Thursday, August 16, 2018

Explicit Issues: Pornography and Morality

By David S. Prescott, LICSW & Kieran McCartan, Ph.D
Some recent social media discussions have returned to the discussion of pornography and its place in the treatment of people who have abused (as well as broader questions of its place in masculinity and society). One case discussion involved an intellectually disabled person while another considered whether it is acceptable for men to look at women’s bodies. Setting aside the complexities of the former and the inevitability of the latter, serious questions remain for practitioners who attempt to balance risk management with client’s rights to engage in behavior deemed legal/not illegal by high courts around the world. Let’s be clear: we are not saying that pornography use is without risks. Author David Ley has written an entire volume dedicated to ethical considerations in pornography usage.
Where to start? A study by Drew Kingston and his colleagues found that pornography use is a risk factor for re-offense primarily among those who are already high risk and use pornography frequently. A new meta-analysis by Joshua Grubbs and his colleagues describes how “pornography-related problems—particularly feelings of addiction to pornography—may be, in many cases, better construed as functions of discrepancies—moral incongruence—between pornography-related beliefs and pornography-related behaviors.” In other words, analysis of the data suggests that so-called pornography addiction may have more to do with morality than with actual addiction. It often seems that the only thing people can agree on is that more research is needed. Sadly, there is no shortage of poorly constructed research seemingly designed to confirm the various authors’ biases and appearing in obscure journals and web sites.
All too often at the front lines of practice, pornography is an inconvenient elephant in the room that invites morality-laden rather than empirically informed responses. In a conversation about the Kingston findings a participant became furious that the subject hadn’t been framed in their preferred light. In another instance involving an adult in group care who requested that he be allowed to possess pornography similar to other clients, an outside consultant took to spreading rumors about those who pointed out there was nothing in the client’s risk profile to prevent his having it. These situations could potentially have had career-altering repercussions. The concern in each instance is that people’s moral beliefs can cloud their judgment about clients in their care, raising questions about who gets to make the decisions about their own life and under what conditions?
Elsewhere, pornography can be more than just the elephant in the room. It can be a source of embarrassment, scorn, rebuke, and debate. Although everyone has an opinion on pornography and very few acknowledge watching it, the viewing figures of “tube” sites like PornHub and YouPorn provide clear evidence to the contrary (Psychology Today piece on pornography viewing). Whatever our moral beliefs, pornography usage is ubiquitous in those parts of the world with Internet access. How this ubiquity will change people over time remains unknown, despite our worst concerns. One wonders about the extent to which professionals in the field of combatting sexual violence are engaged in hypocrisy, and to what extent we cannot study the issues involved more openly or with greater intellectual honesty.
The field of treating sexual abuse has not reached a point, where we can have a detailed, nuanced, and adult conversation about pornography. The debate tends to focus on abuse of power, humiliation, and gender; all of which we agree with. In addition, there is a massive power imbalance in pornography. All pornography is not the same, any more than all other forms of media are the same. Obviously, there are large sections of it that are illegal, highly problematic and have serious cause for concern (child sexual abuse, bestiality, snuff movies to name but a view), but there are other forms of pornography that are normal adult sexual relationships on show (for instance the debate around “ethical” pornography and amateur pornography); however, while important (actually essential) to flag these debates they are not the remit of this discussion (for more information on the reality of Pornography we suggest the work of Maree Crabbe). In many ways, the issues with pornography are the why, where, when and how of its use; its context and need for viewers to engage. The fact that we shy away from talking about sex, sexuality, and healthily relationships in modern society holds us back from further clarity. Professionals and critics can condemn people for watching pornography, but don’t ask why they are viewing it, whether their usage is harmful to themselves or their relationships with others, and if they have considered what is actually happening within it. There is a very real question as to the ethics of condemning the viewer without understanding the context.
These debates come to the fore where we think of certain populations who can’t access sexual expression in the same way as others, either because their primary sexual interest is in children or because their diminished capabilities keep them under the care and/or guardianship of others.
As professionals who work in the field of sexuality and sexual abuse we need to leave our moral issues at the door when engaged in practice with individuals who view pornography, because our role is to help these individuals and not to judge them, especially when we have power and influence over them. We need to help people see what pornography is, what role it serves, and whether its harmful to them (or others) help them stop engaging with it; but this needs to be on a case by case basis and in a neutral way. Again, absent specific empirically based risk considerations whose morality is it?

Thursday, August 9, 2018

Energy Flows Where Attention Goes:Checking our privilege and Influences

By David S. Prescott, LISCW, Kieran McCartan, PhD, & Alissa Ackerman, PhD.

Recent news media events remind us of the importance of establishing the most helpful directions for research and practice. For example, recent allegations of sexual assault in professional contexts have captured the attention of many professionals. In one instance, a university professor has identified himself as a “survivor of sexual violence” after an alleged incident of public groping in the elevator at a conference of the Society for the Scientific Study of Sexuality.

Likewise, recent legal manoeuvring by Brock Turner (whose light sentence in response to a sexual assault on the campus of Stanford University) sparked outrage has again made the news when his lawyers argued that his conviction should be overturned because his crimes involved sexual “outercourse” and not intercourse. Likewise, Bill Cosby has made the news by challenging his designation as a sexually violent predator in Pennsylvania and a registered sex offender. Likewise, a search of recent media accounts shows more instances of workplace sexual assault than can be described here.

As much as we applaud those who step forward in the wake of abuse and the media attention that keeps this topic alive in public discourse, we also believe it’s vital to keep in mind whose lack of privilege keeps them out of the media. As one example, it’s important to keep in mind that being groped in an elevator at a sexuality conference, while worthy of discussion, is not addressing the problem of more severe sexual violence that happens in many communities and rural areas every day. Brock Turner and Bill Cosby are easy media events; understanding the context of sexual violence for less privileged people is much more of a challenge.

Sadly, privileged and photogenic people often receive our attention more than the truly disadvantaged. This needs to change. Likewise, it is essential that our field actively seek out opportunities to conduct research and provide meaningful help where it is needed most. All too often, media accounts focusing on who did what to who overlook the more important questions of what we can do to stop these events from happening.

Those of us who study and provide treatment in the wake of sexual abuse would be wise to consider our own privilege, and how it focuses the lenses through which we view sexual abuse. Of course, even saying this risks appearances that we (the authors) are saying we are somehow “more enlightened than thou”, when we would include ourselves in this caution. All of our media have an opportunity to participate in dialog and debate these most difficult issues.

Thursday, August 2, 2018

Author Q & A with Andreas Witt discussing “The Prevalence of Sexual Abuse in Institutions: Results From a Representative Population-Based Sample in Germany”

Witt, A., Rassenhofer, M., Allroggen, M., Brähler, E., Plener, P. L., & Fegert, J. M. (2018). The Prevalence of Sexual Abuse in Institutions: Results From a Representative Population-Based Sample in Germany. Sexual Abuse. iFirst
The lifetime prevalence of sexual abuse in institutional settings in Germany was examined in a sample representative of the general adult population (N = 2,437). Participants completed a survey on whether they had ever experienced such abuse, its nature (contact, noncontact, forced sexual, intercourse), the type of institution (e.g. school, club), and the relationship of perpetrator to victim (peer, caregiver, staff member). Overall, 3.1% of adult respondents (women: 4.8%, men: 0.8%) reported having experienced some type of sexual abuse in institutions. Adult women reported higher rates of all types than did men, with rates of 3.9% versus 0.8% for contact sexual abuse, 1.2% versus 0.3% for noncontact sexual abuse, and 1.7% versus 0.2% for forced sexual intercourse. We conclude that a remarkable proportion of the general population experiences sexual abuse in institutions, underscoring the need for development of protective strategies. Especially, schools seem to represent good starting points for primary prevention strategies.
Could you talk us through where the idea for the research came from?
The idea for this article has a long history. Since the “so called” abuse scandals in 2010, the topic of child sexual abuse has gained a lot more public and political attention in Germany. Until this point there had only been a few studies on the prevalence of sexual abuse and other types of maltreatment in Germany. So there was clearly a need for data. Interestingly, those who came forward in the “so called” abuse scandals in Germany were men who had experienced sexual abuse in institutions. Additionally, one of our colleagues, Dr. Allroggen had conducted a survey with adolescents that were living in institutions and found tremendously high rates for experiences of sexual abuse. We were therefore interested in the prevalence in the general population of sexual abuse institutions but also leisure activities. Luckily, our department had the chance to participate in a large survey, so we took the chance and included questions about sexual abuse in institutions and leisure activities in the survey.
What kinds of challenges did you face throughout the process?
A big challenge in research on sexual abuse is whether it is ok to ask people for such experiences. Institutional review boards are sometimes hesitant to approve such research due to concerns that asking participants about sexual abuse will induce extreme distress. Fortunately, research on reactions of participants exists that helps to adequately address these concerns. For example Jaffe et al. (2015) report in their meta-analysis that trauma-related research can lead to some immediate psychological distress, however this distress is not extreme. In general, individuals find research participation to be a positive experience and do not regret participation, regardless of trauma history or PTSD. To present those findings helped that the IRB approved our research.
The other issue that we were facing was how to ask individuals about their experiences of sexual abuse. There is no questionnaire that especially assesses sexual abuse in institutions. Therefore, we had to be careful in selecting the questions, as we needed the questions to be non-judgmental. Additionally, when we were designing the questions we were interested in a range of related topics and would have liked to include a lot more questions but resources are limited and so we had to narrow our questions to the essential ones.

What do you believe to be the main things that you have learnt about the prevalence of Sexual Abuse in institutions?
One of the most compelling findings is the amount of people that are affected by sexual abuse within institutions. We also find that experiences of child sexual abuse, as with other  types of child maltreatment, is very common in the general population. When we investigate specific populations, such as children living in institutions the rates are even higher. Our findings also suggest that sexual abuse may occur in a wide variety of settings and that adult caregivers or staff, as well as peers have to be considered as potential perpetrators. Clearly, efforts have to be taken to prevent sexual abuse in different settings and also in regards to perpetrators.
Now that you’ve published the article, what are some implications for practitioners?
Sexual abuse in institutions is an issue. The results of our study indicate that a substantial number of people are affected. Therefore asking about such experiences is necessary, to understand peoples behaviors and health, because we know about the negative and lasting potential of such experiences. Additionally, our results suggest that prevention programs should be established. Especially schools seem to be a good setting for such programs. Additionally, such programs should also address peers as potential perpetrators. 

Friday, July 27, 2018

Reflections on registration and its inherent paradoxes

By Kieran McCartan, PhD, David Prescott, LISCW, & Alissa Ackerman, PhD

On its face, registering individuals who have committed sexual offenses seems like common sense. It neatly ties to public perceptions and myths around these individuals, their rates of recidivism, and levels of risk. The creation of a registry reinforces risk management procedures, public protection policies, and an increasing “audit culture” (one in which there is an ever-increasing focus on monitoring and supervision) within the criminal justice system. It can seem that we are all better protected from sexual abuse when we are constantly monitoring our known sex offenders in the community, although the evidence for this is presently lacking.

The notion that focusing on the small number of people who have been brought to the attention of law enforcement, charged, convicted, and then mandated to register, while ignoring the larger community where sexual victimization occurs every day, is a clear indication that, as a society, we are not actually focusing on risk. Rather, we are making the erroneous assumption that reactive focus of registration is a better, more effective, policy that proactive prevention. This is not the only collateral consequence or contradiction of registries.

There are numerous inherent contradictions – paradoxes – that go hand in hand with developing a register. For example, by feeding myths about the inability of people who have sexually abused to change and the importance of prioritizing an audit culture, professionals and lay people alike can overlook what is actually known to reduce risk and harm. We argue that it is vital to examine the collateral damage caused by policies seemingly steeped in common sense. Doing so may force us to ask if the registry (especially in its current form) is actually fit for the combined purpose of public safety and community (re)integration.

The unfortunate and often unintended messages from the registration of people who have sexually abused include those that are:

-          Anti-rehabilitation: The basic premise of the register is that the police and criminal justice system will have information on known offenders so that if, and potentially when, someone reoffends, law enforcement will know where to find them. This suggests that people don’t change; that once someone is labelled an offender that they will always be an offender. This goes against the basic tenants of treatment/rehabilitation and enables the individual to disengage from the process. Even the most stringent studies of rehabilitative efforts find a larger effect of treatment on recidivism than the registry.

-          Anti-desistence: The register reinforces in people that they will always be a risk and always likely to re-offend, which impacts on their motivation to change and to desist. The inherent message is that they can never be more than the sum of their worst behaviors.

-          Impede the (re)integration of individuals convicted of a sexual offence: There are many unknown and unplanned outcomes of registration for the person on the register, from the sharing of their personal data to where they can live, work and how they can access the internet. This disconnects people from their communities, impeded reintegration.

-          Enforces myths about sexual abuse perpetration: The creation of registries enforces the idea that sexual abuse is perpetrated by a small group of individuals who continually reoffend. The reality, however, is that most individuals who sexually offend are not known to the police and do not have a prior offence at time of arrest.

Despite these concerns and the lack of meaningful supportive evidence, registries have been implemented internationally over the past 15-20 years and they are often seen as good practice in sex offender risk management. There has been virtually no mention in the professional literature of how rehabilitation and registration can work together, or if that is possible. Most western and northern hemisphere countries have a sex offender registry. However, there are variants in the structure and function of these registries. For example, some registries are available only to the police, some only target certain sexual offenses, and some target non-sexual offenses. Registration is the only common denominator.

The USA is an extreme example. The country is fast approaching one million people on the public registry. The USA asks for the most information, sharing much of it publicly. Even the penalties for non-compliance are extreme. Interestingly, countries looking to develop their own registers have looked to the USA as an example, though none has directly replicated it.

The policing and risk management function of the register may have merit, but it is time to reconceptualize it and reconsider the underlying premise to make sure that it is a prosocial, positive risk management tool. As for the USA, there is little room to argue that the registry, in its current form, is prosocial or positive.

When asked, most lay people believe that providing rehabilitative services to people who have committed sexual crimes is one of many good ideas. Given that the registry is likely here to stay, it’s time to consider how we can also promote policies that are going to have a demonstrable impact on public safety.

Thursday, July 19, 2018

Is there such thing as “sexual harm” or is it always Abuse or Trauma?

Danielle Arlanda Harris, PhD, Deputy Director Research, Griffith Youth Forensic Service, Griffith Criminology Institute, Griffith University
Toni Cash, Manager, Practice Advice and Support Team*
Kerri Wyeth, Manager, Practice Response Team*
Kieran McCartan, PhD, Professor, University of the West of England-Bristol

(*Both teams located within Practice Connect under the Queensland Department of Child Safety, Youth, and Women).

The #metoo movement has been called a watershed moment in the way that we think about, respond to, and prevent sexual abuse and harassment. People are talking, which is fabulous. We want people to talk, but language matters, and we need to use the right words.

The Weinstein “event” has led to an increasing number of “brave men and women” coming forth to share their stories. Those stories have been differentially described as revelations, allegations, accusations, disclosures, and delusions. Similarly, the responses by those alleged to have abused have included denials, excuses, justifications, apologies, lies, and responsibility taking. Individuals have been named, shamed, fired, silenced, and “tried by twitter.”

Talking heads are now engaging in nuanced public discussions about the difference between sexual abuse, sexual assault, sexual exploitation, and sexual harassment. These are not the same thing, they do not have the same consequences, or carry the same penalties, and should not be viewed similarly. We have discussed the semantics of sexual abuse, harassment and the #metoo movement on the ATSA blog before. Here, we consider the specific phrase of “sexual harm.” It is challenging to expect members of the public or non-related professions to understand as well as use terminology correctly when even those in the field struggle with language.

We acknowledge the need to use person first language (Willis, 2018) and are beginning to opt for the apparently clunkier “person convicted of a sexual offense” rather than the more pejorative “sex offender” (or worse “predator”). As Nicole Pittman reminded us recently (ATSA conference, 2017): “they’re worth the extra words.” As we continue to negotiate our use of language, it goes without saying we must navigate both legislation and legal jargon as it is used across numerous jurisdictions in multiple countries but also the most sensitive of topics where euphemisms are rife.

ATSA is an international community. Many of us work and travel abroad often.  One can always get mileage out of the flip flop/thong/g-string situation. Since returning to Australia for example, Danielle has had to relearn the language—both legal and practical—to engage in respectful discourse. It was during this process that she came to learn of the challenges and, in some sectors, very strong views about the use of the phrase “sexual harm.”

“Sexual harm” is frequently used as a catchall phrase intended to include various types of violence, abuse, assault, and harm that results from sexual abuse or violence of a sexual nature. The idea of harm—as opposed to other language (i.e., abuse, trauma, etc.)—comes from the field of Zemiology, based on the idea that “harm” is more proactive and adaptive than other terms. It is thought that it is therefore more helpful for people who have experienced sexual abuse or assault and people who have sexually abused others and/or committed sexual offences to move on. However, the word “harm” is divisive in the field of sexual abuse, especially from the perspectives of criminal justice and victim advocacy groups who argue that “harm” lessens the impact and consequences of exactly what a person experiences as a result of sexual abuse.

According to the Queensland Department of Child Safety, Youth, and Women, the harm that a person experiences as a result of sexual abuse is either:

(1) Emotional/psychological harm,

(2) Physical harm or,

(3) Both emotional/psychological and physical harm.

By way of example,

-       If a 16 year old girl reports to her Child Safety Officer that her arm was broken three years ago during an argument with her stepfather, she would be referred to a medical practitioner to ensure that the arm was set properly and the break has healed (thus treating the physical harm) and would likely also be referred to a counsellor to attend to the emotional stress and trauma caused by the same incident (thus treating the psychological harm).

-       If a 16 year old girl reports to her Child Safety Officer that she was vaginally penetrated three years ago by her stepfather, she should similarly be referred to a medical practitioner for an internal exam to ensure that there is no lasting damage, that her vagina has healed (thus treating the physical harm) and would also be referred to a counsellor to attend to the emotional stress and trauma caused by the same incident (thus treating the psychological harm).

Basically, if we understand the harm to be physical then we can target our intervention to the physical harm. Examples include getting medical treatment for damage to the child’s genitals or anus, or diagnosis and appropriate medication for the sexually transmitted infection that the child has contracted. 

Likewise, if we understand the harm to be emotional then we can target our intervention to the emotional harm. Examples here include providing counselling to help the child understand that it was not their fault that the sexual abuse happened to them; or offering assistance that might also focus on the potential risk that the young person poses to others, including safety planning and counselling. 

To be clear, “sexual violence” describes the behaviour that someone is responsible for committing. The “harm” is the resulting impact on the person who has experienced the sexual violence. Quite simply, when someone experiences violence, their resulting physical harm can be treated by a medical doctor and their resulting emotional harm can be treated by a counsellor. The challenge with the use of the phrase “sexual harm” is that it can lead to confusion over how best to help the actual harm that the person has experienced. By observing the presence of the resulting physical and emotional harm that results from the commission of sexual violence we can offer a clear direction for interventions that best cater to the needs of the individual and the actual harm they have experienced.




Friday, July 13, 2018

Toxic Masculinity and How It Can Inform Treatment with Black Boys

By Tyffani Dent, Psy.D.

I work with adolescents who have engaged in problematic sexual behavior. Many of the clients with whom I work are males. Being that within our juvenile justice system there is an over-representation of those who come from marginalized communities, specifically Black and Brown ones---with many explanations for this given from over-policing, racial profiling, poverty not permitting access to services expect through “systems”, etc.---it is not surprising that a significant portion of those I serve are Black. Taking into consideration that the large majority of sexual offenses committed by juveniles are committed by males (Finkelhor, Ormrod, & Chaffin, 2009) it does not surprise me when clients I serve are overwhelmingly black boys, due to a skewed engagement with the juvenile justice system.

When addressing problematic sexual decisions with the boys I counsel, oftentimes the topic of their own early sexual experiences emerges. In these conversations, there are times when they report initiation to sexual behavior occurring at the hands of much older adolescent or adult females and in some cases, male caregivers. Yet, in these discussions, many of them do not view such interactions as sexual abuse or sexually inappropriate, in part, because my community does not often “permit” our boys access to the concept of it being acceptable to not want sexual contact.

Recently, Terry Crews, a famous Black actor, came out and discussed his own #MeToo moment. He disclosed his own experiences with sexual victimization. While some praised him, others including the Rapper 50 Cent, in a tweet, and Senator Feinstein, in a congressional hearing, gave a response with which I am more familiar with--- 50 Cent viewing Mr. Crews’s victimization as discounting his manhood and Senator Feinstein questioning why a big male such as Mr. Crews did not fight back.   This toxic masculinity, which is the push towards hypermasculinity and belief in traditional male stereotypes, is prevalent within our Black and Brown communities in part because of the historical emasculation of Black males since slavery into Jim Crow. The current climate which we live in continues to downplay options for healthy development of a male identity within the Black and Brown communities due to mass incarceration. Such ingrained hypermasculinity impacts not only the starting point in which one engages with Black boys related to what healthy sexual decisions look like, but also in reframing  discriminatory selection of sexual partners as being empowering instead of a sign of “weakness”.

How should the knowledge of toxic masculinity impact our work with especially Black boys who have engaged in problematic sexual behavior?

  1. Explore early sexual experiences-address and normalize feelings of discomfort around sexual contacts with those who were much older and provide them the language to describe it as unwanted and problematic. Allow them the safe space to process this.

  1. Assist in examining how they define manhood. Where did the definitions come from? How do they inform their views of sex and sexuality? The Young Men’s Work curriculum and the book Dare to Be King offer great resources on beginning this discussion from a gender and a racial context.

  1. Reframe masculinity as being an advocate for healthy relationships and being a catalyst for assisting other males in doing the same.

  1. Examine how (if applicable) these boys own problematic sexual decisions were informed by toxic masculinity/hypermasculinity.

  1. When possible, engage other Black men in their lives who can serve as a model for healthy masculinity. When not readily available, identify movies, books, and other mediums in which there are positive portrayals of black manhood. Interwoven in this should also be those stories of black men and boys who have experienced victimization, struggles with their own identifies, and other traumas---which can provide a framework for further exploration of the impact of trauma and how it may play out uniquely for black boys.



Thursday, July 5, 2018

The assessment and treatment of sex offenders with intellectual disabilities: A work in progress.

By Prof. Kasia Uzieblo & Marije Keulen-de Vos, PhD. (Dutch Chapter of the ATSA, NL-ATSA)
On June 11th NL-ATSA, the Dutch Chapter of ATSA, organized a masterclass on the assessment and treatment of sex offenders with intellectual conjunction with the International Forensic Mental Health Services at the IAFMHS conference 2018 in Antwerp (Belgium).  
A considerable number of sex offenders exhibit intellectual disabilities (ID). These offenders require bespoke assessment, support, and treatment. However, in practice ID and its role in sexual deviant behavior are not always fully recognized nor well understood. To enhance the effectiveness of support and treatment programs for sex offenders with ID, it is of great importance for professionals to be aware of the presence of the ID’s, to understand its influence on (sexual) behavior, and to have knowledge of effective treatment programs.
By organizing this masterclass, we also wanted to honor the works of Prof. William R. Lindsay who unfortunately has passed away in March 2017. William Lindsay had dedicated his career to further our understanding of offending behavior among people with ID and to improve assessment and treatment tools in these offenders. He was mainly passionate about identifying the pathways into forensic services of ID offenders, developing adequate assessment tools and establishing effective, evidence-based treatment programs for these offenders. Notwithstanding his very busy research agenda, he also found sufficient time throughout his career to acquire extensive clinical experience with ID offenders: To honor his invaluable work, the masterclass gave ample attention to Prof. Lindsay’s research throughout all sessions. In order to ensure that in-depth insights into Prof. Lindsay’s views and work would be shared, only presenters who had collaborated with Prof. Lindsay in terms of education and/or research were included in the program.
The presenters of the first session, Prof. Kasia Uzieblo (Thomas More and Ghent University, Belgium) and Dr. Petra Habets (OPZC Rekem, Belgium), focused on the assessment of ID in offenders, a topic that even in books on (sex) offenders with ID is often being overlooked. Given the important consequences of an ID diagnosis in offenders, this observation is rather striking. There is ample evidence showing that the assessment of ID in both research and practice comprise several substantial problems and limitations and does not sufficiently adapt to significant evolutions in intelligence research. The convergent validity of the current measures for IQ (e.g., the Wechsler Scales and the Raven’s Progressive Matrices) exhibits substantial problems. For instance, a study by Habets, Jeandarme, Uzieblo, Oei, and Bogaerts (2014) showed that despite positive correlations among intelligence measures, differences between scores on repeated and different IQ measures of 10 points and more occur far too often. In addition, current intelligence measures seem to not sufficiently tap into the various intellectual abilities as described in current theoretical frameworks of intelligence, including the Cattell-Horn-Carroll Model (CHC-model). Another assessment problem arises when taking into account the second diagnostic criterion of ID, i.e. deficits in adaptive functioning. In contrast to previous editions, the fifth version of the Diagnostic and Statistical Manual for Mental Disorders as well as the upcoming 11th edition of the International Classification of Diseases (ICD-11) underline that it is not the IQ score but rather the level of adaptive functioning that determines the level of support needed. Hence, a reliable assessment of adaptive functioning on the conceptual, social and practical domain becomes of utter importance. However, adaptive functioning is often neglected in the assessment procedures or is not sufficiently taken into account when diagnosing ID. This problem might be intertwined with another issue: There is a lack of reliable, valid, and comprehensive measures for adaptive functioning. Unfortunately, this is not all. Many additional problems, including the lack of culturally fair assessment practices and the effect of comorbid psychiatric disorders on ID assessment, merit attention. In sum, Uzieblo and Habets highlighted the need for adequate, comprehensive assessment procedures for ID that align with the most recent theoretical frameworks of intelligence.
The second presenter, Prof. Leam A. Craig (University of Birmingham, UK), focused on the prevalence of ID in sex offenders, etiological explanations of sexual offending behavior in ID offenders, treatment effects, and risk assessment. Prevalence rates of sex offenders with ID typically range from 21 to 50%. However, we have no way of knowing how accurate these percentages actually are. Prof. Craig offered several etiological explanations of sexual offending in offenders with ID. Some studies on sexual abuse in people with ID suggest that behavioral problems (i.e., sexual inhibition) are a consequence of sexual abuse but not of physical abuse. Another hypothesis is that sex offenders with ID are more impulsive than their non-disabled counterparts, although findings on grooming suggest that individuals with ID do demonstrate delayed gratification. One of the most influential explanations is the counterfeit-deviance hypothesis which assumes that sexual deviant behavior is precipitated by a lack of sexual knowledge, poor social skills, limited opportunities, and sexual naivety rather than deviant sexual interests. However, several studies contradict this assumption. In sum, the developmental pathways into sexual offending in people with ID are not well understood yet. With regard to treatment programs for sex offenders with ID, CBT principles are the most commonly applied in these programs. But two problems occur. These programs are typically based on existing non-ID programs. And there is empirical support for their effectiveness. The latter is partly due to methodological problems, such as few randomized clinical trials and the fact that comparison groups are often not available. Next, Prof. Craig provided an overview of commonly used risk methodologies and instruments. Often, the same instruments are used in offenders with ID and non-ID offenders, such as the SVR-20, Static-99, and the Risk Matrix-2000. The ARMIDILLO-S is an instrument specifically developed for sex offenders with ID. Because of the extensive use of risk assessment within the management and treatment of sexual offenders with ID, the accuracy of predictions is of utmost importance. Prediction, however, remains a tricky thing. We have to be aware of what we are actually predicting. Also, the predictive value of risk offender instruments is dependent on definitions of sexual deviant behavior, sex offender ID characteristics (e.g., higher incidence of family psychopathology, behavioral disturbances at school, sexual naivety, and poor impulse control) and base rates. Given the variation in base rates and recidivism rates across risk categories
in samples of sexual offenders with ID, it appears that it is more helpful to report relative levels of risk rather than absolute rates of recidivism.

In the final presentation, Prof. John Taylor (Northumbria University, UK) discussed several tools for practice. He specifically focused on the added value of Finkelhor’s precondition offending model as a shared multidisciplinary and valuable approach. In this approach, the motivation to sexually offend is dissected in four stages. Stage 1 focuses on aspects that influence motivation, such as sexual arousal to inappropriate stimuli and experience of abuse. Stage 2 addresses overcoming self-control. More specifically, cognitive distortions, stress, drug/alcohol abuse and organic factors may lead to disinhibition. Stage 3 emphasizes external control. For example, external factors such as social isolation, discontinuation of supervision or structure, and unusual living/sleeping arrangement may increase the risk of offending. Finally, stage 4 focuses on overcoming victim resistance. Different influencing factors may be prominent in different offenders. Based on these factors, an individualized risk management plan including the level of risk, probability of risk, clinical interventions and management strategies can be developed. In the Northgate Sex Offender Treatment Program (Northumberland, Tyne & Wear NHS Foundation Trust) patients are encouraged to work through three developmental levels over the course of 12-24 months. First (phase 1, pre-treatment group) patients are desensitized to working in a group setting. Next (phase 2, intermediate group, patients are encouraged to discuss more personal issues, emotional difficulties and other things they would like to change. Finally (phase 3, is the offence related group), patients are encouraged to consider behavior related to their offences.

Several discussions with the participants during the masterclass indicated that many practitioners are struggling with the assessment in and treatment of ID offenders. There is clearly an urgent need to share best practices and to develop evidence-based assessment and treatment tools for practice. Since Prof. Lindsay has highlighted these necessities in his first studies, this field has moved forward, mainly thanks to his work. But we are obviously not there yet, as was made very clear throughout the presentations. Hence, it is of vital importance that experts, including Leam Craig, John Taylor and many others working with ID offenders, will proceed with their invaluable work in research and practice. We should also remain working on that two-way bridge between research and practice that Prof. Lindsay had been striving for. Maybe it is utopian to think that we will ever find a solution for all the problems we encounter when working with ID offenders. But nevertheless, we should follow in the footsteps of William Lindsay, and at least aspire to reach this destination.

Want to know more about the aforementioned topics? Some good reads:

Craig, L. A. (2010). Controversies in assessing risk and deviancy in sex offenders with intellectual disabilities. Psychology, Crime & Law, 16(1-2), 75-101.

Craig, L. A., & Lindsay, W. R (2010) Sexual offenders with intellectual disabilities: Characteristics and prevalence. In, L. A. Craig., W. R. Lindsay., & K. D. Browne, (Eds.), Assessment and Treatment of Sexual Offenders with Intellectual Disabilities: A Handbook. (pp. 13-36). Wiley-Blackwell.
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