Model Underpinning Treatment for Sex Offenders With Mild Intellectual Disability: Current Theories of Sex Offending

Is There a Dose-Response Relationship Between Cannabis Use and Violence? A Longitudinal Study in Individuals with Severe Mental Disorders

Introduction: Recent longitudinal studies point toward the existence of a positive relationship between cannabis use and violence in people with severe mental disorders (SMD). However, the existence of a dose-response relationship between the frequency/severity of cannabis use and violence has seldom been investigated. Therefore, this study aims to determine if such a relationship exists in a psychiatric population. Methods: To do so, a total of 98 outpatients (81 males and 17 females, all over 18 years of age) with SMD were recruited at the Institut universitaire de santé mentale de Montréal (Montréal, Canada) and included in the analyses. Clinical evaluations were conducted every 3 months for a year. Substance use, violent behaviors, and potential covariables were assessed through self-reported assessments, urinary testing, as well as clinical, criminal, and police records. Using generalized estimating equations, the association between cannabis use frequency (nonusers, occasional, regular, and frequent users) and violence was investigated, as well as the association between the severity of cannabis use and violent behaviors. Results: It was found that cannabis use frequency and severity were significant predictors of violent behaviors. After adjustment for time, age, sex, ethnicity, diagnoses, impulsivity, and use of alcohol and stimulants, odds ratios were of 1.91 (p<0.001) between each frequency profile and 1.040 (p<0.001) for each increase of one point of the severity of cannabis use score (ranging from 0 to 79). Conclusions: Despite the high attrition rate, these findings may have important implications for clinicians as cannabis use may have serious consequences in psychiatric populations. Nevertheless, the mechanisms underlying this association remain unclear.

How effective are interventions at enhancing empathy for service users with an intellectual disability who engage in sexually abusive behaviour? A review of the literature

BACKGROUND

Sexual offending has been attributed to empathy deficits, implicating interventions targeting empathy as a potential mechanism for reducing sexually harmful behaviour. However, there is less known about how appropriate and effective interventions are for individuals with intellectual disabilities. This review aims to provide a comprehensive synthesis of research findings in this area.

METHOD

Four databases were searched, yielding 13 studies meeting the inclusion criteria which were appraised using the CCAT.

RESULTS

CBT group treatments adapted from mainstream treatment programmes for people with intellectual disabilities were widely used, demonstrating improvements in empathy and reductions in sexually abusive behaviour overall.

CONCLUSIONS

Studies are limited by sample sizes, lack of control groups and inconsistent definitions of intellectual disabilities and sexually abusive behaviour. Future research should include evaluation of models other than CBT, further assessment of empathy-specific interventions and understanding of the mechanism underpinning empathy change.

The relationship between maltreatment victimisation and sexual and violent offending: differences between adolescent offenders with and without intellectual disability

BACKGROUND

Juveniles with intellectual disabilities (ID) are more often victims of maltreatment and more often perpetrators of abuse than juveniles without ID. Because previous research on the relationship between maltreatment victimisation and subsequent offending behaviour was primarily performed in non-disabled samples, the present study aimed to examine differences between juvenile offenders with and without ID in the relationship between maltreatment victimisation and sexual and violent offending.

METHOD

The sample consisted of juvenile offenders with ID (n = 102) and without ID (n = 526) who appeared before the courts for a criminal act and for whom the Washington State Juvenile Court Assessment (WSJCA) was completed. Pearson correlation coefficients were calculated to determine the strength of the relationship between maltreatment and offending, Fisher's z tests were calculated to assess the significance of the differences between the two groups in the strength of the correlations, and multiple logistic regression analyses were performed to examine the unique contribution of maltreatment victimisation to the prediction of violent and sexual offending.

RESULTS

Seventy per cent of the juvenile offenders with ID and 42% of the juvenile offenders without ID had experienced abuse and/or neglect. Both sexual and violent offending were more common in juvenile offenders with ID than in juvenile offenders without ID. Moreover, the relationship between different forms of maltreatment and sexual offending was stronger in juvenile offenders with ID than in juvenile offenders without ID.

CONCLUSIONS

Given the high rates of abuse and neglect victimisation and the strength of the association between victimisation and sexual offending, especially in juvenile offenders with ID, treatment should focus on potential trauma and other problems associated with the abuse.

Differences between juvenile offenders with and without intellectual disability in offense type and risk factors

The present study aimed to examine differences between American juvenile offenders with and without intellectual disability (ID) in offense type and risk factors. The sample consisted of adolescents with ID (n=102) and without ID (n=526) who appeared before the courts for a criminal act and for whom the Washington State Juvenile Court Assessment (WSJCA) was completed. Results showed that adolescents with ID had committed more offenses against persons compared to adolescents without ID. Few differences in risk factors were found between juvenile offenders with and without ID in the domains of school, family and use of free time. Juvenile offenders without ID more often had problems in the relationship and alcohol/drugs domain, whereas juveniles with ID more often experienced problems in the domains of attitude, aggression and skills.

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.

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.

A preliminary evaluation of the adaptation of four assessments for offenders with special needs

BACKGROUND

Appropriate assessment is an essential part of treating sexual offenders. Few assessments exist that can be used with offenders who have lower levels of intellectual functioning and/or literacy deficits.

METHOD

This study describes the adaptation of four self-report assessments for sexual offenders with special needs: (i) the Social Intimacy Scale (SIS: Miller & Lefcourt, 1982); (ii) the Relationship Scales Questionnaire (RSQ: Griffin & Bartholomew, 1994a); (iii) the Criminal Sentiments Scale (CSS: Gendreau, Grant, Leipciger, & Collins, 1979); and (iv) the Victim Empathy Distortion Scale (QVES: Beckett & Fisher, 1994). Each scale was adapted in an effort to simplify content and language and to improve readability. Preliminary data are presented on the comparability of each adapted measure to the original, as well as the internal consistency, reliability, and concurrent validity of the adapted tests.

RESULTS

The SIS and the QVES were identified as appropriate assessment measures, comparable to the original with good reliability and validity. One subscale of the RSQ had fair reliability and validity, while the remaining subscales had varied psychometric properties. The adapted CSS had poor psychometric qualities and the adaptation of this test appears not to have been successful.

CONCLUSIONS

The relevance of these findings to our understanding of offending by this population is discussed.

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.

A comparison of the application of the self-regulation model of the relapse process for mainstream and special needs sexual offenders

The self-regulation model of the relapse process (Ward & Hudson, 2000) has been developed and empirically validated on general sexual offender populations (Bickley & Beech, 2002), but not on specific sexual offender populations. This paper aims to investigate whether special needs offenders, as compared to mainstream sexual offenders, can be categorized into the offense pathways described in the model. In addition, this paper aims to evaluate the application of the self-regulation model in highlighting the treatment needs of the special needs group. Special needs sexual offenders are defined as a treatment population that includes individuals with lower functioning, limited social and communication skills, and literacy deficits. Participants were classified into the self-regulation model using a method developed by Bickley and Beech (2002). Demographic and offense information were collected and comparisons made between the special needs and mainstream groups. The results showed that the sexual offenders with special needs could be reliably classified into the offense pathways of the self-regulation model. The largest group of special needs offenders was in the approach-automatic group, followed by the approach-explicit group. The results indicated no significant differences in representation in the offense pathways between the special needs and mainstream sexual offenders. The results also indicate that the special needs group would benefit from a responsive approach to treatment, which incorporates appropriate treatment targets identified by the self-regulation model.

Forensic aspects in people with intellectual disabilities

PURPOSE OF REVIEW

The past few years have seen a growth in research of forensic issues relating to people with intellectual disabilities. This review examines a broad spectrum covering 2005 and 2006, for which articles are already available. Given the diversity of publications, reference will also be made to some of the main articles of 2004 to provide a context.

RECENT FINDINGS

We are now at the stage where people are questioning the existing forensic psychiatry evidence base for people with intellectual disabilities. This review examines the assessment and treatment of three different groups, that is, fire setters, sexual offenders and those with problems of anger and aggression along with service outcome research, the criminal justice system, and a round up of other related research.

SUMMARY

The growth of research in this area has aided the development of assessment and treatment instruments and treatment models for people with intellectual disabilities. This has helped to highlight the specialist and complex nature of this group. The review also looks at services from the point of delivery and the difficulty in research methodology and quantifying outcomes that take into account a changing society and current health inequalities.

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

Several authors have suggested that lack of sexual knowledge is a primary reason for inappropriate sexual behaviour in men with intellectual disabilities. This hypothesis, counterfeit deviance, is tested in the current report with two separate cohorts comparing sex offenders and controls, both with intellectual disability. The Socio-Sexual Knowledge and Attitudes Test was completed on all participants and any significant differences between groups indicated that the sex offender cohort had a higher level of knowledge. The hypothesis has not been supported. In addition, a positive relationship was found between intellectual ability and knowledge for the control cohort but not for the sex offender cohort.

Quality of life and relationships in sex offenders with intellectual disability

BACKGROUND

Hayes (1991) and Day (1994) have developed hypotheses about the importance of social and developmental variables in the aetiology of sexual offences in offenders with intellectual disability. The present study is the first of its kind to investigate the perceived quality of life and relationships of sex offenders in comparison to an appropriate control group.

METHOD

A group of 28 sex offenders with intellectual disability (ID) were compared with 28 members of a control group of individuals with ID. All participants completed the Significant Others Scale (SOS) which assesses self-perceptions of potential and ideal support from significant others in the individual's life, and the Life Experience Checklist (LEC) which assesses experiences and opportunities across 5 living domains: home, leisure, freedom, relationships and opportunities.

RESULTS

There were no differences between the groups on age and IQ. On the SOS there were no differences between the groups on the number of times each significant other was reported. Actual and ideal levels of support from both mother and father were lower for sex offenders than the control group. On the LEC, sex offenders reported lower scores on the relationships and leisure sections.

CONCLUSIONS

Poorer relationships and little indication of any wish to change that state of affairs suggests lower levels of integration and identification with society for sex offenders compared with the control group.