Assessing risk for sexual recidivism: some proposals on the nature of psychologically meaningful risk factors

Are There Any Biomarkers for Pedophilia and Sexual Child Abuse? A Review

The use of biomarkers in medicine is a common and valuable approach in several clinical fields. Understanding the relationship between measurable biological processes and clinical outcomes not only is indispensable in the face of understanding physiological processes in healthy as well as in diseased organisms but also for understanding and evaluating treatment effects. Therefore, also in the context of forensic psychiatry, biomarkers and their potentially beneficial effects are of growing interest. The objective of this review is to examine if there are biomarkers that may serve as a tool to support diagnostic process, treatment evaluation, and risk assessment of pedophilic individuals and child sexual offenders. In the first part, we present an overview of the current neurobiological, as well as physiological and psychophysiological approaches to characterize pedophilia and child sexual offending. Secondly, we discuss and evaluate the impact of these approaches on the development of biomarkers for diagnosis, therapy, and risk assessment in pedophilic subjects and child sexual offenders. We conclude that a lot of research has already enhanced our neurobiological knowledge about pedophilia and child sexual offending. Although there surely exist promising parameters and approaches, in our view currently none of these is ready yet to serve as a clinically applicable diagnostic, response, or predictive biomarker for pedophilia and child sexual offending. Therefore, further work remains to be done. The development of a composite diagnostic biomarker to assess deviant sexual interest, combining several measures like functional magnetic resonance imaging, electroencephalogram, eye tracking, and behavioral approaches seems to be most promising. A valid and reliable measurement of deviant sexual interest, insensitive to manipulations could significantly support clinical diagnostic process. Similarly, regarding therapy evaluation and risk assessment, a composite biomarker to assess inhibitory control functions seems to be promising. Furthermore, the application of the Research Domain Criteria-approach, a new approach for investigating and classifying mental disorders, offers the possibility to take research to a new level.

Psychometric properties of the Dynamic Risk Outcome Scales (DROS) for individuals with mild intellectual disability or borderline intellectual functioning and externalizing behaviour problems

BACKGROUND

The present study examined the psychometric properties of the Dynamic Risk Outcome Scales (DROS), an instrument developed to measure dynamic risk factors in individuals with mild intellectual disabilities or borderline intellectual functioning (MID-BIF) and externalizing (including offending-like) behaviour problems.

METHOD

The sample consisted of 606 clients (86% male) from inpatient treatment wards at a facility for individuals with MID-BIF and externalizing behaviour problems.

RESULTS

The DROS showed an acceptable factor structure, good internal consistency, significant test-retest reliability and fair to excellent inter-rater reliabilities for most subscales and total score. Compared to the Adult Behavior Checklist (ABCL; Achenbach & Rescorla, 2003 Manual for the ASEBA adult forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families), the DROS showed convergent and divergent validity, concurrent and longitudinal validity.

CONCLUSIONS

The DROS is a reliable and valid instrument to measure dynamic risk factors in clients with MID-BIF. Future research on the DROS will focus on the assessment of recidivism and the inclusion of internalizing problems.

Family Lovemap and Erotically Related Protective Factors

The article provides a conceptual framework of variables likely interconnected to protective factors for sexually abusive youth associated with the Family Lovemap Aggregate of MEGA^♪, a risk assessment tool for sexually abusive youth. Family Lovemap Aggregate is composed of the ingredients family's familial bio-physio-neuro-psycho-sexio-social history and culture including transmissible predispositions related to erotic development. Intimacy deficits are discussed, specifically their association to erotically related protective factors extrapolated from a variety of data points and sources. This includes findings of sizable study samples of the MEGA^♪ validation (N = 1184), cross-validation (N = 1056), a second cross validation study (N = 543), a third cross-validation (N = 1,118 [1979-2017] Miccio-Fonseca, 2017c). Also included combined samples of cross validation studies (N = 2,717 [1979-2017] Miccio-Fonseca, 2017d); combined samples of validation and cross validation studies N = 3,901 [1979-2017] Miccio-Fonseca, 2017e).

Looking inside a circle: volunteer experiences of circles of support and accountability

Circles of Support and Accountability (CoSA) is a promising reintegration framework whereby community volunteers support individuals convicted for sexual offenses to reintegrate safely into the community. CoSA has grown in popularity, yet little is known about volunteers' experiences of CoSA, including how they cope with their core member being recalled or reoffending. The aim of the current study is to explore the experiences of CoSA volunteers in New Zealand. In-depth interviews were used to explore experiences. The findings relating to general experiences explored balancing risk management and social support, questioning the place of religion in CoSA, confronting stereotypes, and volunteering in a risk-averse society. The findings also revealed both the commitment to CoSA, and the stress and guilt felt by the volunteers following a recall or re-offense. Findings are discussed in terms of their implications for current and ongoing volunteers, as well as for community approaches to criminal justice.

Dynamic Risk Factors, Protective Factors and Value-Laden Practices

Dynamic risk (and to a lesser extent protective) factors are the foundation of correctional practice; the assumption that they exist, can be measured and are able to change is at the heart of what forensic practitioners do. However, there has recently been a surge in interest and debate around what these constructs are and how they relate to offending. In progressing this debate, we shift the focus from risky characteristics, behaviours and contexts (e.g. antisocial attitudes, associates, drug abuse), to the practices (i.e. goal-directed actions) to which these descriptions refer. Embedded within practices are values (i.e. priorities, motivators, norms), and underpinning them human capacities. Identification of these capacities and relevant contexts (i.e. norms, opportunities) can inform rehabilitation, which strengthens them to support healthier and less harmful functioning. We offer examples of risk and protective factors for sexual offending, although the ideas are not limited to this type of behaviour.

Child sexual abuse in India: A systematic review

Objective

Child Sexual Abuse (CSA) is a pressing human right issue and public health concern. We conducted a systematic review of quantitative and qualitative studies published in the past decade on CSA in India to examine the distribution of the prevalence estimates for both genders, to improve understanding of the determinants and consequences of CSA and identify gaps in the current state of research.

Methods

For this systematic review, we searched electronic literature databases (PubMed, POPLINE, and PsycINFO) for articles published in English on Child Sexual Abuse in India between January 1, 2006 and January 1, 2016 using 55 search terms. Data were extracted from published articles only.

Findings

Fifty-one studies met inclusion criteria for the review. The review indicates that prevalence rates of CSA is high among both boys and girls in India. Due to heterogeneity of study designs and lack of standardised assessments, reported prevalence estimates varied greatly among both genders in different studies. There is a need to conduct representative studies using a validated instrument to obtain valid epidemiological estimates. Commercial sex workers, men who have sex with men, and women with psychiatric disorders were at higher risks for sexual abuse during childhood. In addition, the synthesis of qualitative data across studies included in the review suggests that exposure and perpetration of CSA is a multifaceted phenomenon grounded in the interplay between individual, family, community, and societal factors. The review indicates poor physical, behavioural, social, and mental health outcomes of CSA in India. We conclude with a research agenda calling for quantitative and qualitative studies to explore the determinants and perpetration of child sexual abuse in India from an ecological lens. This research agenda may be necessary to inform the development of a culturally tailored primary prevention and treatment strategy for CSA victims in India.

"It's Sort of Reaffirmed to Me That I'm Not a Monster, I'm Not a Terrible Person": Sex Offenders' Movements Toward Desistance via Peer-Support Roles in Prison

Individuals incarcerated in prisons across the United Kingdom and abroad are able to volunteer for a variety of peer-support roles, which are characterized by prisoner-to-prisoner helping. Some research has found that such roles can represent turning points in the lives of those who have offended and encourage movements toward desistance. This proposed redemptive influence is argued to result from the prosocial behaviors that such roles appear to elicit in their holders. The present study aims to explore the mechanics of this claimed influence. While a limited amount of research has attempted this on a general offending population, no research has done so with a sample of sexual offenders. Given the intensive treatment programs involved in such contexts, and the requirements for sexual offenders to demonstrate reduced risk, the authors believe those serving time for sexual offenses represent an important sample on which to explore the potentially redemptive properties of peer-support roles. To this end, 13 peer supporters participated in semistructured interviews. Transcripts were analyzed using a phenomenologically oriented thematic analysis. Results suggest that sexual offenders who adopt peer-support roles are able to live up to desired selves by "doing good" in prison, "giving back," and consequently resisting negative labels. These benefits have been theoretically linked with better reintegration outcomes for sexual offenders, who are publicly denigrated in the extreme and find it especially difficult to (re)integrate. Suggestions regarding the future utility of such schemes are offered.

Three Central Dimensions of Sexual Recidivism Risk: Understanding the Latent Constructs of Static-99R and Static-2002R

The most commonly used risk assessment tools for predicting sexual violence focus almost exclusively on static, historical factors. Consequently, they are assumed to be unable to directly inform the selection of treatment targets, or evaluate change. However, researchers using latent variable models have identified three dimensions in static actuarial scales for sexual offenders: Sexual Criminality, General Criminality, and a third dimension centered on young age and aggression to strangers. In the current study, we examined the convergent and predictive validity of these dimensions, using psychological features of the offender (e.g., antisocial traits, hypersexuality) and recidivism outcomes. Results indicated that (a) Sexual Criminality was related to dysregulation of sexuality toward atypical objects, without intent to harm; (b) General Criminality was related to antisocial traits; and (c) Youthful Stranger Aggression was related to a clear intent to harm the victim. All three dimensions predicted sexual recidivism, although only General Criminality and Youthful Stranger Aggression predicted nonsexual recidivism. These results indicate that risk tools for sexual violence are multidimensional, and support a shift from an exclusive focus on total scores to consideration of subscales measuring psychologically meaningful constructs.

"It's Not Something I Chose You Know": Making Sense of Pedophiles' Sexual Interest in Children and the Impact on Their Psychosexual Identity

Sexual interest in children is one of the most strongly predictive of the known risk factors for sexual reconviction. It is an important aspect of risk assessment to identify the presence of such interest, and an important task for treatment providers to address such a sexual interest where it is present. It has been argued that understanding pedophiles' deviant sexual interest in children can enhance risk assessment, management, and treatment planning. This research study aims to explore the phenomenology of deviant sexual interest in children, the impact it has on pedophilic offenders' identities, and their views on the treatability of that interest. The study used semistructured interviews and repertory grids to make sense of participants' experiences. The results revealed three superordinate themes: "'living' with a deviant sexual interest," "relational sexual self," and "possible and feared sexual self." The analysis unpacks these themes and repertory grid analysis is used to explore a subset of participants' identities in more detail. The results reveal that there needs to be an acceptance from both client and therapist that their sexual interest in children may never go away. Through this acceptance, clients could work on enhancing sexual self-regulation, recognizing their triggers, and so managing their sexual thoughts, feelings, and behavior. Implications for treatment are also discussed.

Examining Implicit and Explicit Evaluations of Sexual Aggression and Sexually Aggressive Behavior in Men Recruited Online

The purpose of the current study was to explore the relationship between implicit and explicit evaluations of sexual aggression and indicators of sexually aggressive behavior in samples of students and community men recruited online. Participants were male undergraduate students recruited online from a Canadian University ( N = 150) and men recruited from the community via an online panel ( N = 378). Participants completed measures of implicit and explicit evaluations of sexual aggression, cognitive distortions regarding rape, self-reported past sexually aggressive behavior, and self-reported proclivity to commit sexually aggressive behavior. We found that more positive explicit evaluations and more cognitive distortions were moderately to strongly associated with sexual aggression; however, this was not the case for implicit evaluations of rape. Our results suggest that explicit evaluations of sexual aggression and cognitive distortions may be relevant for understanding sexual aggression against adults, and that more research is needed exploring whether or not implicit evaluations are associated with sexually aggressive behavior.

Risk Assessment Interviews: Exploring the Perspectives of Psychologists and Indeterminate Sentenced Prisoners in the United Kingdom

This study explores the forensic risk assessment interview from the perspectives of qualified prison-based psychologists and indeterminate sentenced prisoners in the United Kingdom. It focuses on the psychologist-prisoner relationship in the interview context. Twenty-one in-depth individual interviews were conducted with psychologists and prisoners and analysed using Grounded Theory methods. The analysis identified the following categories reflecting participants' descriptions of risk assessment interviews: "Emphasising Clarity and Transparency," "Collaborative Engagement," "Making a Respectful, Boundaried yet Human Connection," "Respecting Individuality," and "Having a Purposeful Conversation." Analysis demonstrated that these categories of meaning reflected the broader notion of risk assessment interviewing as "A Difficult Balancing Act." The views of prisoners and psychologists about the risk assessment interview were remarkably similar and provide some direction and guidance for practitioners navigating this challenging but essential aspect of forensic psychological work.

The Perceived Role of General Self-Regulation and Prosocial Support on the Decision Not to Act Among Men Sexually Attracted to Children

Recent research highlights potential differences between groups of men sexually attracted to children regarding child molestation behavior, attitudes toward sex with children, and the decision not to act on their attractions. The present study furthered this line of research by investigating the roles of general self-regulation and prosocial support on the decision not to act among 69 men sexually attracted to children. Mixed-methods analysis of survey results provided mixed evidence regarding their relevance to refraining from engaging in child molestation behavior. Quantitative results suggested that self-control, but not prosocial support, showed a major influence on participants' decision not to act. Qualitative results offered a more nuanced understanding of the roles of both of these factors in participants' decisions. Overall, findings support an approach for investigating men sexually attracted to children that focuses on differences between men who do and do not act on their attractions, as well as on the active decision to refrain from engaging in child molestation behavior. Implications for research and clinical practice are highlighted.

Advances in the Assessment of Sexual Deviance

PURPOSE OF REVIEW

This paper reviews recent research into four different approaches to the assessment of offense-related sexual deviance.

RECENT FINDINGS

Two of these approaches, structured rating scales and phallometry, have a sufficient basis in research for clinical use but have undergone significant refinements in recent years. One approach, the use of cognitive tasks to indirectly assess sexual deviance, is approaching the point where it has a sound research basis for clinical use though too many promising tasks have yet to make the transition from laboratory to clinical practice. This approach has however begun to map the earlier stages of sexual response including preconscious processes. The final approach, assessment through neuroimaging, is at the earliest stage of development with research findings having yet to reach sufficient stability for clinical application. Existing assessment technologies, despite their limitations, allow professionals to assess offense-related sexual deviance. New approaches, currently being developed, potentially allow a better understanding of underlying processes and, when sufficiently mature, will be more therapeutically useful.

Diagnostic Issues in the Paraphilias

PURPOSE OF REVIEW

To examine the empirical bases underlying the diagnoses of the paraphilias. We address issues concerning the reliability of these diagnoses and their implications for etiology, treatment, and prognosis.

RECENT FINDINGS

Research on these issues with the paraphilias is quite limited except for those paraphilics whose interests lead them to sexually offend. Even among these clients, research has, for the most part, failed to distinguish those who meet criteria for a paraphilia from those who do not, thereby limiting the possibility of drawing firm conclusions regarding the value of a paraphilic diagnosis. Speculations regarding the etiology of the paraphilias are for the most part limited to those who sexually offend and these theories do not distinguish those who do, or do not, meet paraphilic criteria. Treatment of sex offenders, when effective, appears to have the same impact regardless of whether or not clients meet criteria for a paraphilia. In terms of prognosis, it was only among untreated child molesters that a paraphilic diagnosis (in this case "pedophilia") predicted long-term outcome. In the face of these problems, we suggest a dimensional approach to diagnoses may represent an improvement over the current categorical model.

A Brief History of Psychological Theory, Research, and Treatment With Adult Male Sex Offenders

PURPOSE OF REVIEW

The goal of this paper is to provide a history of psychological theories, research, and treatment of male sex offenders from the onset of modern approaches that emerged in the 1960s up to the present time. The questions addressed in this paper primarily concern the reasons and justifications for the observed changes.

RECENT FINDINGS

Current conceptualizations of the motivations of sex offenders are quite comprehensive with a central focus on deficits in attachment and coping skills. Research now provides an empirical foundation for the issues to be addressed in treatment and for the manner in which treatment is delivered. Advances in theory and research have brought the field of sex offender treatment to the point where the empirical bases point to a structure that, if followed, seem likely to achieve the goal of reduced recidivism.

What Works in Israeli Prison-Based Sex Offender Rehabilitation Programs: Program Participants' Perspective

This study invited 10 of the 22 sex offenders enrolled in a prison-based rehabilitation program in one of the prisons in Israel to engage in the two first of the 4-D ( Discover, Dream, Design, and Deliver) stages of the Appreciative Inquiry . Consistent with the responsivity principle, and the IA tenets, program participants were interviewed to Discover components to which they were responsive and Dream/envision additional ones that would increase engagement and progress. Content analysis of the interviews indicated that despite the initial decision to enrol based on external incentives, participants eventually engaged in group therapy and expressed the desire to understand and regulate their sexual behaviour. While the the modules of Cognitive Behabioral Group Therapy (CBT) were viewed as assets, the lack of sufficient recruitment criteria, the large therapy group size, and its open-ended structure were mentioned as impediments reaching therapeutic goals. Social workers/therapists were criticized for their request that they be informers, and for their accusative therapeutic style whenever sexual issues were broached. Recommendations derived from the offenders' narrative were to increase staff professionalism to create a therapeutic alliance that promotes trust and open communication. Criminal justice practitioners may then take up the challenge of the never-ending process of Appreciative Inquiry to Design and Deliver program components envisioned by the participants to increase participants' responsivity to the program and thus its effectiveness.

The Role of Forensic Factors and Potential Harm to the Child in the Decision Not to Act Among Men Sexually Attracted to Children

To date, sexual abuse prevention efforts have largely focused on tertiary prevention strategies designed to prevent recidivism among forensic samples of men with a history of sex offending behavior. The present study used mixed methodology to investigate the role of several forensic and related factors on the decision not to commit a sex offense among two groups of community men who self-reported a sexual attraction to children: those who reported a history of acting on their attractions (Acted, n = 29) and those who reported never acting on their attractions (Not Acted, n = 71). Participants from both groups described in their own words the factors that contributed to their decision not to act on their attractions. They also responded to quantitative and qualitative questions regarding the influence and role of the following factors on their decision not to act: (a) the possibility of jail or punishment, (b) mental health treatment, and (c) not wanting to hurt the child. Results were compared across groups, and across prompted and unprompted responses. Analyses highlighted harm to the child as a particularly salient factor in the decision not to act among men in the community at risk for sexually offending. The present study suggests that investigating potential protective factors may be an important direction for future research among samples of community men at risk for both first-time and repeat offenses against children.

Multimodal neuroimaging measures and intelligence influence pedophile child sexual offense behavior

Pedophilia is a heterogeneous disorder for which the neurobiological correlates are not well established. In particular, there are no biological markers identifying individuals with high risk to commit child sexual offense (CSO). Pedophiles with CSO (P+CSO; N = 73), pedophiles without CSO (P-CSO; N = 77), and non-pedophilic controls (NPC; N = 133) were assessed using multimodal structural neuroimaging measures including: cortical thickness (CT), surface area (SA), and white matter fractional anisotropy (FA), as well as full scale IQ (FSIQ) performance. Cortex-wise mediation analyses were used to assess the relationships among brain structure, FSIQ and CSO behavior. Lower FSIQ performance was strongly predict with P+CSO (Wald Chi² = 13.0, p = 3.1 × 10^-5). P+CSO had lower CT in the right motor cortex and pronounced reductions in SA spanning the bilateral frontal, temporal, cingulate, and insular regions (P_{FWE-corrected} < 0.05). P+CSO also had lower FA particularly in the corpus callosum (P_{FWE-corrected} < 0.05). The relationship between SA and P+CSO was significantly mediated by FSIQ, particularly in the prefrontal and anterior insular cortices (P_{FWE-corrected} < 0.05). Within P+CSO, left prefrontal and right anterior cingulate SA negatively correlated with number of CSOs (P_{FWE-corrected} < 0.05). This study demonstrates converging neurobiological findings in which P+CSO had lower FSIQ performance, reduced CT, reduced SA, and reduced FA, compared to P-CSO as well as NPC. Further, FSIQ potentially mediates abuse by pedophiles via aberrant SA, whereas the CT and FA associations were independent of FSIQ differences. These findings suggest aberrant neuroanatomy and lower intelligence as a potential core feature underlying child sexual abuse behavior by pedophiles.

Assessing violence risk with Aboriginal and Torres Strait Islander offenders: considerations for forensic practice

Forensic professionals and courts have frequently expressed concern about the susceptibility of contemporary risk assessment tools to cultural bias. Furthermore, progress in the development of valid methods of assessment for offenders who identify from Aboriginal and Torres Strait Islander cultural backgrounds has been slow. This paper considers how cultural perspectives on risk are essential to the development of assessment methods that have greater validity and acceptance by both courts and the community. This will involve considering the social, cultural and political determinants of risk in each cultural group and the identification of those risk factors that are most relevant to forensic decision-making.

Qualitative Analysis of Attitudes Toward Adult-Child Sexual Activity Among Minor-Attracted Persons

This study uses qualitative methodology to explore narrative responses to a question regarding the harmful versus beneficial effects of adult-child sex on children. Data were gathered from a survey of self-identified minor-attracted persons (MAPs). Two hundred and sixty-seven survey participants provided narrative responses. Results indicated a significant amount of variability in perceptions of harm and of mitigating or aggravating factors. Understanding the subjective perspectives of MAPs, the range of their attitudes, and the issues that they identify as pertinent is critically important for clinical efficacy in the treatment of pedophilia.

Assessment of Sex Offenders With the Minnesota Multiphasic Personality /Inventory-2-Restructured Form

This study examined the association between scores on the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) with static and dynamic risk assessment instruments, including the STATIC-99 and Level of Service Inventory-Revised (LSI-R). The sample included 304 male adults who were convicted of sexual offenses against children and were referred to a sex offender treatment program. On average, the sample had a Low-Moderate risk of re-offending according to the STATIC-99 and LSI-R. The results indicated that MMPI-2-RF scale scores in this setting are characterized by relatively high levels of under-reporting and externalizing psychopathology compared with the normative sample. We also found that scale scores in this sample produced reliability estimates that were similar to the normative sample. Finally, external correlations between the MMPI-2-RF scales and the risk assessment instruments indicated that the test was associated in expected ways with constructs measured by these instruments. Correlations were most robust among scales in the externalizing/behavioral dysfunction domain of the MMPI-2-RF. Overall, the results of the study support and guide use of the test in this population.

Therapeutic Climate Within a Treatment Program for Categorical Deniers

The purpose of this study was to examine whether the therapeutic climate within a sex offender "deniers" program, where denial was not challenged, would be equivalent to the therapeutic climate within a conventional program where sex offenders were admitting responsibility. Using a sample of 77 sex offenders, therapeutic alliance and group climate were measured early and late in treatment. As expected, therapeutic alliance was more difficult to attain with deniers early in treatment, particularly therapeutic bond; however, by the end of the treatment, there were no significant differences in therapeutic alliance. There did not appear to be significant differences in group climate early or late in treatment except for the deniers reporting significantly lower levels of open expression of anger and disagreement within the group and, in contrast to the admitters, making significant improvements in group climate over time. Implications for the treatment of categorical deniers and further research suggestions are discussed.

An Etiological Approach to Sexual Offender Assessment: CAse Formulation Incorporating Risk Assessment (CAFIRA)

PURPOSE OF REVIEW

Case formulations (CF) have been the cornerstone of effective practice in clinical psychology since the 1950s and now form one of the core competencies in clinical and forensic assessment. The use of CFs within forensic settings is becoming more relevant when working with offenders who have experienced significant trauma, suffered from personality disorder, and have displayed sexually abusive behavior. Furthermore, most North American and European jurisdictions insist that expert witnesses adopt an idiosyncratic approach to risk assessment and consider the characteristics of the individual as part of a wider formulation of the problem behavior. This article focuses specifically on CF incorporating risk assessment procedures of sexual offenders.

RECENT FINDINGS

While empirical support for the use of risk analysis and formulation in managing offending behavior generally, and sexual offending behavior in particular, is limited, there is mounting evidence to suggest that CF can improve understanding of an individual's problem sexual behaviors. We argue that by integrating risk formulations into the CF provides a conceptually robust link between the etiologically development of the problem sexual behavior and effective assessment and risk management of sexual offenders. As forensic treatment programs increasingly moved toward strength-based approaches, in keeping with the Risk-Need-Responsivity principles Andrews and Bonta (2004), and the Good Lives Model Ward and Stewart (Prof Psychol Res Pract 34:353-60, 2003) of offender rehabilitation, the use of CFs in the assessment, treatment, and management of sexual offenders is indispensable. We present an etiological framework for understanding risk in an individual sexual offender by integrating a case formulation model to include the use of (static, stable, and acute) actuarial and clinical risk assessment measures as well as protective risk factors, referred to as the CAse Formulation Incorporating Risk Assessment (CAFIRA) model.

Sex Offender Risk Assessment: Where Are We and Where Are We Going?

PURPOSE OF REVIEW

Risk assessment is one of the most ubiquitous tasks in the criminal justice system, informing virtually every decision made about offenders. This review, intended for researchers and practitioners, outlines some of the most important recent advances, emerging issues, and recommendations in sex offender risk assessment.

RECENT FINDINGS

The underlying nature and purpose of risk scales is reviewed, with implications for how we should evaluate them. Limits of recidivism probability estimates are discussed, and efforts to advance a common language for describing risk levels are highlighted. Advances in risk communication and field validity are summarized. The utility of protective risk factors in risk assessments is debated. Emerging areas in assessing offender change and assessments with child pornography offenders are discussed. Despite critical advances in the last few years, there are still important gaps in knowledge, particularly for risk communication, field implementation, offender change, and child pornography offenders.

The Stigma of Pedophilia

Abstract. There is an emerging consensus among researchers that having pedophilic interests is not synonymous with child sexual abuse or other amoral behavior. Nevertheless, misconceptions about pedophilia are highly prevalent among the general public and mental health practitioners. This article provides an overview of recent findings on the stigma of pedophilia and derives guidelines for mental health practitioners based on these results. We argue that stigmatization of people with pedophilic sexual interests has undesired indirect effects on risk factors for child sexual abuse, particularly on an emotional and social level. Also, fear of being rejected or treated unethically may prevent pedophilic individuals at risk for sexual offending from confiding in medical practitioners or psychotherapists. Psychologists working with pedophilic individuals in forensic or clinical settings should be aware that stigmatizing people with pedophilia may increase their risk of sexual offending, and provide help to deal with potential stigma-related repercussions.

Primer on the Contribution of Crime Scene Behavior to the Forensic Assessment of Sexual Offenders

Abstract. Over the last decades several attempts in developing incrementally valid risk indicators above and beyond standard actuarial and dynamic risk assessment instruments have been undertaken without much success. The current review will summarize current developments regarding the validity of detailed crime scene analysis for forensic assessments of sexual offenders. To this end, this overview will focus on two issues: First, we will discuss the issue of sexual offender risk assessment based on crime scene information. Second, we will outline how crime scene behavior contributes to the assessment of sexual interest in children. In each section we will introduce the reader to new approaches and instruments for risk assessment and diagnosing pedophilic sexual interest based on crime scene information, respectively, and discuss their validity. Finally, we will discuss the implications of these recent developments for risk assessment, risk management, offender treatment, and future research.

The utility of peer-support in enhancing the treatment of incarcerated sexual offenders

Purpose

In the quest to maximize treatment gains, recent research has shifted focus from treatment itself to the context in which treatment takes place. Such investigations have alluded to rehabilitative climate, therapeutic alliance, prison social climate, and the efficacy of group process. The purpose of this paper is to review peer-support as a mechanism via which these goals might be reached.

Design/methodology/approach

A review of the literature on peer-support in carceral settings was undertaken in February 2017.

Findings

While there is very little research exploring peer-support in the context of offender rehabilitation, there are some promising signs from many qualitative investigations that peer-led roles can bridge many gaps in support within the therapeutic context.

Research limitations/implications

More research on the potential negative impact of peer-support in carceral setting is needed.

Practical implications

This paper proposes that the implementation of peer-support programs that operate alongside treatment interventions represent an encouraging direction for the future. It is argued that prisoner-led peer-support initiatives that are characterized by shared problem solving and reciprocal emotional support can greatly reduce the anxiety prisoners face surrounding treatment. It is suggested that, through peer-support, treatment gains may be enhanced and better assimilated into program-completers’ lives.

Social implications

Peer-support may assist current treatment approaches with sexual offenders and could therefore potentially contribute to reductions in recidivism.

Originality/value

This paper is the first to review peer-support in the context of imprisonment and offender therapy. It therefore provides an important status update for future researchers wishing to investigate this topic, and outlines several priorities that such research might interrogate further.

Behavioral Monitoring of Sexual Offenders Against Children in Virtual Risk Situations: A Feasibility Study

The decision about unsupervised privileges for sexual offenders against children (SOC) is one of the most difficult decisions for practitioners in forensic high-security hospitals. Facing the possible consequences of the decision for the society, a valid and reliable risk management of SOCs is essential. Some risk management approaches provide frameworks for the construction of relevant future risk situations. Due to ethical reasons, it is not possible to evaluate the validity of constructed risk situations in reality. The aim of the study was to test if behavioral monitoring of SOCs in high-immersive virtual risk situations provides additional information for risk management. Six SOCs and seven non-offender controls (NOC) walked through three virtual risk situations, confronting the participant with a virtual child character. The participant had to choose between predefined answers representing approach or avoidance behavior. Frequency of chosen answers were analyzed in regards to knowledge of the participants about coping skills and coping skills focused during therapy. SOCs and NOCs behavior differed only in one risk scenario. Furthermore, SOCs showed in 89% of all cases a behavior not corresponding to their own belief about adequate behavior in comparable risk situations. In 62% of all cases, SOCs behaved not corresponding to coping skills they stated that therapists focused on during therapy. In 50% of all cases, SOCs behaved in correspondence to coping skills therapists stated that they focused on during therapy. Therapists predicted the behavior of SOCs in virtual risk situations incorrect in 25% of all cases. Thus, virtual risk scenarios provide the possibility for practitioners to monitor the behavior of SOCs and to test their decisions on unsupervised privileges without endangering the community. This may provide additional information for therapy progress. Further studies are necessary to evaluate the predictive and ecological validity of behavioral monitoring in virtual risk situations for real life situations.

An Evaluation of a Community-Based Psycho-Educational Program for Users of Child Sexual Exploitation Material

Online sexual offenders represent an increasingly large proportion of all sexual offenders. Many of these offenders receive noncustodial sentences, and there is a growing need for community-based interventions. The aim of this study was to evaluate a psycho-educational program for community dwelling users of child sexual exploitation material (CSEM). A total of 92 adult male participants completed self-report measures at pre and post. A subset of participants also completed measures after a follow-up period. Results suggested benefits across depression, anxiety, and stress; social competency, including locus of control and self-esteem; and distorted attitudes. Furthermore, these effects remained 8 to 12 weeks following program completion. Our results suggest that CSEM users are amenable to treatment in the community and that there are beneficial outcomes in affective and interpersonal functioning following psycho-education. These factors represent treatment targets for sexual offenders and are recognized risk factors for contact sexual offense recidivism.

Dynamic Risk Assessment of Sexual Offenders: Validity and Dimensional Structure of the Stable-2007

In this study, the predictive and incremental validity of the Stable-2007 beyond the Static-99 was evaluated in an updated sample of N = 638 adult male sexual offenders followed-up for an average of M = 8.2 years. Data were collected at the Federal Evaluation Center for Violent and Sexual Offenders (FECVSO) in Austria within a prospective-longitudinal research design. Scores and risk categories of the Static-99 (AUC = .721; p < .001) and of the Stable-2007 (AUC = .623, p = .005) were found to be significantly related to sexual recidivism. The Stable-2007 risk categories contributed incrementally to the prediction of sexual recidivism beyond the Static-99. Analyzing the dimensional structure of the Stable-2007 yielded three factors, named Antisociality, Sexual Deviance, and Hypersexuality. Antisociality and Sexual Deviance were significant predictors for sexual recidivism. Sexual Deviance was negatively associated with non-sexual violent recidivism. Comparisons with latent dimensions of other risk assessment instruments are made and implications for applied risk assessment are discussed.

Factors Predicting Desistance From Reoffending: A Validation Study of the SAPROF in Sexual Offenders

The present study aims at validating the German version of the Structured Assessment of PROtective Factors (SAPROF) for violence risk in a representative sample of incarcerated adult male sexual offenders. Sexual offenders ( n = 450) were rated retrospectively with the SAPROF using the database of the Federal Evaluation Centre for Violent and Sexual Offenders (FECVSO) in the Austrian Prison System. Interrater reliability and predictive validity of the SAPROF scores concerning desistance from recidivism were calculated. Concurrent and incremental validity were tested using the combination of the SAPROF and the Sexual Violence Risk-20 (SVR-20). Interrater reliability was moderate to excellent, and predictive accuracy for various types of recidivism was rather small to moderate. There was a clear negative relationship between the SAPROF and the SVR-20 risk factors. Whereas the SAPROF revealed itself as a significant predictor for various recidivism categories, it did not add any predictive value beyond the SVR-20. Although the SAPROF itself can predict desistance from recidivism, it seems to contribute to the risk assessment in convicted sexual offenders only to a limited extent, once customary risk assessment tools have been applied. Implications for clinical use and further studies are discussed.

What Money Can't Buy: Different Patterns in Decision Making About Sex and Money Predict Past Sexual Coercion Perpetration

Self-reported impulsivity has been found to predict the perpetration of sexual coercion in both sexual offenders and male college students. Impulsivity can be conceptualized as a generalized lack of self-control (i.e., general perspective) or as a multifaceted construct that can vary from one context to the other (i.e., domain-specific perspective). Delay discounting, the tendency to prefer sooner smaller rewards over larger delayed rewards, is a measure of impulsive decision making. Recent sexual adaptations of delay discounting tasks can be used to test domain-specific assumptions. The present study used the UPPS-P impulsivity questionnaire, a standard money discounting task, and a sexual discounting task to predict past use of sexual coercion in a sample of 98 male college students. Results indicated that higher negative urgency scores, less impulsive money discounting, and more impulsive sexual discounting all predicted sexual coercion. Consistent with previous studies, sexuality was discounted more steeply than money by both perpetrators and non-perpetrators of sexual coercion, but this difference was twice as large in perpetrators compared to non-perpetrators. Our study identified three different predictors of sexual coercion in male college students: a broad tendency to act rashly under negative emotions, a specific difficulty to postpone sexual gratification, and a pattern of optimal non-sexual decision making. Results highlight the importance of using multiple measures, including sexuality-specific measures, to get a clear portrait of the links between impulsivity and sexual coercion.

"An Adventure That Went Wrong": Reasons Given by Convicted Perpetrators of Multiple Perpetrator Sexual Offending for Their Involvement in the Offense

There is little empirical research examining the reasons behind multiple perpetrator sexual offending. A limited number of studies provide reasons for offending offered by perpetrators of this type of sexual violence, but only one published study exists where these perpetrators were interviewed regarding their offense. The Multi-Factorial Model of Multiple Perpetrator Sexual Offending (MPSO) proposed that various factors (individual, sociocultural, and situational) play a role in this type of sexual assault, noting in particular the importance of group dynamics and processes. In the current study, 25 convicted perpetrators of multiple perpetrator sexual offending housed in educational centers and prisons in Portugal were interviewed about their involvement and reasons for participating in the offense. The findings suggested that group processes and dynamics play an important part in this type of sexual offending. Furthermore, the results provided some evidence to support the factors proposed by the Multi-Factorial Model of MPSO. These findings have implications for prevention and treatment programs and for the assessment of offenders.

Emotions and Cognitions Associated with the Stigma of Non-Offending Pedophilia: A Vignette Experiment

Cognitive and affective antecedents of the desire to avoid or punish non-offending pedophilic individuals are not well understood. In this article, we examined the effects of non-offending motivation (internal vs. external) and sexual orientation (pedophilic vs. teleiophilic) on cognitive apprehensions (amorality, dangerousness, abnormality), emotions (fear, anger, disgust), punitive attitudes, and social distance toward a man experiencing a sexually transgressive impulse. A total of 205 U.S.-based MTurk workers were randomly assigned to one of four groups in this 2 × 2 factorial vignette study. As expected, pedophilic orientations and extrinsic non-offending motivations led to stronger negative apprehensions and emotions, as well as higher social distance and punitive attitudes. When controlling for the other emotions, disgust mediated the effect of pedophilic orientation on social distance, while anger and fear mediated the effect of non-offending motivation on punitive attitudes. Disgust, fear, and anger were furthermore differentially associated with perceived amorality, dangerousness, and abnormality. This research helps clarify why desires to punish or avoid non-offending pedophilic men are so strong, even when they never commit sexual crimes.

Committed as a Violent Sexual Predator in His 10th Decade: A Case Study

We report a case study of Atypical Offender (AO), a man who was civilly committed as a sexually violent person several years after his 90th birthday. In this article, we review the factors that usually contribute to virtually zero rates of sexual crime among nonagenarians for clues as to why these protective factors did not apply to this exceptional case. Psychological assessments and court records portrayed AO as having many of the features expected of persistent sexual offenders against children (e.g., pedophilic interests, child-oriented lifestyle). What was unusual, however, was AO's exceptional good health and vigor, which was maintained well into his tenth decade. Consequently, we recommend that forensic evaluators of older sexual offenders systematically consider the offenders' health as part of the overall risk assessment.

Predicting Offenders' Institutional Misconduct and Recidivism: The Utility of Behavioral Ratings by Prison Officers

Measures of current behavior are rarely incorporated into risk assessment. Therefore, the current study used a behavior rating scale to assess prison officers' observations of inmates prison behavior and examined the contribution of these ratings for risk assessment. Prison officers rated 272 sexual and violent offenders in three different correctional treatment facilities in Berlin, Germany. Factor analysis revealed three psychologically meaningful factors measuring externalizing, internalizing and adaptive prison behavior. The construct validity of the three factors was established through correlational analyses with standardized risk assessment instruments. Externalizing and internalizing behaviors were significant predictors of violent recidivism after release. In addition, externalizing was a significant predictor of institutional misconduct, whereas adaptive and internalizing behavior predicted whether an inmate was granted privileges (e.g., minimum-security confinement). Logistic regression analyses indicated that externalizing behavior ratings added incrementally to the Level of Service Inventory-Revised for the prediction of institutional misconduct and violent recidivism. The results indicate that prison officers observe important prison behaviors and that behavioral ratings can improve risk assessment.

Web-Based Health Services in Forensic Psychiatry: A Review of the Use of the Internet in the Treatment of Child Sexual Abusers and Child Sexual Exploitation Material Offenders

In recent years, web-based health services for a variety of mental disorders have been developed and evaluated. Evidence suggests that guided internet-based therapy can be as effective as conventional face-to-face therapy. In forensic psychiatric practice, few web-based treatments have been implemented up to now. However, to our knowledge, there do not yet exist guided internet-based treatments for child sexual abusers and child sexual exploitation material offenders. This review aims at examining under what conditions patients are most likely to benefit from internet-based treatments. In addition, some computer-based health services in forensic psychiatry will be summarized and their potentials and weaknesses will be discussed. Subsequently, the review focuses on the implications for the development of online treatments for child sexual abusers as well as on a variety of ethical and legal issues that practitioners may encounter during the development, evaluation and delivery of online health services. The review will conclude with proposed quality standards for the development and implementation of web-based interventions for child sexual abusers and child sexual exploitation material offenders. By virtue of the low number of psychotherapists offering therapy to this clientele as well as individual barriers to seeking treatment such as fear of stigmatization, feelings of shame, long access routes, or limited mobility due to physical handicaps, the development of mental eHealth services in this sector could close an important healthcare gap. By increasing the density of supply, more child sexual abusers and child sexual exploitation material offenders would have the chance to engage in treatment and, ultimately, more incidents of sexual assault against minors could be prevented.

Social Anxiety and Loneliness in Adults Who Solicit Minors Online

This study examined the association of social anxiety, loneliness, and problematic Internet use (PIU) with the online solicitation of minors. Within a convenience sample of adult Internet users from Germany, Finland, and Sweden ( N = 2,828), we compared the responses of participants who had not interacted sexually with strangers online ( n = 2,049) with participants who sexually interacted with unknown adults online ( n = 642), and both groups with adults who sexually solicited unknown minors online ( n = 137). Online sexual interaction with adults was associated with higher levels of social anxiety, loneliness, and PIU compared with not sexually interacting with strangers online. Sexually soliciting minors online was associated with higher levels of social anxiety, loneliness, and PIU compared with sexually interacting with adults and not sexually interacting with strangers at all. Interestingly, compared with those with adult contacts, loneliness was specifically pronounced for participants who solicited children, whereas social anxiety and PIU were pronounced for participants soliciting adolescents. These findings suggest that social anxiety, loneliness, and PIU may be among the motivators for using the Internet to solicit individuals of different age groups for sexual purposes. These factors emerged as specifically relevant for adults who sexually solicited minors and who reported greater impairments compared with adults who sexually interacted with adults. These characteristics may thus be important to consider for assessment and treatment procedures for individuals soliciting minors online.

Emotional Congruence With Children Is Associated With Sexual Deviancy in Sexual Offenders Against Children

Emotional congruence with children is a psychologically meaningful risk factor for sexual offending against children. The present study examines the correlates of emotional congruence with children in a sample of 424 adult male sexual offenders who started a period of community supervision in Canada, Alaska, and Iowa between 2001 and 2005. Consistent with previous work, we found sexual offenders against children high in emotional congruence with children were more likely to be sexually deviant, have poor sexual self-regulation, experience social loneliness, and have more distorted cognitions about sex with children. Overall, our findings are most consistent with a sexual deviancy model, with some support for a blockage model.

Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11)

The World Health Organization is currently developing the 11th revision of the International Classifications of Diseases and Related Health Problems (ICD-11), with approval of the ICD-11 by the World Health Assembly anticipated in 2018. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) was created and charged with reviewing and making recommendations for categories related to sexuality that are contained in the chapter of Mental and Behavioural Disorders in ICD-10 (World Health Organization 1992a). Among these categories was the ICD-10 grouping F65, Disorders of sexual preference, which describes conditions now widely referred to as Paraphilic Disorders. This article reviews the evidence base, rationale, and recommendations for the proposed revisions in this area for ICD-11 and compares them with DSM-5. The WGSDSH recommended that the grouping, Disorders of sexual preference, be renamed to Paraphilic Disorders and be limited to disorders that involve sexual arousal patterns that focus on non-consenting others or are associated with substantial distress or direct risk of injury or death. Consistent with this framework, the WGSDSH also recommended that the ICD-10 categories of Fetishism, Fetishistic Transvestism, and Sadomasochism be removed from the classification and new categories of Coercive Sexual Sadism Disorder, Frotteuristic Disorder, Other Paraphilic Disorder Involving Non-Consenting Individuals, and Other Paraphilic Disorder Involving Solitary Behaviour or Consenting Individuals be added. The WGSDSH's proposals for Paraphilic Disorders in ICD-11 are based on the WHO's role as a global public health agency and the ICD's function as a public health reporting tool.

"I Am a Different Man Now"-Sex Offenders in Circles of Support and Accountability: A Prospective Study

In Circles of Support and Accountability (CoSA), a group of trained and supervised volunteers support a sex offender (core member in a circle), with the aim of supporting the core member's transitions toward full desistance. A prospective, multi-method design was used to explore psychological and social transitions in core members. Data were collected at the start of their circle, after 6 months, and after 12 months. Qualitative data were collected in semi-structured interviews with 17 core members and a total of 29 professionals, and analyzed with Kwalitan, a computer-assisted program for qualitative data analysis. Quantitative data were assessed with self-report questionnaires for sex offenders. Mean differences between t0, t1, and t2 were tested with repeated-measures ANOVAs. Qualitative results indicated improvements in reflective skills, openness, and problem-solving skills, as well as social skills, agency, and self-regulation. Quantitative results documented improvements in emotion regulation and internal locus of control, and positive trends in self-esteem and coping skills. Due to the small sample size, our results must be interpreted with caution. Core members as well as professionals reported a unique contribution of circles to their process, but this claim needs further confirmation.

Sexually violent predator risk assessments with the violence risk appraisal guide-revised: A shaky practice

Twenty-two jurisdictions in the United States permit the involuntary civil confinement of sexual offenders upon expiration of their criminal sentence and, if committed, these individuals face possible lifetime commitment. One of the legal requirements that psychologists must address in sexually violent predator evaluations is the likelihood that an individual will engage in dangerous sexual behavior and consideration of the probabilities for sexual recidivism contained in actuarial experience tables best address this inquiry. Clinicians find it increasingly difficult to affirm the likelihood threshold in the face of decreasing base rates and score-wise probability estimates for sexual recidivism reported in contemporary actuarial experience tables. The Violence Risk Appraisal Guide-Revised (VRAG-R) has been promoted to assess sexually violent predators because it has been presented as a more accurate predictor of sexual recidivism and the results more likely satisfy the legal standard of sexual dangerousness. This article conducts an in-depth analysis of the predictive and psychometric properties of the VRAG-R that are most relevant to the fit of the VRAG-R when addressing the sexual dangerousness standard proscribed by SVP laws. Recommendations for future research are offered to improve the fit of the VRAG-R to the legal inquiry of sexual dangerousness and implications for using the current iteration of the VRAG-R in forensic practice are discussed.

Validity in Phallometric Testing for Sexual Interests in Children: A Meta-Analytic Review

Valid assessment of pedohebephilic interests (i.e., sexual interest in children) is fundamental to forensic clinical practice. Phallometric testing-which measures changes in penile circumference or volume, while stimuli depicting different ages and sexual activities are presented-is widely used in clinical and research settings to detect such interests. This meta-analysis summarizes studies comparing sexual offenders against children and various types of controls on phallometric tests for pedohebephilic interests (37 samples; N = 6,785) and studies examining the relationship between phallometric test scores and sexual reoffending (16 samples; N = 2,709). The findings suggest that several phallometric testing procedures are valid indicators of pedohebephilic interest. Certain methodological features of phallometric tests were associated with greater validity, such as, slide or audio-plus-slide stimuli and z-score-based indices. In addition, phallometric tests for pedohebephilic, pedophilic, and hebephilic interests predicted sexual reoffending which provides further evidence that phallometric test scores are valid indicators of sexual interest in children. In general, the interpretation of phallometric test scores as indicators of pedohebephilic interests is supported.

Inhibiting Sexual Arousal to Children: Correlates and Its Influence on the Validity of Penile Plethysmography

The current study examined the extent to which 1136 men were able to inhibit their sexual arousal on a phallometric assessment, when instructed to do so. Although the observed changes between the two conditions (i.e., Normal and Suppression) were small to moderate in magnitude, the change was not more than what would be expected by measurement error for most participants (e.g., 83% of pedophilic sex offenders against children did not successfully inhibit their sexual arousal in the Suppression condition). There were very few variables that were associated with the ability to suppress. Higher Pedophilia Index scores in the Suppression condition predicted a greater likelihood of sexual recidivism among sex offenders (hazard ratio = 1.17, 95% CI [1.04, 1.32]), but the ability to suppress sexual arousal was not found to predict sexual recidivism. The current study highlights the importance of accounting for measurement error and found that, when doing so, most sex offenders against children are unable to successfully inhibit their sexual arousal to children when instructed to do so, and that the ability to suppress sexual arousal is not associated with recidivism.

An Evaluation of the Reliability, Construct Validity, and Factor Structure of the Static-2002R

The fundamental psychometric properties of the subscales found in the Static-2002R, an actuarial measure of sexual recidivism risk, were evaluated in the current study. Namely, the reliability, concurrent and construct validity, and factor structure of the Static-2002R subscales were examined with a sample of 372 adult male sex offenders. In addition to using validated measures of sexual violence risk to examine concurrent validity, construct-related measures taken from extant risk measures and psychometric tests were correlated with three of the subscales to assess overall construct validity. Moderate support was found for the reliability of the Static-2002R. The concurrent and construct validity of the General Criminality, Persistence of Sexual Offending, and Deviant Sexual Interest subscales were supported. Generally, these findings further support the Static-2002R as a valid sex offender risk appraisal instrument that encompasses multiple distinct, clinically relevant, risk domains.

A Meta-Analysis of Viewing Time Measures of Sexual Interest in Children

Due to unobtrusiveness and ease of implementation, viewing time (VT) measures of sexual interest in children have sparked increasing research interest in forensic contexts over the last two decades. The current study presents two meta-analyses of VT measures adapted to assess pedophilic interest to determine their discrimination between sexual offenders against children (SOC) and non-SOC groups as well as convergent validity (associations with other measures of sexual interest in children). On average, VT measures showed moderate discrimination between criterion groups (fixed-effect d = 0.60, 95 % CI [0.51, 0.68], N = 2705, k = 14) and significant convergent validity with self-reports, penile plethysmography, Implicit Association Tests, and offence behavioral measures ranging from r = .18 to r = .38. VT measures, however, provided better discrimination for adults (fixed-effect d = 0.78, 95 % CI [0.64, 0.92]) than adolescent samples (fixed-effect d = 0.50, 95 % CI [0.40, 0.61]), Q _between = 9.37, p = .002. Moreover, compared to absolute scores, using pedophilic difference scores within adult samples substantially increased VT measures' validity (fixed-effect d = 1.03, 95 % CI [0.82, 1.25], N = 414, k = 7). Results are discussed in terms of their theoretical and applied implications for forensic contexts.