Should Actuarial Risk Assessments be Used with Sex Offenders who are Intellectually Disabled?

Background Objective actuarial assessments are critical for making risk decisions, determining the necessary level of supervision and intensity of treatment ( Andrews & Bonta 2003 ). This paper reviews the history of organized risk assessment and discusses some issues in current attitudes towards sexual offenders with intellectual disabilities. Method We present two risk assessment tools (RRASOR and STABLE‐2000) that appear to have practical utility with this population. Data are presented from a community sample of 81 sexual offenders who are intellectually disabled suggesting that the RRASOR may provide a useful metric of risk for this population. Dynamic risk is assessed using the STABLE‐2000. This tool, based on 16 areas empirically associated with sexual recidivism, samples the individuals’ current behaviour, skill deficits and personality factors. Change in these factors serves to flag the supervisor to changing risk levels. Conclusions In addressing the question of whether we should seek special risk measures normed on people with intellectually disabilities, given the current lack of alternative tools, we conclude that it is reasonable to make use of the risk assessments that have been validated on the general sex offender population.     

Relapse Prevention with Intellectually Disabled Sexual Offenders

The adaptation of relapse prevention theory to sexual offending (W. D. Pithers, J. K. Marques, C. C. Gibat, & G. A. Marlatt, 1983) has represented an important movement in cognitive-behavioural treatment for sexual offenders. However, this model of relapse prevention has been criticised for its limited view and oversimplification of the relapse prevention process (R. K. Hanson, 2000; T. Ward & S. M. Hudson, 1996). As a result, T. Ward and S. M. Hudson (2000a) have developed a multiple pathway model of the relapse prevention process based on self-regulation theory. Although this model continues to be empirically validated on sexual offenders (J. A. Bickley & A. R. Beech, 2002; T. Ward, S. M. Hudson, & J. C. McCormick, 1999), there has been no empirical research regarding the application of this theory to intellectually disabled sexual offenders. This paper discusses whether the characteristics of offenders in each of the relapse offence pathways, as described by T. Ward and S. M. Hudson (2000a), may be similar to the characteristics of intellectually disabled sexual offenders. From a review of the literature, it appears that the intellectually disabled sexual offender may be most likely to offend via the approach—automatic pathway or the avoidant-passive pathway. The potential treatment implications of the self-regulation model for intellectually disabled sexual offenders is discussed, as well as the need for empirical evaluation with regards to the application of this model to the intellectually disabled sexual offender population.     

Sex Offenders with an Intellectual Disability

It is only in recent years that the myth of the incorrigible and untreatable sex offender with an intellectual disability has been seriously questioned. Current assessment and treatment approaches in this area assume that such offenders are accountable for their actions and treatable with appropriately modified techniques. Even though they may be initially hard to engage in the assessment and treatment process, the use of simplified approaches that support the day-to-day reinforcement of treatment concepts is proving to be effective with this population.     

An Actuarial Procedure for Assessing Risk with Juvenile Sex Offenders

Assessments of juvenile sexual offenders that are intended to aid in dispositional decisions occur at a multitude of decision points within the juvenile justice system. Despite the ubiquity of decisions that include considerations of risk, relatively little empirical work has been done on the development and validation of a risk assessment procedure for these young offenders. In this article, we discuss our initial efforts in developing and validating an actuarial risk assessment protocol for juvenile sex offenders using a sample of 96 adolescents that had been admitted, treated, and discharged from the Joseph J. Peters Institute. We conclude with a critical discussion of problems associated with evaluating risk in this population, and of deficiencies and revision requirements in the present protocol.     

Comparison of Two Risk Assessment Instruments for Sexual Offenders

The current research examines the predictive validity of the Static-99 and the SORAG in predicting sexual and violent recidivism among a sample of 258 treated high-risk sexual offenders. While the SORAG was found to have moderate predictive accuracy for both sexual and violent recidivism over a 5-year follow-up period, the Static-99 was found to only predict sexual recidivism. As well, the actual recidivism rates in the current sample were compared to the published risk percentages for each of the instruments. For both the Static-99 and the SORAG the current sample re-offended at a lower rate than expected. Possible explanations for this finding are discussed.     

A Comparison of Anxiety and Depression in Sex Offenders with Intellectual Disability and a Control Group with Intellectual Disability

The aims of this study were to employ modified versions of the 21-item Beck Anxiety and Depression Inventories with a group of 16 sex offenders with mild intellectual disability and borderline intelligence and 16 control participants with similar levels of intellectual disability. Test-retest correlations found high reliability for both assessments across all participants. There was a significant difference between the scores of the 2 groups with the sex offenders reporting significantly lower levels of anxiety and depression than the control participants. The results are discussed by presenting hypotheses on the emotional stability in each group.     

Comparing Offenders against Women and Offenders against Children on Treatment Outcome in Offenders with Intellectual Disability

Background Several studies have shown the positive effects of sex offender treatment for men with intellectual disabilities who have perpetrated sex offences or inappropriate sexual behaviour. The present study investigates the process of treatment change and compares two groups of offenders against adults and offenders against children. Method Participants comprised of 15 men who had offended against adult women and 15 who offended against children. All were treated for 36 months. Groups were compared with repeated measures using the Questionnaire on Attitudes Consistent with Sexual Offending. Results At baseline, offenders against women had higher scores than offenders against children on the Rape scale while on the offences against children scale the opposite was the case. Both groups showed significant improvement with scores reducing to levels consistent with non‐offenders by 36 months. Significant improvements were still recorded from 18 to 36 months of treatment. Re‐offending across both groups was 23%. Conclusion Sex offender treatment can produce significant reductions in cognitive distortions in sex offenders with intellectual disabilities. The importance of continuing treatment for longer than 12 months was endorsed by the results.     

The Intellectually Disabled Offender: Methodological Problems in Identification

Background Reliable evidence concerning the prevalence of intellectually disabled offenders that would inform the clinician's approach to the assessment and management of risk is in short supply. This paper aims to assist the clinician in interpreting the available evidence. Methods A literature search was conducted for all years up to January 2003. Each study was first examined for the methods employed to define and measure intellectual disability. Then, the effect of this on prevalence estimates was considered. Results A wide range of methods has been used to ascertain the presence of intellectual disability – administrative definitions, psychiatric diagnosis, educational background, self‐report and direct measurement of IQ and adaptive behaviour. Conclusions Most studies reviewed used less than adequate ascertainment methods. Reliable answers to two key questions – which offenders have intellectual disabilities and which people with intellectual disabilities offend – therefore remain elusive.     

A Prospective Longitudinal Study of Sexual Recidivism Among Adolescent Sex Offenders

This paper reports on a follow-up of a sample of 303 adolescent male sex offenders from New South Wales, Australia. Adult rearrest and reconviction data were obtained for 292 of these individuals. The mean observation period between their adjudication as adolescents and their follow-up as adults was 7.3 years. Seventy-five (25%) received further convictions for sexual offenses prior to their 18th birthday. As adults, 25 (9%) came to the attention of police for further alleged sexual offenses, including 14 (5%) who received convictions for these offenses. Of these, 11 (79%) also received new convictions for nonsexual offenses. Overall, 61.3% of subjects received convictions for nonsexual offenses as adults. Results suggest considerable diversity and persistence in delinquent and criminal behavior, and challenge assumptions about high transition rates from adolescent to adult sexual offending.     

The Dynamic Risk Assessment and Management System: An Assessment of Immediate Risk of Violence for Individuals with Offending and Challenging Behaviour

Purpose Research on dynamic risk assessment has developed over the last 10 years and a number of variables have emerged as being possible predictors of future sexual and violent offences. These variables include hostile attitude/anger and compliance with routine. In 2002, Thornton (Sexual Abuse: A Journal of Research & Treatment 14 , 139) developed a framework for dynamic risk assessment which also includes distorted and dysfunctional attitudes, socio‐affective functioning, self‐management and, for sex offenders, sexual interests. In 2000, Hanson & Harris (Criminal Justice & Behaviour 27 , 6) provided empirical support for the predictive power of a number of dynamic factors which they split into stable and acute variables. In their research they found poor social supports, antisocial lifestyle, and poor self‐management strategies to be important in addition to co‐operation with supervision and hostile attitude. The present report describes the development of the Dynamic Risk Assessment and Management System (DRAMS) – an assessment for dynamic/proximal risk factors in people with intellectual disabilities. Method In a field trial, the DRAMS was administered by staff unfamiliar with the formal requirements of the assessment. They were familiar with other ward‐based assessments. Ten subjects were assessed for reliability purposes (total of 45 assessments) and five subjects were assessed consistently over a 3‐month period. Eighteen aggressive incidents were recorded in these five subjects and the relationship between DRAMS assessments and the incidents was calculated. Assessments were recorded on the day of the incident, the day before the incident and on a control day, which was at least 7 days before or after an incident. Results Four items achieved high reliability – mood, psychotic symptoms, self‐regulation, compliance with routine – in addition to total score. Two items achieved intermediate reliability – antisocial behaviour and problems with thinking/attitudes, and three items were not applicable to this client group in that none of the participants was ever rated on them – substance abuse, renewal of emotional relationships and victim access. One item had poor reliability – therapeutic alliance. There were significant differences between the DRAMS assessment on the control day and assessments both on the day prior to the incident and the day of the incident for three of the six subscales and total score. Conclusion Initial results would suggest that the DRAMS is a reliable instrument apart from the therapeutic alliance category. Initial signs suggest that it may be predictive of aggressive incidents in residential settings. Several developments to other settings and the client groups are discussed.     

Response Patterns on the Questionnaire on Attitudes Consistent with Sexual Offending in Groups of Sex Offenders with Intellectual Disabilities

Background This report employs a recently developed assessment on attitudes consistent with sexual offending [Questionnaire on Attitudes Consistent with Sexual Offences (QACSO)] to compare different groups of sex offenders with intellectual disability. Method Two studies are reported each from a different region and each conducted by different individuals. Study 1 compared 12 sex offenders against adults with 12 offenders against children. The six‐scale version of the QACSO was administered including rape and attitudes to women, voyeurism, exhibitionism, dating abuse, homosexual assault and offences against children. Study 2 employed three groups of 10 participants each: offenders against adults, exhibitionists and offenders against children. The seven scale version of the QACSO (stalking added) was used. All questionnaires were administered individually. Results In both studies, the offenders against adults reported higher levels of attitudes consistent with sexual offending in the area of rape and attitudes to women with medium to large effect sizes and a significant difference in study 1. In both studies, offenders against children reported significantly higher levels of cognitive distortions (large effect sizes) in the area of offences against children. Both differences were in the predicted direction and there were no other significant differences on other sections. In general, all three groups reported higher levels of cognitive distortions than non‐offenders. Conclusions There would appear to be some specificity particularly for the rape and attitudes to women scale, and the offenders against children scale. The same specificity does not emerge from other scales of the QACSO. The study also lends support to the inclusion of techniques which explore and challenge attitudes consistent with offending both generally and in relation to specific offences.     

Multimodal Assessment of Dissociation in Adolescents: Inpatients and Juvenile Sex Offenders

Two samples of adolescents were studied to assess the validity of several measures of dissociation. The first sample included 70 males from a residential treatment program for adolescent sex offenders (ASO). The second were 47 psychiatric inpatients. The measures included the DSM-IV field trial questionnaire for Dissociative Disorders of Childhood, Child Dissociative Checklist, Adolescent-Dissociative Experiences Schedule, Trauma Symptom Checklist for Children, and the Dissociation Research scale. Ten of the 70 adolescent sex offender subjects (14.3%) were identified as meeting DSM-IV criteria for a Dissociation-spectrum disorder diagnosis and two (4.2%) of the psychiatric patients. Between-groups analyses with the ASO revealed significant differences on the Child Dissociative Checklist and the Dissociation Research Scale. Cumulative trauma did not differ significantly between the dissociative and nondissociative groups of ASO, but physical abuse was related to a diagnosis of dissociation in this sample. The dissociation measures were highly intercorrelated for both groups, and suggest that they measure a similar construct.     

Assessing Components of Empathy in Sex‐ Offenders with Intellectual Disabilities

Background Because of a lack of research investigating empathy in sex offenders with intellectual disabilities, this study explored empathy in sex offenders and non‐offenders with intellectual disabilities. Specific aims were to explore differences between these groups on measures of the components of empathy. Methods The scores of 21 sex‐offenders and 21 non‐offenders with intellectual disabilities, matched by age, gender and IQ, were compared on the Test of Emotional Perception. Results No differences were found between the two groups across the components of empathy. However, sex offenders who had received treatment performed better on tasks of emotion recognition, emotion replication and response decision than the non‐offenders. Conclusions Further research is needed to understand empathy in sex offenders with intellectual disabilities before any recommendations can be made regarding treatment programmes.     

Risk Assessment: Actuarial Prediction and Clinical Judgement of Offending Incidents and Behaviour for Intellectual Disability Services

Background Research on prediction of violent and sexual offending behaviour has developed considerably in the mainstream criminological literature. Apart from one publication [ Quinsey (2004) Offenfers with Developmental Disabilities, pp. 131–142] this has not been extended to the field of intellectual disabilities. Methods Work on actuarial instruments, dynamic variables, clinical judgement and structured clinical judgement is reviewed. Results A number of studies comparing actuarial instruments in terms of their predictive validity are reviewed. Relative effectiveness and applicability to intellectual disability is considered. A framework for dynamic variables is outlined and the importance of dynamic variables for inclusion in risk prediction is established. Strengths and limitations of clinical judgement are reported and the importance of reliability is noted. Finally, structured clinical judgement is reviewed in terms of the way in which it combines the other three groups of variables. Conclusions The information regarding different methods of risk assessment is integrated with research and opinion contained in the Special Issue. Risk prediction will always be a judgement and as such there will always be errors in judgement. As clinicians, researchers and policy makers it is our duty to employ the latest research information to make predictions that are as accurate as possible. However, we must also help to promote a culture that can be tolerant of inevitable errors.     

‘It’s Intense,to an Extent’: A Qualitative Study of the Emotional Challenges Faced by Staff Working on a Treatment Programme for Intellectually Disabled Sex Offenders

Background This study explores the emotional challenges faced by staff working on a sex offender treatment programme for people with an intellectual disability. Methods Semi‐structured interviews were carried out with eight participants working on a treatment programme for sex offenders with an intellectual disability. Interviews were analysed using interpretative phenomenological analysis. Results Staff experienced a range of negative emotions that they dealt with in a variety of ways including through the use of humour and various emotional defences. Empathy was a challenging and complex issue with individuals taking a variety of positions. Conclusion Staff awareness and understanding of the role of emotions in relation to their own well‐being and in relation to therapeutic processes varied. Emotional intelligence was associated with greater therapeutic understanding. Recommendations are made in relation to personal and professional characteristics and need for clinical supervision to support staff well‐being and the development of therapeutic competence and effectiveness.     

Brief Report: Dimensions of Burnout in Professionals Working with Sex Offenders

This report describes a brief questionnaire to investigate burnout potential in professionals working with sex offenders in clinical, forensic, and human services settings. The Professional Impact Questionnaire, a 31-item inventory with subscales assessing professional performance, coping strategies, and emotional reactions was tested initially with 17 clinicians who provide sex offender evaluations. In an altered format, the questionnaire was administered to 70 clinicians, jurists, and frontline caseworkers and their supervisors. The satisfactory psychometric properties of the original questionnaire were retained in the modified version with this new sample of respondents. Caseworkers reported significantly greater emotional distress than attorneys and judges. For all participants, negative emotional reactions were associated with a sense of impaired work performance. Using positive coping strategies was correlated with reporting relatively few adverse effects on professional functioning.     

Risk Factors for Criminal Recidivism in Older Sexual Offenders

Sexual offenders constitute a substantial proportion of the older male prison population. Recent research findings, with potential consequences for risk management, indicate that recidivism risk might be lower in older sexual offenders. We followed up all adult male sexual offenders released from prison in Sweden during 1993–1997 (N=1,303) for criminal reconviction for an average of 8.9 years. We studied rates of repeat offending (sexual and any violent) by four age bands (<25, 25–39, 40–54, and 55+years), and examined whether risk factors for recidivism remained stable across age groups. Results showed that recidivism rates decreased significantly in older age bands. In addition, the effect of certain risk factors varied by age band. These findings on recidivism rates in older sexual offenders concur with studies from the United Kingdom, United States, and Canada and may suggest some generalizability in Western settings. Further research is needed to address underlying mechanisms.     

Violent Juvenile Sex Offenders Compared with Violent Juvenile Nonsex Offenders: Explorative Findings From the Pittsburgh Youth Study

Only a limited number of studies have compared the psychosocial characteristics of juvenile sex offenders and nonsex offenders. The results of these studies have often been contradictory. Furthermore, studies in normal population groups are rare and most of those studies have been conducted in specific populations. This paper reports on the findings of a prospective, longitudinal study, the Pittsburgh Youth Study, in which violent male sex offenders (n = 39) were compared with violent nonsex offenders (n = 430) based on 66 demographic and psychosocial characteristics. The findings show that the sex offenders resembled the nonsex violent offenders with respect to nearly all child, family, peer and demographic risk factors. Some suggestions are made with regard to future research.