Risk factors for the perpetration of child sexual abuse: a review and meta-analysis

Contact sex offenders with adult and minor victims: Psychopathological and criminological differences

BACKGROUND

Effective classification of individuals who commit sexual offences is important for their assessment, treatment, and risk management. Victim age has often been used as a distinguishing factor between perpetrators.

OBJECTIVE

This study aimed to analyse the distinctive psychopathological and criminological characteristics of contact sexual offenders with adult and minor victims.

PARTICIPANTS AND SETTING

The study involved 97 adult males who were serving a prison sentence in Spain for at least one contact sexual offence against an adult or a minor.

METHODS

Researchers gathered data on criminological variables concerning the offender, victim, and modus operandi from prison records and interviews. Participants completed the Millon Clinical Multiaxial Inventory-III (MCMI-III) in a second session, and between-group differences were analysed.

RESULTS

Sex offenders with minor victims (SOMV) had significantly lower scores than sex offenders with adult victims (SOAV) on the Antisocial (r = -0.283, p = .005) and Sadistic (r = -0.209, p = .04) personality subscales, and on the Alcohol (r = -0.426, p < .001) and Drug dependence (r = -0.332, p = .001) syndrome subscales. SOAV were also more likely to use violence and/or intimidation, use a weapon, offend against female victims, offend against an intimate partner, commit their offences in public places, serve other ongoing prison sentences, and report a history of alcohol and substance abuse. SOMV were older and more likely to offend against family members.

CONCLUSIONS

These results suggest that there are key differences between SOAV and SOMV that should be considered in tailored prevention programmes for each subgroup of offenders.

Factors Associated With Contact Sexual Offending Among a Non-Forensic Sample of Women With Sexual Interest in Children - Results From an Anonymous Online Survey

This study aimed at assessing the extent to which factors associated with male child sexual offending may also be applicable to women with a self-identified sexual interest in children. Participants (n = 42) took part in an anonymous online survey covering questions about general characteristics, general sexuality, sexual interest in children, and previously-perpetrated contact child sexual abuse. Group comparisons between women who reported committing contact child sexual abuse compared to those who had not were conducted in terms of sample characteristics. Furthermore, the two groups were compared regarding the factors of high sexual activity, use of child abuse material, indication of ICD-11 pedophilic disorder diagnosis, exclusivity of sexual interest in children, emotional congruence with children, and childhood maltreatment. Our results revealed that high sexual activity, indication of ICD-11 pedophilic disorder diagnosis, exclusivity of sexual interest in children, and emotional congruence with children were associated with previous contact child sexual abuse perpetration. We recommend further research on potential risk factors relating to child sexual abuse on the part of women.

A Descriptive Model of Voyeuristic Behavior

Over the last 50 years, there has been a plethora of research exploring sexual offending with a recent focus on online offending. However, little research has focused on voyeurism despite convictions and media awareness growing rapidly. Currently, there is sparse theoretical or empirical literature to guide research and practice for individuals engaging in voyeuristic behaviors. As such, 17 incarcerated men with a conviction of voyeurism in the UK were interviewed on the cognitive, affective, behavioral, and contextual factors leading up to and surrounding their offense(s). Grounded theory analyses were used to develop a temporal model from background factors to post-offense factors; the Descriptive Model of Voyeuristic Behavior (DMV). The model highlights vulnerability factors for men engaging in voyeuristic behaviors in this sample. Following this, the same 17 men were plotted through the model and three key pathways were identified: Sexual Gratification, Maladaptive Connection Seeking, and Access to Inappropriate Person(s). The characteristics of each pathway are discussed, and treatment implications considered.

Psychiatric disorders and management of sexual offenders in the prison psychiatric consultation unit of Marseille

Since 2017, complaints of sexual violence have increased in France. At the same time, the management of sexual offenders has been at the center of international public health policies. The prevalence of mental disorders among sexual offenders is an essential field of research. There are some published studies on the prevalence of psychiatric disorders in sexual offenders in detention, but there are few recent published studies among French individuals who were detained. Our objectives were to determine the prevalence of psychiatric disorders among persons detained for sexual offenses and the level of care received according to their diagnosis. For this purpose, we carried out a retrospective observational study from January 2017 to October 2021 of all adult sexual offenders, whether accused or convicted, who were seen in the psychiatric consultation unit of Les Baumettes prison, Marseille, France. The primary outcome measure was the psychiatric diagnosis entered in the medical records. One hundred forty-two patients were included in analysis. All patients were men, and the majority (n = 97, 68.3%) of these patients presented with at least one psychiatric disorder, principally a personality disorder (31.7%). 10.6% presented with a schizophrenic disorder, 4.9% a bipolar disorder, 3.5% a depressive disorder, 5.6% pedophilic paraphilia, and 25.4% an addictive disorder. Their management and comorbid addictions were analyzed in subgroups for each psychiatric disorder. Patients appeared to receive an appropriate level of care for their diagnosed disorder. It seems important to develop structured assessment of recidivism risk for better management of sexual offenders.

Socioeconomic inequalities in child and adolescent mental health in Australia: the role of parenting style and parents' relationships

BACKGROUND

Socioeconomic inequalities in health and their determinants have been studied extensively over the past few decades. However, the role of parenting style and parents' couple relationships in explaining mental health inequalities is limited. Therefore, this study aims to investigate the distributional impact of parenting style (angry parenting, consistent parenting, and inductive parenting) and parents' couple relationships (e.g., argumentative, happy relationships) on socioeconomic inequalities and by extension on mental health status of Australian children and adolescents.

METHODS

This study utilized data from the Longitudinal Study of Australian Children (Waves 1-7), specifically focusing on intact biological parent families, while excluding single-parent and blended-family households. We applied the decomposition index and the Blinder Oaxaca method to investigate the extent of the contribution and temporal impact of parenting style and parents' couple relationships on the mental health status of Australian children and adolescents.

RESULTS

This study revealed that poor parenting style is the single most important factor that leads to developing mental health difficulties in children and adolescents, especially from low socioeconomic status, and it contributes almost 52% to socioeconomic inequalities in mental health status. Conversely, household income, maternal education, employment status, and parents' couple relationships contributed 28.04%, 10.67%, 9.28%, and 3.34%, respectively, to mental health inequalities in children and adolescents.

CONCLUSION

Overall, this study underscores the importance of parenting style and parents' couple relationships as significant predictors of mental health outcomes in children and adolescents. These results highlight the need for targeted interventions to support families from low socioeconomic backgrounds to address the significant mental health inequalities observed in the study population.

Responsible Behavior With Younger Children: Results From a Pilot Randomized Evaluation of a School-Based Child Sexual Abuse Perpetration Prevention Program

Many efforts to prevent child sexual abuse (CSA) aim to teach children strategies for recognizing, resisting, and reporting victimization. There is limited evidence that victimization-focused efforts actually prevent CSA. Moreover, these efforts often overlook the fact that many children and adolescents engage in problem sexual behavior against younger children. Responsible Behavior with Younger Children (RBYC) is a novel universal school-based perpetration-focused intervention that aims to prevent the onset of inappropriate, harmful, or illegal sexual behavior by adolescents against younger children.1 Responsible behavior with younger children was designed to provide adolescents and their parents with the knowledge and tools to help adolescents interact appropriately with younger children and avoid CSA behaviors. In this paper we describe intervention development, summarize lessons learned from implementing RBYC in four urban schools, and report results from our pilot randomized waitlist-controlled trial (RCT) with 160 6th and 7th grade students. Results indicate RBYC was associated with increased accuracy in youth knowledge about CSA and CSA-related laws, and with increased behavioral intention to avoid or prevent CSA with younger children and peer sexual harassment. Although the sample was small and the effects were relatively modest, the findings do suggest that RBYC holds promise for preventing the onset of problem sexual behavior.

Use of technology in evidence-based programs for child maltreatment and its impact on parent and child outcomes

Introduction

Technology has been used in evidence-based child maltreatment (CM) programs for over a decade. Although advancements have been made, the extent of the application of technology in these programs, and its influence on parental and child outcomes, remains unclear within the context of changes that emerged because of the COVID-19 pandemic. This scoping review provides a contextualized overview and summary of the use of technology in evidence-based parenting and child programs serving families impacted by child maltreatment and the effects of technology-enhanced programs on target outcomes.

Materials and methods

Using Arksey and O'Malley's methodological framework, we searched seven databases to identify peer-reviewed and grey literature published in English from 2000 to 2023 on evidence-based programs, according to the California Evidence-Based Clearinghouse (CEBC), that included technological supports for two populations: at-risk parents for child maltreatment prevention, and children and youth 0-18 years exposed to child maltreatment. All study designs were included.

Results

Eight evidence-based parenting programs and one evidence-based child trauma program were identified as using technology across a total of 25 peer-reviewed articles and 2 peer-reviewed abstracts meeting inclusion criteria (n = 19 on parent-level programs; n = 8 on child-level programs). Four studies were published in the context of COVID-19. Two main uses of technology emerged: (1) remote programmatic delivery (i.e., delivering all or part of the program virtually using technology) and (2) programmatic enhancement (i.e., augmenting program content with technology). Improvements across parenting and child mental health and behavioral outcomes were generally observed.

Discussion

Technology use in evidence-based child maltreatment programs is not new; however, the small sample since the start of the COVID-19 pandemic in this review that met inclusion criteria highlight the dearth of research published on the topic. Findings also suggest the need for the inclusion of implementation outcomes related to adoption and engagement, which could inform equitable dissemination and implementation of these programs. Additional considerations for research and practice are discussed.

Evaluating the Effectiveness of a Live Musical Theater-Based Approach to Child Sexual Abuse Prevention in Elementary Schools

Hugs and Kisses is a theater-based child sexual abuse (CSA) prevention program designed for children in kindergarten through fifth grades. The purpose of this cross-sectional case study is to evaluate how a comprehensive live musical theater program can prepare teachers to discuss and identify the signs of CSA, help children increase their knowledge, and learn prevention strategies to stop CSA in the future. A total of 154 teachers and 2,700 children from 31 schools participated in this program during 2016. Findings show this program increases children's awareness of touch and action knowledge through five primary safety lessons taught during the program and reinforced by a teacher led in-person discussion after the play. Nearly 85% of the students across all grade levels in this sample understood the lessons taught in the play, and students whose teachers held an in-class discussion after the play scored better than those students whose teachers did not hold a discussion. Teachers who were prepared with training resources also held longer in-class discussions compared to those who were not prepared. The Hugs play has the potential to be a national model for evidence-based CSA programs.

Is the Affordable Care Act Medicaid Expansion Associated With Reported Incidents of Child Sexual Abuse?

There is substantial evidence that adequate access to healthcare among low-income adults through the Affordable Care Act Medicaid expansion mitigates risk factors associated with childhood maltreatment, including parental financial insecurity, substance use, and poor mental health. Indeed, studies identified reduced reports of child neglect in states that expanded Medicaid, relative to those that did not. However, it is unknown whether Medicaid expansion is associated with reported child sexual abuse (CSA). We present findings from a study evaluating the association of Medicaid expansion with incidents of CSA reported to child protective services. Using a difference-in-differences approach, we analyzed data from the National Child Abuse and Neglect Data System to examine the effects of state-level adoption of the Medicaid expansion on CSA reports per 100,000 children across 2008-2018. Results indicated no statistically significant association between Medicaid expansion and CSA incidents. We discuss potential reasons for differential association of macro-level policies on types of child maltreatment.

Realization, Self-View, and Disclosure of Pedophilia: A Content Analysis of Online Posts

In order to treat individuals with pedophilia¹ who are at risk of committing offenses, disclosure of the attraction must first take place. The aim of this study was to understand processes of initial recognition of pedophilic attraction, disclosure, and help-seeking. We conducted a qualitative content analysis of online posts from self-identified individuals with pedophilia, finding four categories: (1) Awareness and Initial Self-View (with emotions including denial, shame, and fear), (2) Disclosure (typically made to family, friends, or therapists, but also done online in an anonymous way), (3) People's Reactions to Disclosure (ranging from rejection to support), and (4) Current Self-View (including minimization, distortions, despair, resignation, and non-offending/anti-contact commitment). Our findings highlight the internal process experienced by individuals with pedophilia when first recognizing their attraction to minors, what is involved in disclosure, the importance of others' reactions after disclosure, and the factors that can reinforce a non-offending commitment. Clinical and social implications are discussed.

Online forum use in child attracted persons

Social support for child-attracted persons (CAPs) may be important for increasing well-being, thereby reducing the risk of committing child sexual abuse. Unfortunately, in-person social support may be difficult to obtain because of stigma. CAPs may instead turn to online forums for people who are sexually attracted to children. The present study looks at the emotional, informational, and tangible support CAPs offered and received through online forums. We recruited 353 CAPs from Twitter and multiple online forums. The survey covered basic demographics, frequency of forum use, reasons for forum use, social support received or offered, helpfulness of forums, and their quality of offline support. Most CAPs said that they initially sought out forums to avoid feeling alone in their attraction; the quality of offline support was rated as moderate. Emotional support and informational support were the most frequently endorsed forms of social support. CAPs who visited more forums reported forums to be less helpful, which could reflect “forum shopping.” A Poisson regression predicting online support from quality of offline support and various demographic and forum use variables did not reveal any significant results. This is the first quantitative study to look at the benefits of forums for CAPs regarding specific types of social support. The authors consider if certain forums, in addition to professional help, could be part of a repertoire of resources for CAPs who may be struggling.

Viewing Time Measures of Sexual Interest and Sexual Offending Propensity: An Online Survey of Fathers

Relative viewing times (VTs)-time required to view and evaluate sexually salient images-discriminate individuals with a sexual interest in children, as indirectly indexed by their history of sexual offending against children, from those without such history. In an online sample of 652 fathers, we measured VTs and sexual attraction ratings to child and adult images. We assessed participants' sexual offending history and propensity (self-reported likelihood to have a sexual contact with a child, a non-consensual sexual contact with an adult, and propensity toward father-daughter incest). In contrast with VT studies involving clinical or forensic samples, VTs and attraction ratings failed to discriminate participants with a sexual offending history. VTs successfully distinguished participants with a propensity to sexually offend against children but failed to identify those with a propensity toward incest. Conversely, attraction ratings distinguished participants with a propensity toward incest but failed to identify those with a propensity to sexually offend against children. Correlations between VTs and attraction ratings were small. Results illustrate, for the first time, the distribution of VT measures in community fathers, support the feasibility of online administration of VT tasks to detect propensity to sexually offend against children, and indicate that sexual interest in children and incest propensity are distinct.

Improving Our Risk Communication: Standardized Risk Levels for Brief Assessment of Recidivism Risk-2002R

A Five-Level Risk and Needs system has been proposed as a common language for standardizing the meaning of risk levels across risk/need tools used in corrections. Study 1 examined whether the Five-Levels could be applied to BARR-2002R (N = 2,390), an actuarial tool for general recidivism. Study 2 examined the construct validity of BARR-2002R risk levels in two samples of individuals with a history of sexual offending (N = 1,081). Study 1 found reasonable correspondence between BARR-2002R scores and four of the five standardized risk levels (no Level V). Study 2 found that the profiles of individuals in Levels II, III, and IV were mostly consistent with expectations; however, individuals in the lowest risk level (Level I) had more criminogenic needs than expected based on the original descriptions of the Five-Levels. The Five-Level system was mostly successful when applied to BARR-2002R. Revisions to this system, or the inclusion of putatively dynamic risk factors and protective factors, may be required to improve alignment with the information provided by certain risk tools.

Adverse Childhood Experiences, Aggression, Empathy, and Psychopathology in Adult Males Accused of Rape

BACKGROUND

Investigating the underlying psychosocial factors is a cornerstone of planning need-based intervention for adult males accused of rape. Unresolved debates on its etiology, mediation, or interaction among causal psychosocial variables fuel curiosity to scrutinize it further. Hence, we studied potential influence of and relation between adverse childhood experiences, aggression, empathy, and psychopathology in adult males accused of rape in India and investigated the risk factors for the same.

METHODS

With a correlational research design, 40 literate and consenting adult males medically confirmed for rape were recruited using convenient sampling. The assessment was done on Adverse Childhood Experiences, Aggression Questionnaire, Symptom Checklist-90, and Interpersonal Reactivity Index. Descriptive statistics, Pearson's product-moment correlation, and stepwise linear regression analysis were calculated.

RESULTS

Approximately 75% of the participants experienced at least one category of Adverse Childhood Experiences. Scores above cut-off points were obtained on anger, hostility, fantasy, and personal distress. Significant correlations were obtained between adverse childhood experiences and psychopathology; between hostility and psychopathology, perspective taking, and personal distress; and in case of indirect aggression, with perspective taking and empathetic concerns. Regression analysis revealed that an increase in Symptom Checklist-90 global scores increases hostility and that lower personal distress predicts higher scores on hostility on Aggression Questionnaire.

CONCLUSIONS

Adverse childhood experiences, aggression, and psychopathology play a critical role and, therefore, should be included as core components of the prevention of rape or relapse prevention programs at the community level.

Lay People´s Myths Regarding Pedophilia and Child Sexual Abuse: A Systematic Review

INTRODUCTION

The term "paedophilia erotica" was first coined in 1886 by the psychiatrist Krafft-Ebing and it was considered a "psycho-sexual perversion." It was at the beginning of the twentieth century that the term "pedophilia" was adopted and it started to appear in medical dictionaries. Sexual abuse is legally defined as the engagement in sexual contact with a person below a specified age or who is incapable of giving consent. Both, pedophilia and child sexual abuse (CSA) are worldwide phenomena requiring deep scientific knowledge in order to improve prevention strategies. Individuals' misconceptions of pedophilia and CSA may legitimize sexual violence, which can influence prevention strategies and policies.

OBJECTIVES

This review aimed to summarize existing research to help answer the question: "What are laypeople´s myths regarding pedophilia and CSA?"

METHODS

This systematic review followed the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify as many relevant articles as possible. A literature search was conducted using PubMed, Web of Science, Scopus, and EBSCOhost databases for articles published before January 2022. Sixty-one articles were included in the current review.

RESULTS

Overall, findings revealed a significant number of myths regarding pedophilia and CSA, organized into the following categories: (i) blame diffusion, (ii) denial of abusiveness, (iii) restrictive stereotypes, (iv) victim age and consequences, (v) social stigma, (vi) punitive attitudes, and (vii) treatment.

CONCLUSION

Findings suggested that laypeople's perceptions should be taken into account when devising prevention policies. Additionally, perceptions should also be a target of prevention since there is evidence of social stigma and prejudice involving individuals with pedophilia. Such phenomena can contribute to social, emotional, and cognitive problems, among said individuals as well as causing these individuals to exhibit a higher risk for abusive behavior and less help-seeking. Glina F, Barroso R, Cardoso D, et al. Lay People´s Myths Regarding Pedophilia and Child Sexual Abuse: A Systematic Review. Sex Med Rev 2022;XX:XXX-XXX.

Multidisciplinary Approach to Emergent Sexual Abuse in a Pediatric Emergency Department: A Simulated Child Advocacy Center Model of Care

INTRODUCTION

The purpose of this study was to compare child sexual abuse interview disclosures and judicial outcomes for cases of child and adolescent sexual abuse/assault seen in a pediatric emergency department (PED) before and after the implementation of a simulated child advocacy center (CAC) multidisciplinary model of care.

METHOD

A retrospective chart and legal records review was conducted from both the PED model of care group and the simulated CAC multidisciplinary model of care for judicial outcomes, child sexual abuse interview disclosures, and sexual abuse case characteristics.

RESULTS

The simulated CAC multidisciplinary model of care did not result in increased indictments, pleas, trials, or disclosure of sexual abuse in the sexual abuse interview when compared with the PED model of care. The simulated CAC multidisciplinary model of care did result in a significantly higher rate of sexual abuse interview completion.

DISCUSSION

Demographic risk factors for sexual abuse victimization as well as perpetration have been identified in the literature and were supported by this study. Law enforcement and child protective services were more frequently present in the PED under the simulated CAC multidisciplinary model allowing for improved protection of children.

Childhood victimization and poly-victimization of online sexual offenders: A developmental psychopathology perspective

BACKGROUND

Research on childhood victimization of individuals involved in online sexual offending during adulthood is scarce. Studies focusing on adverse childhood of individuals involved in offline child abuse suggested that childhood trauma was associated with an increased probability of sexual offending during adulthood.

OBJECTIVE

The purpose of this study is to explore the role that childhood victimization may have in the development of risk factors that increase the likelihood of being involved in online sexual offending.

PARTICIPANTS

This comparative study analyzed the characteristics of 127 individuals involved in online sexual offending who did not experience childhood victimization and 77 individuals involved in online sexual offending who experienced childhood victimization.

METHODS

Bivariate and regression analyses were conducted to identify variables associated with the presence of victimization and polyvictimization during childhood. Next, structural equation modeling analysis was used to identify the direct and indirect relationships between childhood (poly)victimization and the development of risk factors.

RESULTS

Results showed that individuals who experienced childhood victimization presented different risk factors and cognitions compared to those who did not. Depending on the type of victimization experienced, criminogenic cognitions, antisocial behaviors, and sexual interests for children were more likely to be developed.

CONCLUSIONS

For individuals involved in online sexual offending during adulthood, childhood abuse is directly associated with the development of offense-supportive cognitions, substance abuse, and youth engagement in sexual offending, while sexual interests for children and sense of loneliness are indirect consequences of childhood trauma.

Assessing Rape Myth Acceptance: A Contribution to Italian Validation of the Measure for Assessing Subtle Rape Myth (SRMA-IT)

The study aimed to validate the Italian version of the Measure for Assessing Subtle Rape Myths developed by McMahon and Farmer. A sample of 3,915 university students (70.8% female) completed the questionnaire. After an exploratory factor analysis, a confirmatory factor analysis tested the resulting four-factor structure of the Italian Subtle Rape Myth Acceptance (SRMA-IT) Scale ("She Asked for It"; "He Didn't Mean To"; "It Wasn't Really Rape"; and "She Lied"), consistent with McMahon and Farmer's initial hypothesis. The Italian validation did not include items related to intoxication. Internal consistency of the subscales was good (α from .78 to .90). Convergent validity between all subscales and System Justification-Gender was detected: A strong relationship was observed (r is from .19 to .33; p < .001). The independent-sample T test then showed that women accepted all four rape myths significantly less than men: Effect size is more than moderate for the myth "She Asked for It" (Cohen's d = .60) and between small and moderate for the other myths (d is from .35 to .42). Acceptance of rape myths is often associated with higher men's proclivity to rape and with tendency to raped women's double victimization (they can be not believed or blamed when they disclose the rape). Having a validated instrument to measure rape myth acceptance can enhance empirical research on this topic and help to develop interventions of prevention both for men in the society and for the first responders to disclosures, also sustaining a culture of respect and of contrast to violence.

Childhood sexual victimization, pedophilic interest, and antisocial orientation

According to the sexually abused-abuser hypothesis, childhood sexual victimization (CSV) among males increases the likelihood of later sexual offending against children. Why CSV is related to sexual offending against children, however, has yet to be determined. To explore mechanisms that may link CSV to sexual offending, we tested the relationship between CSV and the two main risk domains: pedophilic interest and antisocial orientation. In four studies, men convicted of sexual offences against children under 15 who reported experiencing CSV were generally more sexually interested in children—especially male children—and were more antisocial than those who did not report experiencing CSV. A meta-analysis of the results across our four studies showed that CSV was moderately associated with greater antisociality, but less so with pedophilic interests. Future research should test the extent to which pedophilic interest and antisocial orientation explain the relationship between CSV and sexual offending against children among convicted sexual offenders.

Epidemiology of Child Maltreatment during the COVID-19 Pandemic in Saudi Arabia

Child maltreatment, especially during health crises, is a major public health issue transcending cultural, social, and racial contexts. We assessed the sociodemographic and related risk factors associated with the types and rates of child maltreatment. We also assessed the economic, social, and environmental characteristics of child maltreatment victims and their perpetrators, as they were reported to the Saudi National Family Safety Program (NFSP), with consideration of the COVID-19 pandemic’s impact. A secondary data analysis of a retrospective review was conducted to compare types and rates before and during the COVID-19 outbreak, utilizing descriptive and multivariate analyses on anonymized data from the NFSP. According to a predetermined list of relevant risk factors for child maltreatment outlined by the NFSP, these anonymized data were obtained and analyzed with no exclusion criteria (n = 1304). The findings showed that a child’s age correlated significantly and positively with their odds of being physically maltreated; as a child’s age increased by one year, on average, their corresponding predicted odds of being physically maltreatment tended to rise by a factor equal to 7.6% (p < 0.001). Neglected children, compared to those who had not been previously neglected, were predicted to be almost twice (2.23 times more) as likely to be victims of physical maltreatment on average (p < 0.001). Children were notably more likely to experience sexual abuse during the COVID-19 pandemic than those exposed to abuse during the period before (1.69 times). The COVID-19 pandemic was associated with significantly lower odds of physical child maltreatment (47.7% less). This study found no statistically significant effect of the COVID-19 pandemic on children’s odds of being emotionally maltreated (p = 0.169). These findings support the existence of specific risk factors for child maltreatment for both child victims and perpetrators. They also attest to the significant differences between different types of maltreatment. A systematic, proactive system is needed to screen and document child maltreatment with a higher degree of integration with community reporting systems.

Child Sexual Abuse and Problems Reported by Survivors of CSA: A Meta-Review

A systematic meta-review of reviews and meta-analyses on problems reported by survivors of Child Sexual Abuse (CSA) was conducted. The aim was to comprise a comprehensive overview of 1) problems reported by survivors of CSA, and 2) variables moderating these relations. Two raters independently conducted a search through PubMed, PsychINFO, Campbell Library, Cochrane Library and Web of Science. Twenty-five reviews and meta-analyses reporting on 53 problems related to CSA were analyzed. All fell into five domains: medical, psychological, sexual, repeated (self-)harm, and a final category of other problems. Thirty-six of all problems (68%) were consistently and significantly more commonly reported by CSA survivors as compared to individuals without a history of CSA. Most moderator analyses did not significantly influence these relationships. In conclusion, CSA is associated with various problems across different domains and overall, these problems are prevalent independent of specific characteristics of and circumstances surrounding the abuse.

Dismantling Inequities in Adolescent and Young Adult Health through a Sexual and Reproductive Health Justice Approach

This article provides an overview of the social determinants of adolescents and young adults' (AYAs') sexual and reproductive health (SRH), from a global health perspective. The status of AYAs' SRH constitutes leading health indicators across nations and globally, and reveals the well-being of this population. Throughout the article, AYAs' SRH is approached from a health equity perspective, which includes SRH health rights and reproductive justice. Using this health equity lens, salient topics are presented: sexual abuse/assault among AYAs; immigrant and refugee populations; child, early, and forced marriage; human trafficking; and female genital mutilation. The article also discusses access to SRH services and comprehensive education. Practical implications and resources are offered for healthcare providers for their daily encounters with AYAs, as well as for community, institutional level, and advocacy action. Healthcare providers are well positioned to advance AYAs SRH through mitigating inequities and in so doing, they are assuring the health of the population and future generations.

Team Sports and Sexual Violence: Examining Perpetration by and Victimization of Adolescent Males and Females

The authors examined whether team athletic involvement is related to sexual violence victimization and perpetration among male and female high school students. A secondary data analysis was conducted with Minnesota Student Survey data gathered from 122,501 Minnesota eighth-grade, ninth-grade, and 11th grade students. Multivariable logistic regression indicates that sport-involved youth are more likely to be involved in sexual violence than peers not involved in sports. For example, highly sport-involved males are significantly more likely to coerce a partner into sex (odds ratio [OR] = 1.35, 95% confidence interval [CI] = [1.01, 1.67]) and be coerced (OR = 1.19, 95% CI = [1.02, 1.38]) than nonsport peers. The results suggest high school sport programs could be an important site to implement comprehensive sexual violence prevention programs targeted at individual actions as well as harmful cultural norms and systematic inequities.

Recidivism Rates of Treated, Non-Treated and Dropout Adolescent Who Have Sexually Offended: a Non-Randomized Study

The primary objective of this study was to evaluate the effectiveness of a cognitive-behavioral treatment in reducing recidivism by adolescents who have sexually offended (ASO). A secondary objective was to determine whether typologies based on victim age (child, adult/peer, mixed) and relationship (intrafamilial, extra familial, intra/extra familial) discriminate ASO in terms of response to treatment and recidivism. The sample comprised 327 adolescents 12-18 years old (M = 15.8 years, SD = 1.9) who were evaluated in an outpatient clinic after committing a contact sexual assault. Official data on recidivism (criminal charges) was collected after a follow-up period of 21-162 months (M = 7.8 years, SD = 32.2). Survival analysis indicated that adolescents who completed treatment (n = 62) had a recidivism rate for violence (including sexual violence) almost half that of adolescents who had either not completed the treatment or not received treatment (n = 261), (16.1 vs. 30.7%). Neither of the two typologies studied had any effect on the completion of treatment. However, sexual aggression against adults/peers was associated with an increased probability of violent re-offending. These results confirm the effectiveness of this cognitive-behavioral treatment -which targets risk factors associated with sexual aggression as well as those associated with violence in general-in ASO.

Widespread and interrelated gray matter reductions in child sexual offenders with and without pedophilia: Evidence from a multivariate structural MRI study

AIM

To further investigate the neuroanatomical correlates of child sexual offending and disentangle them from the neural correlates of pedophilia, using a multivariate analytical approach in order to minimize loss of statistical power.

METHODS

This study presents structural MRI data on gray matter in an incarcerated, male population of 22 pedophilic and 21 non-pedophilic child sexual offenders, and 20 violent non-sexual offender controls, based on a multivariate whole-brain approach using source-based morphometry.

RESULTS

We identify a network of several neuroanatomical regions exhibiting interrelated reduced gray matter in both child sexual offender groups relative to controls, comprising extensive clusters in the bilateral cerebellum and frontal lobe, as well as smaller clusters in the bilateral parietal, temporal, and occipital lobes, the bilateral basal ganglia, the medial cingulate and the hippocampus.

CONCLUSION

Our results speak to the interpretation that there are inter- and possibly connectivity-related brain structural abnormalities in child sexual offenders that are not (only) pertaining to pedophilia per se. Interpretations and limitations of the present data are discussed and recommendations for future works are given.

Caregiver Vulnerabilities Associated With the Perpetration of Substantiated Child Maltreatment in Canada: Examining the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) 2008

Most of the research on caregiver vulnerabilities associated with the perpetration of child maltreatment (CM) focuses on perpetrators of child physical or sexual abuse. Less is known about the association of specific caregiver vulnerabilities and the risk of other CM types or how these vulnerabilities are related to child harm. The aim of the study was to examine the association of caregiver's vulnerabilities with types of substantiated CM and child physical and mental/emotional harm as a result of maltreatment. Data were from the Canadian Incidence Study of Reported Child Abuse and Neglect collected in 2008 (CIS-2008). The CIS-2008 consisted of investigations of children aged 15 years and younger from 112 child welfare sites across Canada (N = 15,980). Descriptive statistics and logistic regression were used to examine relationships between caregiver vulnerabilities and outcomes of interest. Caregiver vulnerabilities were prevalent among cases of CM substantiated by child welfare agencies across Canada. Low social support, domestic violence, mental health issues, and substance abuse problems were noted among a substantial proportion of abusive caregivers. Caregiver cognitive impairments and domestic violence perpetration were associated with increased odds of child physical harm, but only among children aged 0 to 4 years. Most individual types of caregiver vulnerabilities were associated with increased odds of child mental or emotional harm across all child age groups. Insight into caregiver vulnerabilities associated with the perpetration of CM may help inform intervention targets prior to a family's involvement in the child welfare system.

Eye tracking and child sexual offenders: a systematic review

Eye tracking is used in sexology to identify attractiveness and sexual desire indirectly. This systematic review summarizes results of works that have used eye tracking to analyse paedophilic interest in order to investigate its potential as a useful forensic tool. Six studies met the inclusion criteria. Five of them concerned a large study project and used approximatively the same sample of paedophiles (inpatients), forensic patients (without a sexual interest in children) and healthy controls to make comparisons between the three groups. One study added 11 self-declared paedophiles (outpatients) for a comparison between inpatient paedophiles, outpatient paedophiles and controls (healthy and forensic inpatients). One study compared a group of child sexual offenders with non-offenders. All studies used static pictures of male and female subjects at different pubertal stages. Some studies divided every picture into a different area of interest. Dependent variables used are fixation latency (early attention) and relative fixation time, (later attention). Each study identified significant differences between the paedophile group versus other groups: shorter fixation latency on child pictures, longer fixation time on child pictures and number of fixation most important on child pictures. Two scores (age preference index and attentional control index) showed hight and/or moderate sensitivity and specificity. Although the results suggest the eye tracking can discriminate between paedophile interest and non-paedophile interest, there are too few studies on this specific topic and further research is needed with larger and different sample, carried out by different research teams. If these findings were confirmed, it remains unclear as to their impact in a forensic context when presented openly in Court.

Swedish and Norwegian Police Interviewers' Goals, Tactics, and Emotions When Interviewing Suspects of Child Sexual Abuse

As the suspect interview is one of the key elements of a police investigation, it has received a great deal of merited attention from the scientific community. However, suspect interviews in child sexual abuse (CSA) investigations is an understudied research area. In the present mixed-methods study, we examine Swedish (n = 126) and Norwegian (n = 52) police interviewers' self-reported goals, tactics, and emotional experiences when conducting interviews with suspected CSA offenders. The quantitative analyses found associations between the interviewers' self-reported goals, tactics, and emotions during these types of suspect interviews. Interviewers who reported experiencing more negative emotions were more likely to employ confrontational tactics. Specifically, anger was positively associated with the goal of obtaining a confession and with aggressive tactics like raising one's voice and emphasizing the seriousness of the crime. Frustration and disgust displayed similar patterns. Somewhat contrasting these quantitative results, the thematic analysis identified a strong consensus that emotions should not and do not affect the police interviewers' work. Furthermore, the police interviewers described a range of strategies for managing emotions during the interview and for processing their emotional reactions afterwards. The present findings highlight the relevance of emotional processes in CSA suspect interviews and provide an initial exploration of the potentially complex relationship between the goals, tactics, and emotional experiences of police interviewers who question CSA suspects.

Die Entwicklung von Sexualität bei Kindern und Jugendlichen mit sexuellen Gewalterfahrungen

Zusammenfassung. Theoretischer Hintergrund: Zu den Folgen sexueller Gewalt gehören neben somatischen und psychischen Folgen auch Veränderungen in der Entwicklung der Sexualität. Fragestellung: Ziel dieses Reviews ist es, einen systematischen Überblick über den aktuellen Forschungsstand bezüglich der Entwicklung von Sexualität bei Kindern und Jugendlichen nach sexuellen Gewalterfahrungen zu geben. Methode: Eine systematische Literaturrecherche wurde in den Datenbanken PubMed, ERIC, Cochrane und PubPsych durchgeführt. Die Folgen von sexueller Gewalt bezüglich der Sexualität wurden systematisch analysiert. Ergebnisse: Es konnten insgesamt 127 Studien zur Sexualität nach sexueller Gewalt identifiziert werden, die acht Unterkategorien zugeordnet werden konnten: Sexuelles Risikoverhalten, Teenagerschwangerschaft, jugendliche Sexualstraftäter_innen, sexuelle Verhaltensauffälligkeiten, sexuelle Überzeugungen, Prostitution, Geschlechtskrankheiten und körperliche Symptome. Diskussion und Schlussfolgerung: Insgesamt zeigt die Literaturrecherche, dass die Sexualität von Kindern und Jugendlichen mit sexuellen Gewalterfahrungen teilweise nur lückenhaft untersucht wurde.

Are Mental Health, Family and Childhood Adversity, Substance Use and Conduct Problems Risk Factors for Offending in Autism?

Mental health difficulties, family and childhood adversity factors, substance use and conduct problems have all been linked to offending behaviour in the general population. However, no large-scale study with comparison groups has investigated these risk factors in relation to autistic offenders. The current research included 40 autistic offenders, 40 autistic non-offenders, 40 typically developed (TD) offenders and 39 TD non-offenders. Conduct problems risk factors differentiated autistic offenders from both non-offender groups (autistic and TD) and mental health risk factors differentiated autistic offenders from both TD groups (offenders and non-offenders). Further research is required to understand more about the role of both conduct problems risk factors in autistic offenders (e.g., age at onset, frequency of behaviours) and the mental health needs of autistic offenders.

Child maltreatment in the time of the COVID-19 pandemic: A proposed global framework on research, policy and practice

BACKGROUND

Child protection is and will be drastically impacted by the COVID-19 pandemic. Comprehending this new reality and identifying research, practice and policy paths are urgent needs.

OBJECTIVE

The current paper aims to suggest a framework for risk and protective factors that need to be considered in child protection in its various domains of research, policy, and practice during and after the COVID-19 pandemic.

STRATEGY

From an international collaboration involving researchers and child protection professionals from eight countries, the current paper examines various factors that were identified as playing an important role in the child protection system.

THE INITIAL SUGGESTED FRAMEWORK

Through the use of an ecological framework, the current paper points to risk and protective factors that need further exploration. Key conclusions point to the urgent need to address the protection of children in this time of a worldwide pandemic. Discussion of risk and protective factors is significantly influenced by the societal context of various countries, which emphasizes the importance of international collaboration in protecting children, especially in the time of a worldwide pandemic.

CONCLUSION

The COVID-19 pandemic has stressed the urgent need to advance both theory and practice in order to ensure children's rights to safety and security during any pandemic. The suggested framework has the potential to advance these efforts so that children will be better protected from maltreatment amidst a pandemic in the future.

Responsible Behavior with Younger Children: Examining the Feasibility of a Classroom-Based Program to Prevent Child Sexual Abuse Perpetration by Adolescents

Child sexual abuse (CSA) is a preventable public health problem typically addressed with either after-the-fact interventions or prevention programs focused on teaching children to protect themselves and report abuse. Such responses do little to prevent CSA victimization, leading to calls for prevention efforts targeting individuals most at risk of perpetrating CSA. These individuals include young adolescents, who are prone to making mistakes and bad decisions when it comes to their sexual behaviors. To begin to address this call to action, we developed Responsible Behavior with Younger Children (RBYC), a universal school-based prevention program to provide sixth and seventh grade students (and their parents and educators) with the knowledge, skills, and tools to prevent engaging younger children in sexual behaviors. School-based CSA prevention interventions are often met with feasibility and acceptability concerns including that (a) people at risk of offending are impervious to prevention efforts, (b) schools do not have the resources to take on additional programs, and (c) the content is too sensitive for educators, parents, and students. The goal of this article is to describe how the RBYC program was developed to address these concerns. We also summarize data on the feasibility of the RBYC program obtained from focus groups with educators, parents, and students during the development of the program and interviews with educators after a pilot randomized controlled trial (RCT). Feedback received during program development and after the pilot RCT suggests that RBYC is relevant, salient, palatable, and feasible for implementation in middle schools.

Coping Using Sex During the Coronavirus Disease 2019 (COVID-19) Outbreak in the United Kingdom

BACKGROUND

The use of sex to cope with negative affective states during the coronavirus disease 2019 (COVID-19) pandemic may be influenced by various sociodemographic and psychological characteristics.

AIM

We aimed to examine the effects of social distancing, loneliness, difficulties in emotion regulation, and self-regulation on participants self-reported coping using sex during lockdown in the United Kingdom.

METHODS

Participants had to be residents of the United Kingdom, aged between 18-60 years, fluent in English, and had to have an Internet connection. They were instructed not to participate if they had consumed alcohol in the previous 24 hours. A total of 789 participants aged 18-59 years completed an online survey. Participants provided self-report measures of social distancing, loneliness, and difficulties in emotion regulation. A Go/No-Go task was used to assess self-regulation.

OUTCOMES

Participants self-reported their use of sex to cope over a 14-day period during lockdown, as well as retrospectively for a 14-day period immediately preceding lockdown. Coping using sex items included consensual and non-consensual themes.

RESULTS

Overall, there was no increase in coping using sex during lockdown compared with before lockdown. Findings showed that 30% of participants reported increased coping using sex during lockdown compared with before, 29% reported decreased coping using sex, and 41% reported no change. All regression models included age, gender, ethnicity, diagnosis of psychiatric condition, level of education, being at high-risk for difficulties relating to COVID-19, living alone, and diagnosed or suspected COVID-19 as covariates. Being younger, being male, and greater emotion dysregulation were associated with higher coping using sex total and consent subscale scores during lockdown. Being younger, being male, not living alone, and less adherence to social distancing advice were associated with coping using sex with a theme of rape/violence during lockdown.

CLINICAL TRANSLATION

A proportion of participants used sex to cope more often during lockdown compared with before. Less adherence to social distancing advice and emotion dysregulation were associated with using sex to cope during lockdown.

STRENGTHS & LIMITATIONS

Strengths of this study were the large sample size and inclusion of key sociodemographic characteristics as covariates. The main limitations were the cross-sectional design and a sample that was mostly white, educated, and female.

CONCLUSION

Participants who had difficulty regulating emotions were more likely to use sex to cope. It is important that support is available for people who have problems regulating their emotions during the pandemic and that they have access to appropriate help and advice. Gillespie SM, Jones A, Uzieblo K, et al. Coping Using Sex During the Coronavirus Disease 2019 (COVID-19) Outbreak in the United Kingdom. J Sex Med 2021;18:50-62.

"Victim, Perpetrator, or Just My Brother?" Sibling Sexual Abuse in Large Families: A Child Advocacy Center Study

Sibling sexual abuse (SSA) is a continuum of childhood sexual behaviors that do not fit the category of age-appropriate curiosity. Although SSA may be the most prevalent and longest lasting form of intrafamilial sexual abuse-as well as the one with the worst repercussions-it is also the least reported, studied, and treated. Based on 100 mostly religious Jewish families referred to a child advocacy center (CAC) in Jerusalem from 2010 to 2015, this qualitative study examines SSA characteristics, dynamics, and perceptions of deviancy in multisibling subsystems. The findings are based on an analysis of case summaries, demographic charts, and documented conversations between social workers and siblings. Qualitative document analysis reveals two types of SSA dynamics: "identified perpetrator" and "routine relationship," the latter being a particularly understudied dynamic that challenges common stereotypes. We also found sibling perceptions of deviancy to vary along a continuum from deviant to completely normative. These perceptions are affected by the type of dynamics as well as by factors associated with disclosure. Our findings highlight the importance of studying the lived experiences of children involved in SSA as an input with critical policy, treatment, and research implications. Interventions must be adjusted to the family system and sibling subsystem's perceptions and needs to avoid treatment that exacerbates the crisis already experienced by the family. Common assumptions-there must be a "perpetrator"; abuse is necessarily traumatic; and treatment should focus on the trauma-are challenged by the routine type. We conclude that treatment should account for the complexity of SSA by shedding these assumptions and considering the sibling subsystem as an autonomous unit within the large family.

The relevance of sexual biographies in individuals convicted of child sexual abuse offenses for the development of pedosexual interests and sexual recidivism

In the literature concerning the etiology of pedosexual interests, the potential role of early sexual experiences in childhood and adolescence has been discussed. Several studies demonstrated a link between own sexually abusive experiences in childhood and sexual offending later in life which tends to be even stronger for pedosexual offenders. Furthermore, some findings indicate associations between other developmental factors and deviant sexual interests in adulthood. For the present study, sexual biographical data of N = 223 imprisoned men convicted of sexual offenses against children from Austria was analyzed to retrospectively examine whether own sexually abusive experiences and non-abusive forms of early sexual experiences and behaviors are linked to subsequent pedosexual interests and to sexual recidivism. Previous findings concerning the link between own sexually abusive experiences during childhood and subsequent pedosexual interests could partly be replicated. Furthermore, early masturbation behavior characteristics as well as non-abusive prepubescent sexual experiences were linked to indicators of pedosexual interests and also to sexual recidivism. Exclusively pedophilic men showed the strongest accumulation of early sexual experiences and behaviors. Implications of the findings for theory and risk assessment are discussed.

Explicit and Implicit Self-Esteem, Narcissism, and Recidivism Risk in a Sample of Men Who Have Sexually Offended Against Children

The relationship between implicit and incongruent explicit and implicit (i.e., discrepant) self-esteem, narcissism, and sexual offending against children requires further research. We examined the relationships between self-esteem, narcissism, and risk of violent (including sexual) recidivism and compared sexual offenders against children (n = 28) and non-sexual offenders (n = 44) on these measures. All participants were adult men. In both groups, greater narcissism was associated with greater risk. Among sexual offenders against children, contrary to theoretical accounts and previous research findings, higher explicit self-esteem was associated with greater risk. However, further analysis indicated that explicit self-esteem may only be relevant to recidivism risk insofar as it reflects narcissism. Neither implicit nor discrepant self-esteem were related to recidivism risk in either group. Group comparisons indicated that sexual offenders against children had lower explicit self-esteem and narcissism than non-sexual offenders. In summary, our findings suggest that although sexual offenders against children have lower explicit self-esteem and narcissism than other offenders, within this group, higher explicit self-esteem and greater narcissism may be associated with greater risk. Taken together, previous and current findings suggest that including measures of narcissism in psychological assessment batteries administered to sexual offenders against children could be beneficial. Our findings also further question the wisdom of targeting low self-esteem in correctional treatment programs aimed at reducing recidivism.

Paraphilia and Antisociality: Motivations for Sexual Offending May Differ for American Whites and Blacks

There has been little research on the sexual offending behavior of different racial groups. This study compares the characteristics and risk factors for American, non-Hispanic Whites (n =797) and Blacks (n = 788) who had been convicted of a sexual crime in New Jersey. The results indicated that Whites appeared more paraphilic whereas Blacks displayed higher antisociality. Despite the differences, however, the Static-99R, sexual recidivism risk tool, predicted equally well for both racial groups: Whites (area under the curve [AUC] = .76) and Blacks (AUC = .78). The findings suggest that there may be opportunities to improve treatment for the individuals at risk for sexual offending by tailoring interventions to the distinctive risk-relevant characteristics of Whites and Blacks.

Preventing child sexual abuse: A systematic review of interventions and their efficacy in developing countries

BACKGROUND

Research on prevalence, risk factors, and prevention interventions for child sexual abuse has continued to focus on western and developed countries. Where country-level prevalence data or large-scale research exists, rates of child sexual abuse are consistently higher in developing and non-western countries than their western and developed counterparts.

OBJECTIVE

We systematically reviewed research on the nature of child sexual abuse interventions in developing countries, the settings and populations included to identify types of child sexual abuse prevention initiatives being implemented in developing countries and their effectiveness.

METHODS

Following PRISMA guidelines, we conducted a systematic search of six databases and identified eight studies to include in our analysis.

RESULTS

Most empirically evaluated interventions in developing countries have focused on preschool and primary school-aged children. Most have focused on interventions delivered in educational settings, with a lack of focus on population-level interventions to prevent child sexual abuse. Researchers have used outcomes measuring knowledge or skills for young people in self-protection and help-seeking, not deployment of those skills, actual reduction in prevalence of CSA, or improvements in conditions of safety in organizational contexts.

CONCLUSIONS

If the focus on school-based strategies to prevent child sexual abuse continues in developing countries, a significant gap in knowledge of the efficacy of population-level interventions outside of school contexts, and consistency across the application of interventions will remain. Evaluations are needed that address the efficacy of broader government-led or whole-of-community prevention interventions to reduce actual prevalence of child sexual abuse, or that can link increased knowledge and skill with reduced victimization.

Child Sexual Abuse: The Need for a Perpetration Prevention Focus

In the evolution of efforts to reduce child sexual abuse (CSA) rates in the United States, there has been a gradual shift to add preventive measures to after-the-fact interventions (i.e., interventions and policies implemented after the abuse has already happened, such as services and treatment for victims and punishment, treatment, and management of offenders). Prevention of CSA perpetration, however, is often missing from these efforts, despite decades of experts calling for broader prevention solutions. The current paper describes the scope of the problem of CSA, highlights problems with an over-reliance on after-the-fact interventions, and describes promising perpetration-focused CSA prevention interventions. While most existing preventive efforts focus on teaching children to protect themselves from incurring sexual harm, perpetration prevention efforts may hold more promise by addressing the onset of harmful behavior. As such, perpetration prevention efforts can contribute to a more robust and comprehensive approach to CSA - an approach that focuses on prevention of harm from occurring in the first place, as well as responding once harm has occurred.

Recommendations for Preventing Child Sexual Abuse in Youth-Serving Organizations: Implications From an Australian Royal Commission Review of the Literature

Evidence suggests that tens of millions of children and adolescents are involved in youth-serving organizations (YSOs) outside of their homes on a daily basis. Children's involvement with YSOs clearly offers a broad array of emotional, social, and personal development benefits. This involvement can, however, also be associated with a variety of safety risks, including the potential for child sexual abuse (CSA) victimization and the myriad short- and long-term consequences to its victims and their families. Recognizing the significance of CSA within YSOs, the Australian Royal Commission into Institutional Responses to Child Sexual Abuse funded a comprehensive review of the literature on risk and protective factors related to CSA in institutions. This yielded more than 400 primarily research articles from the United States, United Kingdom, and Australia, examining institutional CSA victims, perpetrators, and settings. Findings were provided regarding six specific types of institutional settings, including faith-based, early childhood education, childcare and schools, health care, out-of-home/foster care, and sport. This article is based on the findings of Kaufman and Erooga's comprehensive literature review and Royal Commission findings. It provides a brief review of critical risks associated with CSA victims, perpetrators, and organizational settings, as well as highlights risks particular to specific types of YSOs and risks that are present across these organizations. Optimal prevention directions and strategies are outlined in response to identified patterns of organizational risk. Recommendations for YSO policy enhancements are also provided to complement the article's prevention focus. Finally, suggestions are offered for future research directions to foster the development of an evidence-based foundation for work in this area.

Two Sides of One Coin: A Comparison of Clinical and Neurobiological Characteristics of Convicted and Non-Convicted Pedophilic Child Sexual Offenders

High prevalence of child sexual offending stand in contradiction to low conviction rates (one-tenth at most) of child sexual offenders (CSOs). Little is known about possible differences between convicted and non-convicted pedophilic CSOs and why only some become known to the judicial system. This investigation takes a closer look at the two sides of "child sexual offending" by focusing on clinical and neurobiological characteristics of convicted and non-convicted pedophilic CSOs as presented in the Neural Mechanisms Underlying Pedophilia and sexual offending against children (NeMUP)*-study. Seventy-nine male pedophilic CSOs were examined, 48 of them convicted. All participants received a thorough clinical examination including the structured clinical interview (SCID), intelligence, empathy, impulsivity, and criminal history. Sixty-one participants (38 convicted) underwent an inhibition performance task (Go/No-go paradigm) combined with functional magnetic resonance imaging (fMRI). Convicted and non-convicted pedophilic CSOs revealed similar clinical characteristics, inhibition performances, and neuronal activation. However, convicted subjects' age preference was lower (i.e., higher interest in prepubescent children) and they had committed a significantly higher number of sexual offenses against children compared to non-convicted subjects. In conclusion, sexual age preference may represent one of the major driving forces for elevated rates of sexual offenses against children in this sample, and careful clinical assessment thereof should be incorporated in every preventive approach.

Differentiating Adults With Mixed Age Victims From Those Who Exclusively Sexually Assault Children or Adults

Although adults who have sexually offended against both child and adult victims (i.e., adults with mixed aged sexual offense victims [MASOVs]) have been found at increased risk to reoffend, they have been a neglected and rarely studied group of individuals who have sexually offended. The present study explored their differentiating characteristics by comparing them with adults who had sexually offended exclusively against children (child sex offense victims [CSOVs]) or adults (adult sex offense victims [ASOVs]). Using an extensive database gathered on offenders examined for civil commitment, we found that although MASOVs were not distinguished from the other types of offenders by any specific developmental trauma, they cumulatively tended to be higher across traumas. They evidenced lower self-esteem relative to both other offender types. In addition, MASOVs, like ASOVs, exhibited higher levels of psychopathy relative to CSOVs. The implications of these findings for etiology and treatment are discussed.

Violent behaviour in early psychosis patients: Can we identify clinical risk profiles?

AIMS

The objective of this study is to explore, within a sample of early psychosis patients (EPP), if subgroups regarding rate of violent behaviour (VB) against others can be identified on the basis of dynamic risk factors (treatment modifiable characteristics).

METHODS

In a sample of 265 EPP, treated at the Treatment and Early Intervention in Psychosis Program in Lausanne, we conducted a latent-class analysis on the basis of the main dynamic VB risk factors (substance use disorder [SUD], positive symptoms, insight, and impulsivity). VB were restricted to "serious violence" and were assessed through patients self-report, interview with relatives or forensic services and with a standardized instrument.

RESULTS

The analysis confirmed the heterogeneity of the sample regarding rate of VB. Patients could be stratified within 4 subgroups, 3 of which were at increased risk of VB. The two groups with the highest rates of VB displayed specific clinical profiles. The first one was characterized by high levels of impulsivity, hostility, positive symptoms and SUD, and the second, by low level of insight and low social functioning. These patterns suggest that significant difficulties in social interaction may contribute to the emergence of aggressive reactions against others.

CONCLUSIONS

Identification of EPP at increased risk of VB seems possible on the basis of dynamic risk factors. If confirmed prospectively, this could pave the way to the development of preventive strategies and specific interventions.

Child sexual offenders show prenatal and epigenetic alterations of the androgen system

Child sexual offending (CSO) places a serious burden on society and medicine and pedophilia (P) is considered a major risk factor for CSO. The androgen system is closely linked to sexual development and behavior. This study assessed markers of prenatal brain androgenization, genetic parameters of androgen receptor function, epigenetic regulation, and peripheral hormones in a 2 × 2 factorial design comprising the factors Offense (yes/no) and Pedophilia (yes/no) in analyzing blood samples from 194 subjects (57 P+CSO, 45 P-CSO, 20 CSO-P, and 72 controls) matched for age and intelligence. Subjects also received a comprehensive clinical screening. Independent of their sexual preference, child sexual offenders showed signs of elevated prenatal androgen exposure compared with non-offending pedophiles and controls. The methylation status of the androgen receptor gene was also higher in child sexual offenders, indicating lower functionality of the testosterone system, accompanied by lower peripheral testosterone levels. In addition, there was an interaction effect on methylation levels between offense status and androgen receptor functionality. Notably, markers of prenatal androgenization and the methylation status of the androgen receptor gene were correlated with the total number of sexual offenses committed. This study demonstrates alterations of the androgen system on a prenatal, epigenetic, and endocrine level. None of the major findings was specific for pedophilia, but they were for CSO. The findings support theories of testosterone-linked abnormalities in early brain development in delinquent behavior and suggest possible interactions of testosterone receptor gene methylation and plasma testosterone with environmental factors.

Understanding Men's Self-Reported Sexual Interest in Children

A few studies have found that even in the general population, a minority of adults-men as well as women-report some sexual interest in a young age group. The purpose of the present study was to identify factors associated with self-reported sexual interest in children among a community-based sample of men. Using an online survey methodology, we examined the extent to which different types of childhood adversities (witnessing parental violence, sexual, physical, and emotional abuse), atypical childhood sexual experiences, and participants' self-reported likelihood of engaging in a variety of sexual behaviors (heightened sexual interest) were related to sexual interest in children (SIC) reported by a non-forensic/non-clinical sample of 173 men. Data were analyzed using hierarchical multiple regression. After controlling for physical and emotional abuse and witnessing parental violence, self-reported experiences of childhood sexual abuse (CSA) significantly increased the amount of variance explained in SIC scores. However, only early masturbation and current heightened sexual interests contributed significantly to the final model. Total variance explained by the model as a whole was 24% (adjusted R² = 20%). Early masturbation and heightened sexual interests significantly mediated the relationship between CSA and SIC scores. Findings add to the small but growing body of literature examining the etiology of pedophilic sexual interests in non-clinical samples.

Risk factors for interpersonal violence: an umbrella review of meta-analyses

BACKGROUND

Interpersonal violence is a leading cause of morbidity and mortality. The strength and population effect of modifiable risk factors for interpersonal violence, and the quality of the research evidence is not known.AimsWe aimed to examine the strength and population effect of modifiable risk factors for interpersonal violence, and the quality and reproducibility of the research evidence.

METHOD

We conducted an umbrella review of systematic reviews and meta-analyses of risk factors for interpersonal violence. A systematic search was conducted to identify systematic reviews and meta-analyses in general population samples. Effect sizes were extracted, converted into odds ratios and synthesised, and population attributable risk fractions (PAF) were calculated. Quality analyses were performed, including of small study effects, adjustment for confounders and heterogeneity. Secondary analyses for aggression, intimate partner violence and homicide were conducted, and systematic reviews (without meta-analyses) were summarised.

RESULTS

We identified 22 meta-analyses reporting on risk factors for interpersonal violence. Neuropsychiatric disorders were among the strongest in relative and absolute terms. The neuropsychiatric risk factor that had the largest effect at a population level were substance use disorders, with a PAF of 14.8% (95% CI 9.0-21.6%), and the most important historical factor was witnessing or being a victim of violence in childhood (PAF = 12.2%, 95% CI 6.5-17.4%). There was evidence of small study effects and large heterogeneity.

CONCLUSIONS

National strategies for the prevention of interpersonal violence may need to review policies concerning the identification and treatment of modifiable risk factors.Declarations of interestJ.R.G. is an NIHR Senior Investigator. The views expressed within this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

The Cycle of Abuse: When Victims Become Offenders

Various psychological theories exist in the literature to explain the behavior of men who commit child sex offences, including the belief that child sexual abuse (CSA) is a predisposing factor for the transition from victim to offender. These theories are, however, unable to explain the fact that while most victims of CSA are female, most perpetrators of CSA are male. The sex specificity of CSA in terms of victims and offenders suggests that the experience of CSA and its psychosocial effects may be different for boys, compared to girls. We hypothesize that CSA experiences may involve risk factors that affect the development of sexually abusive behavior for boys, rather than girls. Our aim was to determine whether the literature provides evidence of a cycle of abuse from victim to offender, and, if so, to document its characteristics. We undertook a comprehensive literature review of studies on both victims and offenders, including studies which revealed the following: age of onset of CSA, duration of abuse, gender of the abuser, the relationship between victim and abuser, grooming behaviors, the types and severity of abuse, and disclosure of abuse. While we found no evidence for the existence of a cycle of abuse for female CSA victims, we discovered evidence to support the existence of a cycle of abuse for male CSA victims who had experienced particular abuse characteristics. As an original contribution to the literature, we identified four factors that may be associated with a boy's transition from victim to offender as well as the methodological issues to be addressed in future research. Based on criminological theories, we argue that these four factors share a common theme, that is, that they represent experiences of power (for the abuser) and powerlessness (for the victim).

Situational Factors Related to Childhood Sexual Abuse in the Orthodox Jewish Community Among Adult and Juvenile Offenders

In recent years, increasing attention has been paid to situational factors associated with childhood sexual abuse (CSA) to explain incidence of CSA, as well as to provide potential targets for prevention efforts. However, very few studies have examined situational factors associated with juvenile perpetration, despite juveniles composing a substantial proportion of offenders. In addition, no studies to our knowledge have applied a situational framework to CSA research in the Orthodox Jewish community (OJC). In the present study, we obtained data from therapists regarding 80 victims of CSA in the OJC from both the United States and Israel. We hypothesized that (a) more abusers' first perpetration would be between ages 12 and 17 than between any other age range, which corresponds to increased sexual urges, as well as increased unsupervised access to minors; (b) among juvenile offenders, the time of day of the abuse would depend on the relationship of the offender to the victim; and (c) age of the victim and grooming strategies would be associated with the frequency of abuse. Our first two hypotheses were confirmed, and our third hypothesis was partially confirmed, as younger victims tended to have higher frequency of abuse. Additionally, we discuss possible implications of significant correlations found during exploratory analyses. Our results generally support the importance of considering culturally specific situational factors when studying or developing prevention efforts for CSA.

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.

Clinical characteristics associated with paedophilia and child sex offending - Differentiating sexual preference from offence status

Contrary to public perception, child sex offending (CSO) and paedophilia are not the same. Only half of all cases of CSO are motivated by paedophilic preference, and a paedophilic preference does not necessarily lead to CSO. However, studies that investigated clinical factors accompanying and contributing to paedophilia so far mainly relied on paedophiles with a history of CSO. The aim of this study was to distinguish between factors associated with sexual preference (paedophile versus non-paedophile) and offender status (with versus without CSO). Accordingly, a 2 (sexual preference) × 2 (offender status) factorial design was used for a comprehensive clinical assessment of paedophiles with and without a history of CSO (n = 83, n = 79 respectively), child sex offenders without paedophilia (n = 32) and healthy controls (n = 148). Results indicated that psychiatric comorbidities, sexual dysfunctions and adverse childhood experiences were more common among paedophiles and child sex offenders than controls. Offenders and non-offenders differed in age, intelligence, educational level and experience of childhood sexual abuse, whereas paedophiles and non-paedophiles mainly differed in sexual characteristics (e.g., additional paraphilias, onset and current level of sexual activity). Regression analyses were more powerful in segregating offender status than sexual preference (mean classification accuracy: 76% versus 68%). In differentiating between offence- and preference-related factors this study improves clinical understanding of both phenomena and may be used to develop scientifically grounded CSO prevention and treatment programmes. It also highlights that some deviations are not traceable to just one of these two factors, thus raising the issue of the mechanism underlying both phenomena.