A test of counterfeit deviance: a comparison of sexual knowledge in groups of sex offenders with intellectual disability and controls

Risk Factors for Sexual Offenses Committed by Men With or Without a Low IQ: An Exploratory Study

Although risk factors associated with offending and recidivism are relatively well-established for mainstream sexual offenses, much less is known about men with a low IQ who have sexually offended (MIQSO), let alone those with forensic involvement. In this exploratory study, 137 convicted for the commission of at least one sexual offense and found not criminally responsible because a mental disorder were recruited in a maximum-security hospital. They were all assessed with the SORAG (static risk factors) and the RSVP (dynamic risk factors). Compared with MIQSO (N = 76), men with an average or higher IQ who have sexually offended (MSO, N = 61) obtained significantly higher scores on static factors related with general delinquency (histories of alcohol abuse, non-violent criminality, violent criminality, and sexual offense) and dynamic factors related with sexual delinquency, paraphilia, and recidivism (chronicity, psychological coercion, escalation, sexual deviance, and substance abuse). In contrast, MIQSO obtained significantly higher scores on major mental illness, problems with planning and problems with self-awareness. Logistic regressions revealed that both the SORAG and RSVP were useful to predict group membership. It is concluded that risk factors related with general and sexual delinquency better describe offenses committed by MSO, whereas risk factors related with mental disorder, lack of insight and contextual impulsivity better describe offenses committed by MIQSO.

Persons with Intellectual Disability: Sexual Behaviour, Knowledge and Assertiveness

Background

Persons with ID most often have incomplete, contradictory and imprecise knowledge of sexuality and sexual intercourse itself. They are not provided with sufficient information on their own body and sexuality, and are often discouraged from and sanctioned for trying to sexually express themselves. Sexual abuse due to low sexual assertiveness is also common.

Aim

The principal aim of this study was to establish the presence or absence of sexual activity in adults with ID residing in institutional housing, as well as the level and structure of their knowledge of sexuality, their sexual assertiveness and preparedness to react in a sexually dangerous situation.

Methods

The sample consisted of 100 participants with ID residing in institutional housing. The instruments used included the General Sexual Knowledge Questionnaire, What-if test and Hulbert index of sexual assertiveness. Comparative statistics included coefficient of linear correlation and multiple regression analysis.

Results

The results showed that 82% of the participants are sexually active. Most participants admitted to sometimes having sexual intercourse against their wishes as well as to having difficulty asserting themselves. Their knowledge of pregnancy, contraception and sexually transmitted diseases was very low. Female participants and those that reported having sexual intercourse had more sexual knowledge and were also more sexually assertive.

Conclusion

Knowledge of sexuality and sexual assertiveness of persons with ID residing in institutional housing is very low. Additional information on sexuality is necessary, as well as support in learning to express their own desires and to deal with unwanted sexual activity.

The effectiveness of cognitive-behavioural therapy group-based interventions for men with intellectual disabilities and sexual offending histories: a meta-analysis

BACKGROUND

Data from sex offender treatment programmes (SOTP) on the re-offending of convicted sex offenders from the prison service in England and Wales was recently reviewed and found to be associated with no change in sexual reoffending. While this result is at variance with a number of other reviews it does give rise to concern as most programmes for individuals with intellectual disabilities adopt similar treatment methods. It is therefore important to consider the treatment outcomes for this client group by conducting a meta-analysis to examine treatment effects.

METHOD

A systematic search of PsychINFO, EMBASE, MEDLINE and CINAHL was conducted in February 2019 using specific inclusion and exclusion criteria. Eighteen papers were identified, and their quality was assessed using a risk of bias framework. Scores on cognitive distortions, sexual knowledge and victim empathy measures as well as reports of further sexually abusive behaviour were pooled together to run a meta-analysis which yielded effect sizes for each outcome.

RESULTS

A large treatment effect was found for reducing cognitive distortions and increasing victim empathy, with a moderate effect found for improvements in sexual knowledge. This meta-analysis also found that 11.5% of individuals with intellectual disabilities who have completed these programmes will go on to display further sexually abusive behaviours.

CONCLUSIONS

The findings suggest that cognitive distortions are significantly reduced following treatment, there are also significant improvements in sexual knowledge and victim empathy. A rate of 11.5% for further reported sexually abusive behaviour during follow up periods was found, which is higher than the rate found for mainstream SOTP completers. Problems regarding the recording of sexually abusive behaviour are considered.

The relationship between cognitive variables and offending behaviour in adults with intellectual disabilities: A systematic review

BACKGROUND

Interventions for offenders with intellectual disabilities (ID) have used cognitive variables as measures of treatment outcome. However, the relevance of cognitive variables to offending in people with intellectual disabilities is unclear. This review aimed to evaluate the evidence for a relationship between cognitive variables and offending in people with intellectual disabilities.

METHOD

A systematic search identified studies comparing offenders and non-offenders with intellectual disabilities on an aspect of cognition. Seven cognitive variables were found and compared across 15 studies. These were appraised for their quality using an adapted quality appraisal checklist. The reliability and validity of cognitive measures were also considered.

RESULTS AND CONCLUSIONS

Other than for cognitive distortions, the evidence for a relationship between cognitive variables and offending in people with intellectual disabilities is currently limited due to methodological weaknesses and the small number of studies assessing each variable. Clinicians are advised to focus on cognitive distortions until better evidence is available.

Examining the questionnaire on attitudes consistent with sexual offending

BACKGROUND

The Questionnaire on Attitudes Consistent with Sexual Offending (QACSO) is an assessment developed by Lindsay, Whitefield, Carson, Broxholme and Steptoe (2004). The QACSO was designed to assess cognitive distortions relating to sexual offending in males with intellectual disabilities (ID). Cognitive distortions form part of the offence chain in sexual offending and as such require effective assessment and treatment.

METHOD

The QACSO manual and studies utilizing the QACSO were examined.

RESULTS

An overview of characteristics of the QACSO is outlined. The strengths and limitations of the measure are discussed, including validity and reliability of the measure and normative samples.

CONCLUSIONS

The QACSO is a valuable tool in assessing cognitive distortions in intellectual disability sexual offenders. Whilst there are some concerns about validity and reliability which it would be beneficial to address, overall the measure has utility in forensic practice and research, and is unique for being developed specifically for intellectual disability offenders.

Men with intellectual disabilities with a history of sexual offending: empathy for victims of sexual and non-sexual crimes

BACKGROUND

The objectives were (a) to compare the general empathy abilities of men with intellectual disabilities (IDs) who had a history of sexual offending to men with IDs who had no known history of illegal behaviour; and (b) to determine whether men with IDs who had a history of sexual offending had different levels of specific victim empathy towards their own victim, in comparison with an unknown victim of sexual crime, and a victim of non-sexual crime, and make comparisons with non-offenders.

METHODS

Men with mild IDs (n=35) were asked to complete a measure of general empathy and a measure of specific victim empathy. All participants completed the victim empathy measure in relation to a hypothetical victim of a sexual offence, and a non-sexual crime, while additionally, men with a history of sexual offending were asked to complete this measure in relation to their own most recent victim.

RESULTS

Men with a history of sexual offending had significantly lower general empathy, and specific victim empathy towards an unknown sexual offence victim, than men with no known history of illegal behaviour. Men with a history of sexual offending had significantly lower victim empathy for their own victim than for an unknown sexual offence victim. Victim empathy towards an unknown victim of a non-sexual crime did not differ significantly between the two groups.

CONCLUSIONS

The findings suggest that it is important include interventions within treatment programmes that attempt to improve empathy and perspective-taking.

Comparison of intellectually disabled offenders with a combined history of sexual offenses and other offenses versus intellectually disabled offenders without a history of sexual offenses on dynamic client and environmental factors

Sexually offensive behavior is prevalent among individuals with intellectual disabilities (ID) and many sex offenders also commit other offenses such as vandalism or assault. We examined the differences between sex offenders with ID and a history of combined sex and other types of offenses (mixed sex offenders) versus offenders with no history of sexual offenses (non-sex offenders). Dynamic client and environmental factors were measured using the Adult Behaviour Checklist (ABCL) and the Risk Inventarization Scale on Sexually Offensive Behavior of Clients with intellectual disabilities (RISC-V). Item, subscale, and total scores were then compared for the two groups. Most of the comparisons did not reveal significant differences between the two groups. The findings call for a general theory of offending behavior to explain the absence of differences between the mixed sex offenders and non-sex offenders with ID.

Staff attributions towards men with intellectual disability who have a history of sexual offending and challenging behaviour

BACKGROUND

Staff working within secure services for people with intellectual disabilities (ID) are likely to work with sexual offenders, but very little attention has been paid to how they think about this sexual offending behaviour.

METHOD

Forty-eight staff working within secure services for people with ID were recruited and completed the Attribution Style Questionnaire in relation to the sexual offending behaviour and challenging behaviour of men with mild ID. Attributions towards challenging behaviour and sexual offending were compared and relationships between level of ID and seriousness of the sexual offence were explored.

RESULTS

The results indicated that staff attributed sexual offending as more external to the staff group than they did for challenging behaviour. Sexual offending behaviour was also seen as more stable, and less controllable by people with ID than was challenging behaviour. Sexual offending was also attributed as more uncontrollable by the staff group than challenging behaviour. There was a significant negative correlation between general intellectual functioning and several attributional dimensions regarding sexual offending, but not challenging behaviour. Sexual offending that was coded as more serious was attributed as universal and uncontrollable by the staff group.

CONCLUSIONS

The differences between staff attributions regarding challenging behaviour and sexual offending potentially relate to the decision-making processes involved in deciding whether or not to involve criminal justice agencies when someone with ID commits a sexual offence. Further research within this area is warranted.

Sexual preferences and recidivism of sex offenders with mental retardation

By some accounts, sex offenders with mental retardation commit sex offenses against children because the offenders lack sexual knowledge or are socially and intellectually immature rather than because of sexually deviant interests. By other accounts, these offenders exhibit pedophilic sexual interests. In this study, phallometrically determined sexual interests, recidivism, and choices of victims of 69 sex offenders with mental retardation are examined and compared with those of 69 sex offenders of average or higher IQ. Consistent with hypotheses, sex offenders with mental retardation exhibit more deviant preferences for prepubertal children, male children, and young children than do the comparison offenders. They are also more likely to have had a prepubertal victim, a prepubertal male victim, and a very young victim. They are no more likely than the comparison offenders to exhibit preferences for extremely coercive sex with children or to exhibit deviant adult activity preferences, nor are they more likely to recidivate violently. Results support the idea that pedophilia is a disorder of neurodevelopment and point to the importance of risk assessments that include assessing sexual preferences among sex offenders with mental retardation.

The Ward and Hudson pathways model of the sexual offense process applied to offenders with intellectual disability

The offense pathways model of Ward and Hudson has had a significant impact on work with sex offenders. Researchers have hypothesised that offenders with intellectual disability (ID) will show a predominantly avoidant and passive pathway. The present study classifies 62 sex offenders with ID according to the four self-regulation pathways. Allocation to pathways is highly reliable and, against prediction, most participants are allocated to approach pathways. Explicit/active offenders have a higher rate of contact offenses and a lower rate of reoffending. Automatic/passive offenders have a lower average IQ. There are no significant differences between groups on victim choice, previous offenses, or assessment of cognitive distortions. The results suggest that treatment may improve understanding of society's laws, promote self-regulation, and reduce recidivism for explicit/active offenders.

Forensic issues in intellectual disability

PURPOSE OF REVIEW

The present paper reviews some of the most significant findings in the field of forensic issues related to intellectual disability over the last 2 years.

RECENT FINDINGS

Recent publications have explored the prevalence and assessment of intellectual disabilities in the criminal justice system, as well as individual characteristics of intellectual disabled offenders. Service by the criminal justice system and treatment of intellectual disabled offenders have also been explored. New insights into violence and sexual offences have been achieved, however identification and evidence-based treatment of intellectual disabled offenders are not widely explored issues.

SUMMARY

Progress in treatment studies, studies of the function of the criminal justice system and risk assessments have resulted in improvements in these aspects during recent years. The wide range of services involved in successful initiatives has been addressed, but some crucial aspects still receive too little attention. Differences between countries and cultures have not been emphasized, and the progress that has been achieved seems to be confined to countries with a clear policy and organized services for offenders with intellectual disabilities.

Research issues in forensic psychiatry

PURPOSE OF REVIEW

Forensic psychiatry is a multidisciplinary specialty within the context of criminal and civil law. This paper reviews a broad spectrum of research areas within the forensic psychiatric field, covering publications in 2006.

RECENT FINDINGS

New developments can be divided into four subject areas. The first relates to risk assessment, the second to the epidemiology of violence, the third refers to treatment outcome studies, and the fourth relates to topics of interest within different offender groups.

SUMMARY

There seems to be a growing interest in specifying the needs of different offender groups, such as intellectually-disabled patients, adolescents and women. When it comes to effective treatment models for these subgroups, however, it is not always clear if sufficient attention is paid to the presence of comorbid disorders and their consequences, even in research publications.

Trends and challenges in forensic research on offenders with intellectual disability

BACKGROUND

The Journal of Intellectual & Developmental Disability has a well-respected history of establishing the parameters and contributing to developments in the field of offenders with intellectual disability (ID).

METHOD

The field has seen a number of developments over the past 15 years, and this paper identifies several trends that have emerged in the research during this period, including work on prevalence of ID in prison populations, development of risk assessment, consideration of staff issues, developing the psychometrics of offence-specific assessments, evaluating treatment methods, and testing the underlying theoretical frameworks which attempt to account for offending.

RESULTS AND CONCLUSIONS

We refer to a number of studies which have advanced these developments in the field and draw the reader's attention to the way in which papers in this special issue contribute to and further develop each of these research trends.

Sexual knowledge and attitudes of men with intellectual disability who sexually offend

BACKGROUND

Various explanations of sexual offending in men with intellectual disability (ID) have stressed sexual deviance and a lack of developmental socio-sexual knowledge.

METHOD

Using the normative dataset of people with ID from the development of the Socio-Sexual Knowledge and Attitudes Assessment Tool - Revised (SSKAAT-R: Griffiths & Lunsky, 2003), two samples of individuals with ID and a history of sexual offence were compared on sexual knowledge to matched samples of individuals with ID and no known sexual offences.

RESULTS

Offenders with ID who were identified as having engaged in sexually inappropriate behaviour, such as public masturbation or touching someone inappropriately, did not differ in terms of sexual knowledge from their matched sample of individuals with ID with no sexual offence history, whereas offenders who had committed more serious offences demonstrated greater sexual knowledge than matched non-offenders. When only those individuals who had received prior sex education were compared in terms of sexual knowledge, there were no differences between groups. However, sex offenders (serious offences) expressed more liberal attitudes than sex offenders (inappropriate behaviour) and non-offenders towards same-sex activities.

CONCLUSIONS

The study points to the dynamic effect of socio-sexual education on offenders' knowledge and attitudes, and highlights potential differences in the knowledge and attitudes of different subtypes of offenders.

An exploratory evaluation of the Ward and Hudson Offending Pathways model with sex offenders who have intellectual disability

BACKGROUND

It was predicted that offenders with intellectual disability (ID) categorised according to Ward & Hudson's (1998b) self-regulation theory as having an Approach goal would have higher levels of distorted cognitions, less victim empathy, and a history of more prolific offending compared to those with an Avoidant goal. Offenders categorised as having a Passive strategy were hypothesised to have lower levels of general intellectual functioning, and more known offences and convictions compared to those with an Active strategy.

METHOD

Using a cross-sectional independent groups design, the offence pathways of 34 men with ID who were taking part in group cognitive behavioural therapy were rated by therapists. Participants assigned to each pathway were then compared using measures of sexual knowledge, distorted cognitions, and victim empathy. Cronbach's alpha for the measures was found to be acceptable.

RESULTS

Offenders with an Approach goal were found to have higher levels of distorted cognitions and more denial about the negative impact of their offending upon their victims on one measure of distorted cognitions, while on another measure of distorted cognitions there were no differences. There were no differences between Approach and Avoidant offenders in terms of victim empathy, socio-sexual knowledge, severity of offending, and victim type. Offenders with a Passive strategy were found to have lower levels of general intellectual functioning than offenders with an Active strategy, but did not have more known offences and convictions.

CONCLUSIONS

The findings provide partial support for the usefulness of the Offending Pathways model in understanding the sexual offence processes of men with ID. The difficulties with this study are further discussed, together with the theoretical implications.