NRP-SOs)-was the focus of the current investigation. Data from 111 individuals with sexual offense histories who received a Hare Psychopathy Checklist-Revised (PCL-R) rating of at least 25 (suggesting the presence of psychopathy) were analyzed. With recidivism operationalized as the accrual of any new serious-that is, violent or sexual-charges, 39 recidivated (RP-SOs), whereas 72 did not (NRP-SOs). A logistic regression was conducted to assess whether NRP-SOs could be differentiated from RP-SOs. Being older at the time of release, a lesser criminal history, and being married predicted nonrecidivism. PCL-R factor scores and sexual deviance were not predictive. These findings highlight the heterogeneity that exists, even among those high in psychopathy.

The Use of Leuprolide Acetate in the Management of High-Risk Sex Offenders.

The present study investigates whether leuprolide acetate (Lupron) adds to the efficacy of traditional sex offender treatment. A group of sex offenders receiving both Lupron and cognitive behavioral therapy (CBT; n = 25) were compared with a group of sex offenders receiving only CBT (n = 22). Treated subjects were compared with norms available with reference to the Static-99R, as well as compared with a sample of untreated, nonsexual violent offenders (n = 81), to provide baseline data regarding risk of violent recidivism. Results indicated that subjects receiving Lupron were at significantly higher risk of recidivism and significantly more likely to be diagnosed with a paraphilia than subjects receiving only CBT, a priori. Both treated groups of sexual offenders recidivated at substantially lower rates than predicted by the Static-99R. Currently, this study represents the only, long-term outcome study on Lupron administration using officially recorded recidivism as the primary dependent measure.

Emotional Congruence with Children: Are Implicit and Explicit Child-Like Self-Concept and Attitude Toward Children Associated with Sexual Offending Against Children?

Some men convicted of sexual offences against children express an exaggerated affiliation with childhood, ascribe child-like characteristics to themselves, experience strong non-sexual liking of children, and hold positive views of children and childhood. These features are generally called emotional congruence with children. The present study examined child-like self-concept, which is an association of self with children and child-like characteristics, attitude toward children, and general emotional congruence with children as correlates of sexual offending against children and pedophilia. Male participants (18 sexual offenders against unrelated children; 7 incest offenders; 22 non-sexual offenders; 54 students) completed newly developed implicit and explicit measures of child-like self-concept and attitude toward children, as well as more established self-report measures of emotional congruence with children. Assessments of pedophilic interest and sexual recidivism risk were obtained from official file information. Sexual offenders against unrelated children reported higher levels of implicit child-like self-concept and self-reported emotional congruence with children when compared to the other three groups. Implicit child-like self-concept showed a small correlation with emotional congruence measures, whereas implicit attitude toward children was moderately correlated with the emotional congruence measures. Implicit child-like self-concept, implicit attitude toward children, and the emotional congruence measures were associated with greater pedophilic interest and sexual recidivism risk. The present findings provide a nuanced understanding of the emotional congruence with children construct and have implications for theory, research, and treatment of sexual offenders against children.

Taxometric Analysis of the Latent Structure of Pedophilic Interest.

The present study examined the latent structure of pedophilic interest. Using data from phallometric tests for pedophilic interest across four samples of offenders (ns = 805, 632, 531, 261), taxometric analyses were conducted to identify whether pedophilic interest is best characterized as taxonic or dimensional. Across the samples, the majority of analyses supported taxonic latent structure in pedophilic interest. Visual inspection of taxometric curves indicated trichotomous latent structure (i.e., three-ordered classes) may characterize pedophilic interest in these samples. In a second step of taxometric analysis, the results supported trichotomous latent structure, indicating the presence of a complement taxon and two pedophilic taxa. In comparison with the complement taxon, the men in the first pedophilic taxon were non-exclusively pedophilic and had similar rates of sexual recidivism and sexual compulsivity. The men in the second pedophilic taxon were exclusively pedophilic, had more child victims and total victims, sexually re-offended at a higher rate, and were more sexually compulsive. The finding of trichotomous latent structure in pedophilic interest is both consistent and inconsistent with previous taxometric studies and has implications for research, assessment, and treatment of pedophilic interest.

Field Inter-Rater Reliability of the Psychopathy Checklist-Revised.

Strong inter-rater reliability has been established for the Hare Psychopathy Checklist-Revised (PCL-R), specifically by examiners in research contexts. However, there is less support for inter-reliability in applied settings. This study examined archival data that included a sample of sex offenders ( n = 178) who entered federal custody between 1992 and 1998. The offenders were assessed using the PCL-R on two occasions. The first assessment occurred at Millhaven Institution, the intake unit for federally incarcerated offenders in the province of Ontario. The second assessment took place upon inmates' transfer to the Regional Treatment Center, which admits federal inmates with intense psychological and psychiatric needs. Intra-class correlation coefficients (ICCs) were calculated for item, total, factor, and facet scores. The ICC absolute agreement for the PCL-R total and factor scores from raters across both settings was slightly better than what has been previously reported by Hare. Results of this study show that the reliability of PCL-R scores in field settings can be comparable to those in research settings. Authors conclude by highlighting the importance of training, consultation, considering different scores for a given item, following the guidelines of the manual in addition to considering measures that enhance neutrality and reliability of findings in the criminal justice system.

Individual Community-Based Treatment of Offenders With Mental Illness: Relationship to Recidivism.

This study explores the effectiveness of psychological intervention at reducing the risk of recidivism among a group of high-risk, high-need offenders housed in a Community Correctional Centre (CCC) operated by the Correctional Service of Canada (CSC). File reviews on 136 male federal offenders living in a CCC in a large metropolitan area were included in the present investigation. Previous research on this sample by our team indicated that the majority of this sample met diagnostic criteria for a variety of psychiatric conditions. Data on the number of individual counseling sessions received and progress in treatment were collected from official file information for the purpose of the present investigation. After accounting for actuarially assessed risk, moderate doses of treatment were found to be associated with 7.7 times less likelihood of recidivism, and high doses of treatment were found to be associated with 11.6 times less likelihood of recidivism, when compared with offenders who received no treatment or were only assessed for treatment. These results are discussed in the context of correctional models of offender risk assessment and rehabilitation. It is notable that a very simple measure of global mental health treatment attendance, with no consideration of such factors as responsiveness, added considerable incremental predictive validity to the results after having statistically accounted for actuarially assessed risk of recidivism.

Does Change on the MOLEST and RAPE Scales Predict Sexual Recidivism?

The purpose of the current study was to examine whether the MOLEST and RAPE scales and change on these measures predicted sexual recidivism in a sample of 146 adult male sexual offenders who participated in a high-intensity treatment program while incarcerated. The majority of subjects had functional scores on the MOLEST and RAPE scales prior to treatment. Of those who had dysfunctional pre-treatment scores, the majority made significant gains. However, the MOLEST and RAPE scales did not significantly predict sexual recidivism. This was the case for pre-treatment scores, post-treatment scores, and change scores. Our findings are generally not consistent with the view that these measures assess dynamic risk factors for sexual recidivism. However, this is the first published study to examine the predictive validity of these scales and more rigorous research is needed before firm conclusions can be drawn.

Does change in hostility predict sexual recidivism?

The purpose of the study was to examine whether scores on a widely used measure of hostility--the Buss-Durkee Hostility Inventory (BDHI)--and change on this measure predicted sexual recidivism in a sample of 120 adult male incarcerated sexual offenders. Pre- and posttreatment scores, simple difference scores, and clinically significant change were examined. The majority of participants had functional scores on the BDHI prior to treatment. Of those who had dysfunctional pretreatment scores, the majority remained unchanged. Higher posttreatment scores on the Assault and Verbal Hostility subscales significantly predicted sexual recidivism. The remaining pre- and posttreatment scores as well as change scores and classifications did not significantly predict sexual recidivism. Our findings suggest that the Assault and Verbal Hostility subscales may be useful for predicting sexual recidivism but were not clearly consistent with the notion that the BDHI assesses a dynamic risk factor(s) for sexual recidivism. Due to a number of limitations of the current study, however, more rigorous research is needed before firm conclusions can be drawn.

Mental health diagnoses and recidivism in paroled offenders.

Although the issue of mental illness among offender populations has received attention in the last number of years, there are a number of issues related to mental illness among such groups that require more study. One such topic relates to the association between mental illness, actuarially assessed risk of recidivism, and observed rates of reoffending. In the present investigation, file information was reviewed to determine the presence of a variety of mental health conditions. Actuarially based risk assessment data were also collected for participants as well as information regarding suspension, new charges, and convictions. A sample of 136 offenders housed in a halfway house operated by Correctional Service of Canada was included in the present investigation. Results indicated very high rates of serious mental illness in this high-risk population. Offenders with borderline personality disorder and attention deficit hyperactivity disorder were significantly more likely to recidivate or be suspended. Suspensions refer to administrative decisions to place an offender in jail due to problematic behaviour (typically involving a breach of his release conditions or new charges/convictions). Offenders with a diagnosis of paraphilic disorder were significantly less likely to recidivate or be suspended. Results are discussed in light of the available literature.

Adverse childhood experiences and adult criminality: how long must we live before we possess our own lives?

BACKGROUND: Empirical research associated with the Kaiser Permanente and Centers for Disease Control and Prevention Adverse Childhood Experiences (ACE) Study has demonstrated that ACE are associated with a range of negative outcomes in adulthood, including physical and mental health disorders and aggressive behavior. METHODS: Subjects from 4 different offender groups (N = 151) who were referred for treatment at an outpatient clinic in San Diego, CA, subsequent to conviction in criminal court, completed the ACE Questionnaire. Groups (nonsexual child abusers, domestic violence offenders, sexual offenders, and stalkers) were compared on the incidence of ACE, and comparisons were made between the group offenders and a normative sample. RESULTS: Results indicated that the offender group reported nearly four times as many adverse events in childhood than an adult male normative sample. Eight of ten events were found at significantly higher levels among the criminal population. In addition, convicted sexual offenders and child abusers were more likely to report experiencing sexual abuse in childhood than other offender types. CONCLUSIONS: On the basis of a review of the literature and current findings, criminal behavior can be added to the host of negative outcomes associated with scores on the ACE Questionnaire. Childhood adversity is associated with adult criminality. We suggest that to decrease criminal recidivism, treatment interventions must focus on the effects of early life experiences.

Comparing sexual offenders at the Regional Treatment Centre (Ontario) and the Florida Civil Commitment Center.

Sexual offender civil commitment (SOCC) continues to be a popular means of managing risk to the community in many U.S. jurisdictions. Most SOCC states report few releases, due in large part to the reluctance of the courts to release sexually violent persons/predators (SVPs). Contemporary risk prediction methods require suitable comparison groups, in addition to knowledge of postrelease behavior. Low SVP release rates makes production of local base rates difficult. This article compares descriptive statistics on two populations of sexual offenders: (a) participants in high-intensity treatment at the Regional Treatment Centre (RTC), a secure, prison-based treatment facility in Canada, and (b) SVP residents of the Florida Civil Commitment Center. Results show that these two samples are virtually identical. These groups are best described as "preselected for high risk/need," according to Static-99R normative sample research. It is suggested that reoffense rates of released RTC participants may serve as a comparison group for U.S. SVPs. Given current release practices associated with U.S. SOCC, these findings are of prospective value to clinicians, researchers, policy makers, and triers of fact.

The Static-99R: are there really differences between the normative groups?

A sample of 348 high-risk sexual offenders was divided into two groups based on the level of preselection (detained, n = 211, and nondetained, n = 137) and the groups were compared on a number of measures which were related to dynamic risk. The hypothesis was that the detained group would score as being higher need on these instruments than the nondetained group. This hypothesis was supported with the detained group reporting greater levels of hostility, cognitive distortions supportive of offending, sexual obsessions, and sexually deviant behaviours. They also scored as being less assertive and as having a more extensive psychiatric history. These findings were interpreted as being supportive of the assertion that the new Static-99R normative groups are related to preselection based on the differences on dynamic factors.

Does consideration of psychopathy and sexual deviance add to the predictive validity of the static-99R?

The Static-99 is the most commonly used actuarial risk assessment tool for the prediction of sexual recidivism. In addition, the use of psychopathy and sexual deviance has been common in assessing sexual offenders, based on research suggesting that these factors have predictive validity. It has also become common practice to modify risk assessments based on the Static-99/99R because of the presence of psychopathy and indicators of deviant sexual interests, although to date there has been no research validating this procedure. The current research was conducted to fill this gap in the literature. Using a sample of 272 sexual offenders, the extent to which psychopathy, sexual deviance, and their interaction added to the predictive validity of the Static-99R was examined. Analyses were conducted using the whole sample as well as subgroups of rapists and child molesters. It was found that although the Static-99R predicted sexual recidivism, adding psychopathy and sexual deviance in a Cox regression analysis did not improve the prediction. This held true for child molesters when examined on their own. For rapists, although psychopathy and sexual deviance did not contribute to the prediction of sexual recidivism, for serious (i.e., violent including sexual) recidivism, the inclusion of psychopathy added to the prediction. Results are discussed in terms of implications for practice.

Pedophilia: an evaluation of diagnostic and risk prediction methods.

One hundred thirty child sexual abusers were diagnosed using each of following four methods: (a) phallometric testing, (b) strict application of Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision [DSM-IV-TR]) criteria, (c) Rapid Risk Assessment of Sex Offender Recidivism (RRASOR) scores, and (d) "expert" diagnoses rendered by a seasoned clinician. Comparative utility and intermethod consistency of these methods are reported, along with recidivism data indicating predictive validity for risk management. Results suggest that inconsistency exists in diagnosing pedophilia, leading to diminished accuracy in risk assessment. Although the RRASOR and DSM-IV-TR methods were significantly correlated with expert ratings, RRASOR and DSM-IV-TR were unrelated to each other. Deviant arousal was not associated with any of the other methods. Only the expert ratings and RRASOR scores were predictive of sexual recidivism. Logistic regression analyses showed that expert diagnosis did not add to prediction of sexual offence recidivism over and above RRASOR alone. Findings are discussed within a context of encouragement of clinical consistency and evidence-based practice regarding treatment and risk management of those who sexually abuse children.

Substance abuse among high-risk sexual offenders: do measures of lifetime history of substance abuse add to the prediction of recidivism over actuarial risk assessment instruments?

There has been relatively little research on the degree to which measures of lifetime history of substance abuse add to the prediction of risk based on actuarial measures alone among sexual offenders. This issue is of relevance in that a history of substance abuse is related to relapse to substance using behavior. Furthermore, substance use has been found to be related to recidivism among sexual offenders. To investigate whether lifetime history of substance abuse adds to prediction over and above actuarial instruments alone, several measures of substance abuse were administered in conjunction with the Sex Offender Risk Appraisal Guide (SORAG). The SORAG was found to be the most accurate actuarial instrument for the prediction of serious recidivism (i.e., sexual or violent) among the sample included in the present investigation. Complete information, including follow-up data, were available for 250 offenders who attended the Regional Treatment Centre Sex Offender Treatment Program (RTCSOTP). The Michigan Alcohol Screening Test (MAST) and the Drug Abuse Screening Test (DAST) were used to assess lifetime history of substance abuse. The results of logistic regression procedures indicated that both the SORAG and the MAST independently added to the prediction of serious recidivism. The DAST did not add to prediction over the use of the SORAG alone. Implications for both the assessment and treatment of sexual offenders are discussed.

Comparison of measures of risk for recidivism in sexual offenders.

Data for both sexual and violent recidivism for the Static-99, Risk Matrix 2000 (RM 2000), Rapid Risk Assessment for Sex Offense Recidivism (RRASOR), and Static-2002 are reported for 419 released sexual offenders assessed at the Regional Treatment Centre Sexual Offender Treatment Program. Data are analyzed by offender type as well as the group as a whole. Overall, the Static-2002 performed best for both outcomes, although differences between measures were not significant. The one exception to this was the RRASOR, which overall performed poorly. For rapists, the Static-2002 performed best for sexual recidivism, and the Risk Matrix 2000 performed best for violent recidivism. None of the measures performed well in predicting recidivism for child molesters. The components of the Static-2002 were examined in a regression analysis predicting sexual recidivism. Persistence of Sexual Offending and Age at Release were the only significant predictors for the group as a whole and for rapists. For child molesters, only the Deviant Sexual Interests component was significant. Results are discussed in terms of the current debate concerning age and risk for reoffence.

Treatment of sexual offenders with psychopathic traits: recent research developments and clinical implications.

This article provides a review of recent literature related to the treatment of psychopathy in forensic settings, with particular focus on studies with sexual offenders. The lack of empirical support for the position that psychopaths are untreatable is noted, and data suggesting optimism is discussed. Research demonstrating an interaction between psychopathy and substance abuse and between psychopathy and sexual deviance is also presented. Both substance abuse disorders and inappropriate arousal are frequently encountered in high-risk groups of sexual offenders. These topics are of relevance, in that the question of whether treatment is beneficial with high-risk sexual offenders, including those who are psychopathic, cannot be answered unless groups presenting with typical concurrent disorders (paraphilias, substance abuse, dependence) are discussed. It is argued that, although the evidence is still preliminary, there is reason for optimism with reference to whether psychopathic sexual offenders are responsive to treatment, including offenders presenting with concurrent disorders.

Comparison of two risk assessment instruments for sexual offenders.

The current research examines the predictive validity of the Static-99 and the SORAG in predicting sexual and violent recidivism among a sample of 258 treated high-risk sexual offenders. While the SORAG was found to have moderate predictive accuracy for both sexual and violent recidivism over a 5-year follow-up period, the Static-99 was found to only predict sexual recidivism. As well, the actual recidivism rates in the current sample were compared to the published risk percentages for each of the instruments. For both the Static-99 and the SORAG the current sample re-offended at a lower rate than expected. Possible explanations for this finding are discussed.

Responsivity issues in the treatment of sexual offenders.

Andrews and Bonta (2003) have presented a model of effective correctional programming focusing on risk, need, and responsivity factors for a general criminal population. When applied to sexual offenders, the first two issues (risk assessment and treatment targets such as cognitive distortions) have received a great deal of research attention. However, little attention has been paid to responsivity issues: those factors that influence the extent to which clients benefit, or fail to benefit, from treatment programs. This article presents a review of several potential responsivity factors related to sexual offender treatment and outlines areas that require further research attention.