Delphi Recommendations for Diagnosis and Treatment of Sexual Interest in Children in Non-Mandated Community Settings.

This study sought to reach an international expert consensus regarding the diagnosis and treatment of adults with a sexual interest in children in cases where treatment is non-mandated. An expert panel of 27 participants (19 professionals and eight individuals with sexual interest in children) completed at least one of three rounds of an online Delphi survey. In the first round, participants responded to open-ended questions about assessment approaches, treatment goals, treatment approaches, and adapting assessment and treatment for sexual exclusivity. In rounds two and three, participants rated their level of agreement with each of the recommendations derived from Round 1. Consensus was reached for 48 practice guidelines, particularly for recommendations that relate to general clinical practice, such as assessing for other mental health conditions. There was more contention for the inclusion of forensic practices. The present recommendations can serve as a set of tentative guidelines that may guide assessment and treatment of sexual interest in children in non-mandated settings.

Sexual Exploitation of Children in Travel and Tourism Perpetration: An Expansion of the Ecosystem Model.

The sexual exploitation of children in travel and tourism (SECTT), also referred to as child sex tourism, involves engaging in sexual activity with someone under the age of 18 in the context of travel and/or tourism. Research on the perpetration of SECTT is vastly underdeveloped. The present review considers the operationalization of SECTT, its prevalence, and existing theoretical models. Existing theory on SECTT provides a good overview of environmental factors that contribute to SECTT, but the model is insufficient in fully accounting for individual-level risk factors related to sexual offending against children. The present paper expands an existing theoretical model of SECTT, the ecosystem model, to account for these individual risk factors and considers their interaction with environmental factors. The paper concludes by highlighting different avenues for future research.

Does the Paraphilia Scale Work for Everyone? Confirmatory Factor Analysis and Measurement Invariance Across Gender and Sexual Orientation Groups.

We conducted three studies to examine the factor structure and measurement invariance of the Paraphilia Scale, a measure of paraphilic interests used in multiple studies. In the first study, we conducted a confirmatory factor analysis (CFA) testing different a priori models with a community sample of 1,040 adults previously reported by Seto et al. (2021), and found support for a hierarchical four-factor model: An agonistic continuum involving coercion or physical pain (biastophilia, sexual sadism, masochism), chronophilias (pedophilia, hebephilia), courtship disorders (voyeurism, exhibitionism, and frotteurism), and fetishism (object fetishism, transvestic fetishism, urophilia-coprophilia). This factor structure was replicated in a second study comprising a combined sample of 400 mTurk participants and 870 university students. The third study analyzed the community sample and found evidence of configural invariance but not scalar or metric invariance across gender (man or woman) and sexual orientation for gender (heterosexual or other sexual orientation). This indicates that the factor structure of the Paraphilia Scale is robust for gender and sexual orientation for gender, but factor loadings differ across these groups, as do the loadings of individual items on the four factors. Implications for research on gender and sexual orientation differences in paraphilic interests are discussed.

Development and Initial Validation of Measures of Proximal Stigmas and Experiences of Discrimination for Minor Attracted People.

Stigma-related stressors are central to understanding psychopathology, distress, and coping in stigmatized groups; individuals who experience attractions to children are a highly stigmatized group. Currently, few validated self-report measures exist to assess stigma-related stressors in minor attracted people (MAPs) and the current research describes the development and initial validation of two measures of internalized stigma and experiences of discrimination. A sample of MAPs (n = 289; mean age = 31.8 years, SD = 12.2) was recruited online and completed a set of self-report measures assessing stigma-related stress, negative mental health outcomes, substance use, and coping. Exploratory factor analyses of the two newly developed stigma-related stress measures were conducted and convergent associations with other constructs were examined for validity evidence. Exploratory factor analyses indicated a two-factor solution to both the measure of internalized stigma and experiences of discrimination. The total scale scores and factors scores generally demonstrated the anticipated patterns of correlations with mental health concerns, distress, coping, and substance use. Clinical intervention with MAPs may benefit from an exploration of stigma-related stressors in clients' lives to improve mental health outcomes. The relatively large sample that was recruited from multiple online forums is a strength of the current study. The use of a self-report measurement modality for all measures used in the study weakens that strength of the validation evidence presented here. These results provide initial validity evidence for the measures of stigma-related stress in MAPs and the promise of stigma processes in understanding negative outcomes in this population.

The Predictive Validity of the Revised Screening Scale for Pedophilic Interests (SSPI-2).

The Revised Screening Scale for Pedophilic Interests (SSPI-2) is a five-item measure that assesses for pedohebephilia (sexual attraction to prepubescent and pubescent children) based on child victim characteristics. We aimed to replicate findings by Seto, Sandler et al. (2017) by examining the predictive validity of the SSPI-2 in an independent sample of 626 men referred for a sexological assessment because of sexual offending against children. SSPI-2 scores were associated with an increased likelihood of sexual recidivism but were not significantly associated with non-sexually violent or non-violent recidivism. When they were entered together, the SSPI-2 did not contribute additional variance to the Static-99R in the prediction of sexual recidivism. Results are consistent with the findings of Seto, Sandler et al. (2017) and suggest that higher scores on the SSPI-2 may be indicative of an increased risk for sexual recidivism in individuals who have sexually offended against children.

A Test of Three Different Explanations for Low Stimulus Response Discrimination in Phallometric Testing.

Phallometric assessment is used to assess men's sexual interest in children and to assist in risk assessment and treatment planning. A common response pattern, especially when the assessment is conducted in a forensic context, is an indiscriminate pattern of penile responses: No sexual stimulus seems to produce a substantially higher response than another. This indiscriminate response profile could be the result of (1) faking good (in particular, reducing the responses to child stimuli); (2) floor or ceiling effects caused by low or high arousability, or (3) non-exclusivity (the individual is similarly sexually interested in both children and adults). In this study of 2,858 adult male patients who underwent volumetric phallometric assessment for sexual interest in children between 1995 and 2011, we tested these three possible explanations. Results showed support for each of the explanations, but the variance accounted for in response discrimination was quite small when considering each explanation (separately or when considered together). We discuss avenues for future research to better discern the causes of indiscriminate responding in phallometric assessment.

A Review of Childhood Sexual Abuse Perpetration Prevention Programs.

PURPOSE OF REVIEW: The present review examines existing childhood sexual abuse prevention programs that are focused on providing services to individuals who are at risk of perpetration. We describe several perpetrator-oriented prevention programs with evaluation data as well as avenues for future development and research. RECENT FINDINGS: Perpetration prevention programs can be divided into anonymous and non-anonymous programs. Anonymous programs include those that provide support via helplines and those that provide self-guided digital interventions. Non-anonymous programs provide traditional psychotherapy. There are several prevention programs with limited evaluation data, but no research to date has aggregated these findings and provided a comprehensive assessment of perpetration prevention. There is insufficient evidence to determine whether perpetration prevention programs are effective. More rigorous evaluations of secondary prevention programs are needed. Despite this, early data suggests that perpetration prevention programs are promising.

A preliminary examination of sexual interest in children in a non-representative community sample of females.

There are few empirical studies examining sexological features of sexual interest in children among females. A non-representative sample of 20 females and 208 males who self-identified as having a sexual interest in children completed an anonymous survey. The primary purpose of the present study was to examine sexological features of sexual interest in children among females. Most females reported interest in prepubescent and pubescent children and rated their interest in different age categories similarly. Most females reported an interest in boys. Females first experienced sexual attractions during childhood, but awareness of sexual interest in children occurred later in their adolescence.

The Association between Maladaptive Coping and Treatment Motivation in Individuals who are Sexually Attracted to Children Living in the Community.

There is a need for community treatment programs for people who are sexually attracted to children, but individuals report difficulty accessing services. Individuals who are sexually attracted to children (n = 293) completed an online anonymous survey that revealed a significant positive association between maladaptive coping and two factors of the treatment motivation measure. The association between maladaptive coping and treatment motivation was attenuated at higher levels of ego dystonic distress/aversion. Results highlight the importance of targeting stigma toward those who are sexually attracted to children to increase treatment seeking behavior.

Differences in Sexual Interest in Children Between Men Who Commit Undetected Versus Detected Sexual Offenses.

This study examined whether men who committed undetected sexual offenses would show more evidence of sexual interest in children than their detected counterparts. It also considered whether denial or minimization of offending history explained observed differences between undetected and detected men. In an archival database of 2,236 men, 96 were undetected and the remainder were detected men who varied in the extent to which they admitted their offending: complete deniers, partial deniers, those who admitted their offense history, and those who disclosed additional unknown offenses. There were differences in self-reported sexual interest in children, but relatively few differences when sexual interest in children was assessed by phallometry or sexual victim history. There were no differences between undetected and detected men who admitted to additional victims. The results suggest that denial is likely more important in understanding group differences on sexual interest in children than detection status.

The Revised Screening Scale for Pedophilic Interests (SSPI-2) May Be a Measure of Pedohebephilia.

INTRODUCTION: The Revised Screening Scale for Pedophilic Interests (SSPI-2) was developed as a screening measure for pedophilia (sexual interest in prepubescent children), but the SSPI-2 items reflect offending against both prepubescent and pubescent children, roughly corresponding to victims under age 15. AIM: We examined whether the SSPI-2 is better interpreted as a measure of pedohebephilia (sexual interest in both prepubescent and pubescent children) by reanalyzing the original SSPI-2 data and reporting its new psychometric properties. METHODS: The sample was comprised of 1,900 men whose clinical assessment data were entered into an archival database. All men in the sample had at least 1 child victim. Phallometric indices based on sexual responses to children relative to adults were used to classify individuals as having pedophilia only, hebephilia only (sexual interest in pubescent children), or pedohebephilia. MAIN OUTCOME MEASURE: The 5 SSPI-2 items were scored based on official file information sent by the referral source and self-disclosures about offending history made during the assessment. RESULTS: The phallometric indices revealed that pedohebephilia was most frequently observed (24%), followed by hebephilia only (16%) and pedophilia only (1%). Classification accuracy analyses suggest that the SSPI-2 may be more appropriately interpreted as a measure of pedohebephilia than hebephilia only; there were too few cases of pedophilia only for classification analysis. Sensitivity, specificity, and positive and negative predictive values are presented to assist users in selecting appropriate SSPI-2 cut-offs. CLINICAL IMPLICATIONS: The SSPI-2 should be interpreted as a measure of pedohebephilia when used in clinical practice or research, and test users should select the most appropriate cut-off score based on their assessment context. Classification accuracy results are modest, and the scale may be most appropriately used in research or as a screening measure. STRENGTHS & LIMITATIONS: The study used a comprehensive clinical database with well-validated measures. A limitation is that the dataset did not contain other assessment measures of sexual interest in children, and we were unable to examine if the SSPI-2 could detect pedophilia only due to its low base rate. CONCLUSION: The SSPI-2 may be best conceptualized as a measure of pedohebephilia. Further, there was significant overlap between pedophilia and hebephilia; pedophilia only was rarely observed. Stephens S, Seto MC, Cantor JM, et al. The Revised Screening Scale for Pedophilic Interests (SSPI-2) May Be a Measure of Pedohebephilia. J Sex Med 2019;16:1655-1663.

The Relationships Between Victim Age, Gender, and Relationship Polymorphism and Sexual Recidivism.

Victim choice polymorphism refers to victim inconsistency in a series of offenses by the same perpetrator, such as in the domains of victim age, victim gender, and victim-offender relationship. Past studies have found that victim age polymorphic offenders have higher rates of sexual recidivism than offenders against adults only and offenders against children only. Few studies, however, have examined gender and relationship polymorphism, or accounted for the impact of the number of past victims. The present study analyzed the relationship between polymorphism and sexual recidivism, while controlling for the number of victims. The sample consisted of 751 male adult sexual offenders followed for an average of 10 years, 311 of whom were polymorphic (41% of the total sample). The main finding suggested that there was an association between sexual recidivism and age and relationship polymorphism; however, these associations were no longer significant after controlling for the number of victims.

Age Diversity Among Victims of Hebephilic Sexual Offenders.

Hebephilia refers to sexual interest in pubescent children who are beginning to show early signs of sexual development but are sexually immature. The present study examined the relationship between hebephilia and victim age choice in a sample of 2,238 adult male sexual offenders. On average, offenders were 39 years old at the time of their assessments, and approximately half (48%) were referred by probation or parole offices. Assessment data included self-report, sexual arousal measured by volumetric phallometry, and victims' ages. Results suggested that, similar to pedophilia, hebephilia had a medium sized association with a greater number of victims under age 11 and a small sized association with a greater number of victims ages 11 to 14. Unlike pedophilia, a small positive association was consistently found between hebephilia and a greater number of victims ages 15 or 16. Furthermore, a small positive association was observed between victim age polymorphism and hebephilia and pedophilia. The present results suggested that hebephilia was associated with a greater number of victims age 14 or younger and had similar victim age correlates to pedophiles.

Taxometric analyses of pedophilia utilizing self-report, behavioral, and sexual arousal indicators.

Pedophilia refers to the recurrent, intense sexual interest in prepubescent children who, by definition, have not developed any secondary sex characteristics. Researchers have begun to investigate whether persons with pedophilia are qualitatively different from those without pedophilia (pedophilia is a taxon) or if people vary in their level of sexual interest toward children (pedophilia is dimensional). Two relatively small studies have previously attempted to address this question, but produced conflicting results. The present study built on these studies with a substantially larger sample of 2,227 men who committed sexual offenses and were assessed at a sexual behavior clinic. The present study also examined a broader range of measures more closely approximating the diagnostic criteria for pedophilic disorder, including phallometric assessment of sexual arousal patterns. The results of 3 taxometric analyses did not find support for the assertion that pedophilia is a taxon. (PsycINFO Database Record

Multiple indicators of sexual interest in prepubescent or pubescent children as predictors of sexual recidivism.

OBJECTIVE: Sexual interest in children is a well-known risk factor for sexual reoffending (recidivism). The present study examined the relationship between sexual interest in prepubescent children (pedophilia) or pubescent children (hebephilia) and sexual recidivism. It extended previous work by using multiple indicators of sexual interest, using a more sensitive phallometric procedure that measures change in penile blood volume, and examining both hebephilia alongside pedophilia, as well as noncontact sexual recidivism. METHOD: Six hundred fifty-six men who had committed a sexual offense underwent a comprehensive sexological assessment that included multiple sexual interest measures: volumetric phallometry, self-report, and sexual behavior. Criminal record data were acquired to examine recidivism. Offenders were followed for an average of 10 years of opportunity. RESULTS: Indicators of hebephilia and pedophilia were significantly associated with noncontact sexual recidivism, but inconsistently associated with contact recidivism. The relationship with phallometrically assessed pedophilia and contact sexual recidivism was significant after controlling for offender age statistically. Phallometrically assessed sexual arousal to children did not add to risk appraised by an actuarial measure. CONCLUSION: Both hebephilia and pedophilia were predictive of noncontact sexual recidivism. The results for contact sexual recidivism are discussed, including a potential confound in previous work on the assessment of sexual interest in children. (PsycINFO Database Record

Evidence of Construct Validity in the Assessment of Hebephilia.

Hebephilia refers to a persistent intense sexual interest in pubescent children. Although not as widely studied as pedophilia, studies of hebephilia have indicated convergence in self-report and sexual arousal. The present study expanded on previous work by examining convergent and divergent validity across indicators of hebephilia that included self-report, sexual behavior, and sexual arousal in a sample of 2238 men who had sexually offended. We included men who denied such interest and specifically examined the overlap between hebephilia and pedophilia and examined pedohebephilia (i.e., sexual interests in both prepubescent and pubescent children). Results indicated that there was considerable convergence across indicators of hebephilia. The results suggested poor divergent validity between hebephilia and pedophilia, as there was substantial overlap between the two constructs across analyses. Finally, a distinct pattern of sexual arousal was found in offenders with pedohebephilia. The results of the present study were discussed with a focus on implications for the assessment of sexual interest in children and the conceptualization of pedohebephilia.

The Revised Screening Scale for Pedophilic Interests (SSPI-2): Development and Criterion-Related Validation.

The Screening Scale for Pedophilic Interests (SSPI) is a structured rating scale of four child victim characteristics: number, age, gender, and relationship of victims. Sexual offenders against children who score higher on the SSPI are more likely to be identified as having pedophilic sexual arousal and are more likely to sexually reoffend. Recent research suggests that child pornography offending is a valid and perhaps independent indicator of pedophilia. In this study, we examined whether child pornography offending would add to the criterion-related validity of the SSPI. In the construction sample of 950 offenders with child victims, the SSPI with a fifth item of child pornography (Screening Scale for Pedophilic Interests-2 [SSPI-2]) was significantly associated with phallometrically assessed sexual arousal to children. In a validation sample of 950 offenders with child victims, the SSPI-2 was again related to phallometrically assessed sexual arousal to children, outperforming the original SSPI. We recommend clinicians and researchers use the SSPI-2 as a structured method of assessing pedophilic sexual interests based on offending behavior.

Distinguishing among weapons offenders, drug offenders, and weapons and drug offenders based on childhood predictors and adolescent correlates.

BACKGROUND: Weapons and drug offences incur a large cost to society and tend to be strongly associated. Improved understanding of their antecedents could inform targeted early intervention and prevention programmes. AIM: This study aimed to examine differences in criminal careers, childhood predictors and adolescent correlates among weapons-only offenders, drugs-only offenders and a versatile group of weapons + drugs offenders. METHOD: We conducted a longitudinal records study of 455 young Canadians charged with drug and/or weapons offences who started their offending in late childhood/early adolescence. RESULTS: Consistent with expectation, differences emerged in their criminal careers as the versatile group had a longer criminal career and desisted from offending at a later age than weapons-only offenders. Against prediction, weapons-only offenders experienced the greatest number of childhood predictors and adolescent correlates. CONCLUSION AND IMPLICATIONS FOR PRACTICE: The three offending groups could be differentiated on offending trajectories and developmental factors.In making links between past events and later behaviour, life-course criminology may inform development of effective early intervention and prevention strategies.As weapons-only offenders experience the greatest level of adversity in childhood and adolescence, they may benefit most (of these three groups) from early intervention and prevention programmes.A reduction in weapon carrying and use might be achieved by early identification of children risk factors (e.g. family adversity) and appropriate intervention.