Recidivism of child molesters: a study of victim relationship with the perpetrator.

OBJECTIVE: To compare the rates among of recidivism or re-offense among convicted child molesters who offend against biological children, stepchildren, and relationships where the child is an extended family member, acquaintance or stranger to the victim. METHOD: Four hundred male subjects 18 years of age or older and at least 5 years older than the victim at the time of the index offense, were convicted of a hands on sexual offense against one or more children under the age of 16. Subjects were grouped into five categories according to the type of relationship the perpetrator had with the victim. The subjects records of criminal arrests and convictions was obtained from the national Royal Canadian Mounted Police data. Subjects were then followed-up for a period of up to 15 years after conviction when they were at risk to re-offend in the community. Survival outcome data after the index sexual offense was collected for all new sexual, violent, and any criminal offenses. RESULTS: A larger proportion of men ( 16.2%) who sexually offended against children who were acquaintances, were charged with a new sexual offense than men who sexually offended against biological (4.8%) or their stepchildren (5.1%). The percentage of men who were subsequently charged with any type of criminal offense and who offended against their biological children (19%) was smaller than men who offended against children where the relationship is an extended family member (40%), acquaintances (35.9%) or strangers (45.2%). CONCLUSIONS: When comparing the different categories of relationship the victim had with the perpetrator, the category of stranger has been highlighted as a group with a higher risk for re-offense. Our results have shown that comparatively, the risk of acquaintance group is a significantly higher risk category than was previously thought. Although professionals are principally concerned with sexual recidivism, general criminality appears to present in relatively large proportions of all child molesters with the stranger group at the highest risk level. While no single factor will predict recidivism in itself, the importance of defining the relationship between the perpetrator and victim is evident from this study.

Differentiation of homicidal child molesters, nonhomicidal child molesters, and nonoffenders by phallometry.

OBJECTIVE: The purpose of this study was to examine the ability of phallometry to discriminate among homicidal child molesters, nonhomicidal child molesters, and a comparison group of nonoffenders. METHOD: Twenty-seven child molesters who had committed or had attempted a sexually motivated homicide, 189 nonhomicidal child molesters, and 47 nonoffenders were compared on demographic variables and psychometrically determined responses to aural descriptions of sexual vignettes. Two phallometric indexes were used: the pedophile index and the pedophile assault index. The pedophile index was computed by dividing the subject's highest response to an aural description of sex with a "consenting" child by his highest response to description of sex with a consenting adult. The pedophile assault index was computed by dividing the subject's highest response to an aural description of assault involving a child victim by his highest response to description of sex with a "consenting" child. RESULTS: Homicidal child molesters, nonhomicidal child molesters, and nonoffenders were not significantly different in age or IQ. Homicidal and nonhomicidal child molesters had significantly higher pedophile index scores than nonoffenders. Significantly more homicidal child molesters (14 [52%] of 27) and nonhomicidal child molesters (82 [46%] of 180) than nonoffenders (13 [28%] of 47) had pedophile index scores equal to or greater than 1.0, but homicidal and nonhomicidal child molesters did not differ from each other. Significantly more homicidal child molesters (17 [63%] of 27) than either nonhomicidal child molesters (71 [40%] of 178) or nonoffenders (17 [36%] of 47) had pedophile assault index scores equal to or greater than 1.0, and nonhomicidal child molesters and nonoffenders were not significantly different from each other. Within-group analyses revealed that of the three groups, only the nonhomicidal child molesters exhibited a significant difference between their pedophile index scores and their pedophile assault index scores; their pedophile index scores were higher. CONCLUSIONS: Consistent with past research, the authors found that the pedophile index is useful in differentiating homicidal and nonhomicidal child molesters from nonoffenders and that the pedophile assault index is able to differentiate homicidal child molesters from nonhomicidal child molesters and nonoffenders.

The relationship of deviant sexual arousal and psychopathy in incest offenders, extrafamilial child molesters, and rapists.

The relationship between deviant sexual arousal, as measured by auditory phallometric stimuli, and psychopathy, as measured by the Psychopathy Checklist-Revised, was examined in 156 incest offenders, 260 extrafamilial child molesters, and 123 rapists. Subjects in each group had never been convicted of another type of sexual offense. Replicating previous research, rapists were more psychopathic than incest offenders and child molesters. Deviant sexual arousal to auditory stimuli was evident only on the Pedophile Index for child molesters. When the relationship between psychopathy and deviant sexual arousal was evaluated in the three groups combined, several significant correlations emerged. However, a finer analysis of these correlations revealed that child molesters evidenced a significant correlation between psychopathy and the Rape Index and psychopathy and the Pedophile Index. There were no such significant findings in the incest offender or rapist groups. Implications of the results are discussed.

Prediction of recidivism in extrafamilial child molesters based on court-related assessments.

One hundred ninety-two convicted extrafamilial child molesters were followed for an average of 7.8 years after their conviction. The percentage of men who had committed a sexual, a violent, or any criminal offense by the 12th year was 15.1, 20.3, and 41.6, respectively. The sexual recidivists, compared with the nonrecidivists; demonstrated more problems with alcohol and showed greater sexual arousal to assaultive stimuli involving children than to mutually consenting stimuli with children. The violent recidivists, compared with the nonrecidivists, were more likely to have a history of violence in the families in which they were raised and were rated significantly more psychopathic on the Psychopathy Checklist--Revised (PCL-R). They also showed more sexual arousal to stimuli depicting mutually consenting sexual interactions with children than to adult stimuli. In terms of any criminal recidivism, recidivists were younger, had completed fewer years of school, and were raised in psychologically more harmful family environments compared with nonrecidivists. They also reported that, before 16 years of age, they were more likely to have been physically abused and were more likely to have been removed from their homes compared to those that did not recidivate. In addition, recidivists demonstrated more general hostility on the Buss-Durkee Hostility Inventory and were rated significantly more psychopathic on the PCL-R. The phallometric assessments revealed, that the criminal recidivists, compared to the nonrecidivists, showed more sexual arousal to stimuli depicting coercive sexual activity with children than consenting sexual activities with children. In addition, they showed more sexual arousal to scenes depicting adult rape then adult mutually consenting sex. Finally, the recidivists also had more charges or convictions for violence and any criminal acts. The small number of significant differences between recidivists and nonrecidivists in the sexual and violent categories precluded an attempt to determine which combination of factors meaningfully predicted reoffending. However, for criminal recidivism, a stepwise discriminant function analysis to assess the combination of factors that most successfully distinguished between groups in terms of criminal recidivism was significant, with subjects' age, total number of criminal convictions, and pedophile assault index being retained for optimal prediction. The procedure correctly classified 70.6% of the original group, 82.8% of the nonrecidivists, and 52.6% of the recidivists. PCL-R Total Score alone was equally successful in a similar discriminant function.

Recidivism in convicted rapists.

Factors associated with recidivism in 86 men convicted of rape were studied. These men had been out of prison for up to 12 years (mean, 7.6 years). The majority of the men had been assessed in a sexual behaviors clinic of a general psychiatric hospital at the time of their conviction. Almost 50 percent of the group had committed some offense by the fifth year out of prison. The recidivism rates for sexual, violent, and any criminal recidivism were 16 percent, 26 percent, and 53 percent, respectively. The ability to predict sexual and violent recidivism in this population of rapists was rather poor. More sexual recidivists, compared with nonrecidivists, had been removed from their family home prior to age 16. Violent recidivists compared with nonrecidivists were also more frequently removed from their homes prior to 16 years of age, and they showed significantly more problems with alcohol. In terms of any criminal recidivism, recidivists compared with nonrecidivists were younger and scored higher on the Michigan Alcohol Screening Test (MAST). They also had more previous charges and/or convictions for violent offenses and more charges and/or convictions for any criminal acts. The combination of age and MAST scores was able to predict 92.6 percent of the nonrecidivists and 53.3 percent of the recidivists. The outstanding feature of the total group of rapists was their poor sexual adjustment as indicated on the Derogatis Sexual Functioning Inventory, on which they scored at approximately the seventh percentile of the population at large. There was also an indication that rapists have problems with hostility, as measured by the Buss-Durkee Hostility Inventory. Furthermore, the range of scores on the MAST indicated that the total group of rapists has serious problems with alcohol. The inability of phallometric assessments and psychopathy as measured by the Psychopathy Checklist-R to predict recidivism are discussed.

Short-term side effects of stimulant medication are increased in preschool children with attention-deficit/hyperactivity disorder: a double-blind placebo-controlled study.

Preschool children with attention-deficit/hyperactivity disorder (ADHD) (27 boys, 5 girls, mean age 4 years 10 months) participated in a double-blind placebo-controlled crossover drug study to assess the side effects of methylphenidate. Children received twice daily, for at least 1 week each, placebo, 0.3 mg/kg methylphenidate, and 0.5 mg/kg methylphenidate. Side effects were monitored by a parent rating scale designed for medication studies. In general, methylphenidate was tolerated relatively well, with no children withdrawing because of adverse effects. Of 17 childhood behaviors usually associated with side effects, 8 behaviors showed significant changes, generally at the higher dose of methylphenidate. Interestingly, 3 of the side effects were associated with improved behavior. The number of side effects appeared higher than what is usually reported in a population of school-age children, but few parents reported them as being severe. Severe side effects were reported in less than 10% of the sample, with approximately as many reports of severe effects on placebo as on low and high doses of the medication. The results indicate that methylphenidate has a relatively low toxicity in preschool children (over the first 7-10 days), that some behavioral changes that might be viewed as side effects of methylphenidate are actually normal behaviors or ADHD behaviors in preschool children (e.g., sociability), that these "side-effect" behaviors are more common in preschool than school-age children, that some "side effects" of methylphenidate are associated with improvements in behavior, and that preschool and school-age children may have different side effects of methylphenidate (e.g., mood changes and anxiety).

Homicidal sex offenders: psychological, phallometric, and diagnostic features.

Homicidal sex offenders represent an understudied population in the forensic literature. Forty-eight homicidal sex offenders assessed between 1982 and 1992 were studied in relation to a comparison group of incest offenders. Historical features, commonly used psychological inventories, criminal histories, phallometric assessments, and DSM diagnoses were collected on each group. The homicidal sex offenders, compared with the incest offenders, self-reported that they had more frequently been removed from their homes during childhood and had more violence and forensic psychiatric contact in their histories. On the self-report psychological inventories, the homicidal sex offenders portrayed themselves as functioning significantly better in the areas of sexuality (Derogatis Sexual Functioning Inventory) and aggression/hostility (Buss-Durkee Hostility Inventory). However, on the Psychopathy Checklist-Revised (PCL-R), researchers rated the homiciders significantly more psychopathic than the incest offenders on Factor 1 (personality traits) and Factor 2 (antisocial history). Police records revealed the homicidal subjects also had been charged or convicted of more violent and nonviolent nonsexual offenses. The phallometric assessments indicated that the homicidal sex offenders demonstrated higher levels of response to pedophilic stimuli and were significantly more aroused to stimuli depicting assaultive acts to children, relative to the incest offenders. Despite the homiciders' self-reports of fairly good psychological functioning, DSM-III diagnoses reliably discriminated between the groups. A large number of homicidal sex offenders were diagnosed as suffering from psychosis, antisocial personality disorder, paraphilias, sexual sadism, sexual sadism with pedophilia, and substance abuse. Seventy-five percent of the homicidal sex offenders had three or more diagnoses compared with six percent of the incest offenders. The article addresses the role of "hard" versus "soft" measures in the assessment and treatment of violent sex offenders. In addition, the usefulness of phallometric assessments and the PCL-R and its subscales are considered.

Child extrafamilial sexual abuse: predicting parent and child functioning.

OBJECTIVE: This study evaluated the emotional and behavioral adjustment of parents and children within 3 months and 1 year after the discovery of child extrafamilial sexual abuse. METHOD: Ninety-two case parents (63 mothers, 29 fathers) and 56 children were compared to a nonclinical comparison group of 136 parents (74 mothers, 62 fathers) and 75 children. Parent adjustment was assessed using self-report measures while child functioning was assessed using a combination of child-, parent- and teacher-report measures. RESULTS: Mothers, fathers and sexually abused children experienced clinically significant effects both initially and at 12 months post-disclosure. Children's perceptions of self-blame and guilt for the abuse and the extent of traumatization predicted their self-reported symtomatology at 3 months and 1 year post-disclosure. Child age and gender also significantly contributed to the prediction of many of the child outcome measures. No abuse-related variable was related to any child self-report measure. Mothers' satisfaction in the parenting role, perceived support and intrusive symptoms predicted their initial emotional functioning. Avoidant symptoms, child's internalizing behavior and mothers' initial emotional functioning were significant predictors of longer-term emotional functioning. CONCLUSIONS: Results emphasize the need to address children's abuse-related attributions and underscore the need to expand our focus beyond the child victims to the traumatized families.

Effects of methylphenidate on preschool children with ADHD: cognitive and behavioral functions.

OBJECTIVE: To report on implications for methylphenidate treatment of this very young age group and the need to examine factors related to achieving compliance. METHOD: Thirty-one children with attention-deficit hyperactivity disorder (ADHD), aged 4 to 6 years, participated in a double-blind, placebo-controlled study using placebo, 0.3 mg/kg, and 0.5 mg/kg of methylphenidate twice per day. RESULTS: Improvements related to medication were obtained on cognitive tests of attention and impulsivity as well as behaviors assessed by parent rating scales. In an interactive setting with their mothers, attentional abilities and the children's ability to work more productively also showed improvement. However, no changes were obtained with respect to the children's tendency to comply with parental requests. Side effects increased slightly with the high dosage of medication but remained mild. CONCLUSION: The results suggest that methylphenidate can be used to improve the functioning of preschool-age children with ADHD, in a manner similar to their school-age counterparts.

Secondary traumatization in parents following the disclosure of extrafamilial child sexual abuse: initial effects.

Disclosure or discovery of extrafamilial sexual abuse (ESA) has the potential to traumatize the entire family system. Little controlled research has examined the initial reactions of parents to this type of trauma. The present study evaluated the adjustment of 93 parents (63 mothers and 30 fathers) within 3 months of the disclosure of ESA. Parents' functioning was compared to that of a nonclinical comparison group of 136 parents (74 mothers, 62 fathers). Parent adjustment was assessed using self-report measures of psychological distress, parent competence, family functioning, marital functioning, life stressors, and environmental support. Results revealed that mothers of sexually abused children, in comparison to mothers of nonabused children, experienced greater overall emotional distress, poorer family functioning, and lower satisfaction in their parenting role. Fathers of sexually abused children also experienced greater overall emotional distress relative to comparison fathers but their level of distress remained below that of mothers. Standard and hierarchical multiple regressions on maternal self-reports revealed that mothers' satisfaction with their parenting role and their perceived level of environmental support predicted their emotional functioning. Abuse-related variables did not contribute to the prediction of emotional functioning. These results emphasize the need to expand our focus beyond the child victims to the traumatized families and to normalize the potential for all close family members to be vulnerable to experience adjustment difficulties following ESA.

Children's emotional and behavioral reactions following the disclosure of extrafamilial sexual abuse: initial effects.

Despite a dramatic increase of the empirical literature on child sexual abuse, very few investigations have examined the initial effects of extrafamilial sexual abuse (ESA). The present study evaluated the emotional and behavioral adjustment of 41 children (mean age 10 years, range 5.4 to 15.5 years) within the first 3 months following the disclosure of ESA. Children's functioning was compared to that of a nonclinical comparison group of 43 children, matched on child's age, gender, and family constellation. Child functioning was assessed using a combination of child-report, primary caregiver-report (i.e., parent), and teacher-report measures. Results revealed that sexually abused children, in comparison to nonabused children, suffered deleterious and clinically significant effects. Standard multiple regressions found that the children's perceptions of self-blame and guilt for the abuse and the extent of traumatization predicted their self-reported symptomatology of depression, social efficacy, and general and abuse-related fears. As well, child's gender predicted the level of general fearfulness. None of the other demographic or abuse-related variables were related to children's functioning. These results underscore the need for multidimensional and multisource assessment of children who experience ESA, and point to the clinical importance of addressing the abuse-related attributions of these children.

Factors associated with academic achievement in children following parental separation.

Elementary school children who maintained their academic performance levels following separation of their parents were compared to those whose levels declined. Although no single measure could accurately predict children's academic adjustment, those who maintained performance levels spent significantly more time with both parents.

Comparison of stereognosis and two-point discrimination testing of the hands of children with cerebral palsy.

The authors compared tests of stereognosis using shape recognition and two-point discrimination with a paper-clip in evaluating sensation in the fingers of 51 patients with cerebral palsy between the ages of six and 20 years, and of 170 controls in the same age-range. The two-point discrimination test had significantly higher sensitivity in detecting tactile sensation than shape recognition, with slightly less specificity. Testing hand sensation should be part of the assessment of patients when considering reconstructive surgery, therapy, or the teaching of specific hand-skills. The two-point discrimination test with a paper-clip is a simple and reliable method of doing so.

Relaxation prophylaxis for childhood migraine: a randomized placebo-controlled trial.

A randomized controlled trial was used to evaluate the effectiveness of relaxation training in the treatment of paediatric migraine. Relaxation training was compared with-two control groups (psychological placebo and 'own best efforts') in a total of 99 children and adolescents with frequent migraine. Daily recording of the headaches following treatment, three months after treatment and at the one-year follow-up indicated that all three treatments were equally effective. The importance of the use of adequate control conditions which generate equivalent expectancies in pain treatment research was confirmed.

Premenstrual tension, expectancy, and mother-child relations.

The role of expectancy in enhancing or mitigating premenstrual symptoms was examined in 51 mothers of preschoolers. Expectancy was manipulated by providing information either in support of a biological cause for genuine universal mood changes or in support of a psychological cause arising out of negative societal myths. A third group was given no information. Mood, cognitive function, and mother-child interaction were assessed both at mid-cycle and premenstrually, and the results suggested that expectancy enhances symptoms. The Psychological group lowered their symptom expectations and reported less negative mood premenstrually as well as fewer symptoms at the end of the test month. The other groups reported no change in symptoms and greater premenstrual negative mood than the Psychological group. All groups demonstrated greater task persistence and more positive mother-child interaction during the premenstrual phase.

Efficacy of ACTH 4-9 analog, methylphenidate, and placebo on attention deficit disorder with hyperkinesis.

The present study compared the efficacy of ACTH 4-9 analog, methylphenidate, and placebo on attention deficit disorder with 30 (HK) children with attention deficit disorder and psychometric measurements. HK children were randomly placed into three groups, according to body weight, and treated with placebo, methylphenidate, and adrenocorticotropic hormone fractions (ACTH 4-9 analog). The results revealed that HK children on methylphenidate manifested a significantly greater vasomotor reactivity, behavioral improvement, and learning receptivity than HK children taking ACTH 4-9 analog and/or placebo. Future research implications with ACTH 4-9 and HK children are discussed.

The effects of anxiety management training on the control of juvenile diabetes mellitus.

The present study was designed to determine whether diabetic control could be improved through the direct psychological management of stress and anxiety. Five poorly controlled female adolescent diabetics ranging in age from 15 to 18 years were used as subjects. All were seen on an outpatient basis over a 6-month period. A single-subject format employing a multiple-baseline design across subjects was used. The independent variable used was a technique known as anxiety management training. Baseline, attention-control, and treatment data were collected on a number of dependent measures. Subjective estimates of anxiety and tension by each subject were gathered on a biweekly basis using the Multifactorial Scale of Anxiety. Diabetic control was assessed daily using the Diastix method and weekly using the 24-hr quantitative glucose method. Data on the five subjects suggested that improved control of stress and anxiety had a positive effect on diabetic regulation. Lower and more stable urine glucose levels using both urine testing methods were found. However, no decreases in the subjects' personal assessment of tension and anxiety were evident.