Why does child sexual abuse occur and how to reduce the risk of reoffending
Treatments
Interventions should deal with the bio-psycho-social factors associated with sexual offences and for interventions to reduce reoffending more generally, models such as the risk-need-responsivity (RNR) framework have been focussed on. This model highlights static and dynamic risk factors and suggests dynamic risk factors should be directed differently across risk groups (Vollm, Craisasati, Grubin, Skett & Williams., 2019)
Hanson, Bourgon, Helmus and Hodgson demonstrated that risk, needs and responsivity can be applied to the treatment of sex offenders
The most influential philosophy in the treatment of sex offenders is the Good Lives Model (GLM) which emerged from positive psych and emphases the development of sex offenders strengths rather than eliminating deficits
Biological interventions such as medication to lower tesosterone or surgical castration were shown to reduce the rates of recidivism (Schmucker & Losel., 2008) but ethical challenges accompany these
Mews, Di Bella & Purver (2017) did an evaluation of men attending treatment between 2000-2012 matched to those with sexual convictions who did not attend the programme. Reconviction rates were higher (10%) in the treatment group compared to the matched group (8%) and these differences emerged only 5-7 years after the offenders were released which is disappointing
Some research worldwide has also found that men who didn't receive treatment had better outcomes (Schmucker & Losel., 2017) this was found in their meta analysis of 29 psychosocial programmes where only five achieved clearly positive results on reoffending
Some treatment programmes were developed which are skills and strength based and show how the risk-need-responsivity model of rehab and desistance theory are applied in practice (Maruna & Mann., 2019) which helps people work towards a new me. Kaizen & Horizon were developed which incorporate group and individual sessions for individuals who accept responsibility
Kaizen
It is a higher dose programme approx 160 hours for individuals who are high risk and high need
Covers a broad range of criminogenic needs with intensive input in relation to crime supportive attitudes, offence related sexual interests and grievance thinking. The Healthy Sex Programme (up to 30 1 to 2 hour sessions) is available to help develop healthy sexual interests
Horizon
It is for men of at least medium recidivism risk involving approximately 60 hours of treatment and targets a range of criminogenic needs including offence supportive attitudes, problem solving, self control and intimacy skills, it also helps develop healthy sexual interests
Circles of support- When people are reintegrated back into society they face a lot of hurdles, failing to find work and develop support networks is associated with an increased risk of general and sexual recidivism (Hoing, Petrina, Duke, Vollm & Vogelvang., 2016)
Brain development research
Ecological niche research
Interlocking neuropsychological functions research
Clinical symptoms: State factors research
Deficits in neuropsychological functioning are highly relevant in theories about the development of sexually aggressive behaviours (Turner et al., 2018, Ward & Beech., 2006)
Neuropsychological functioning covers a wide range of cognitive abilities that are under the control of specific brain structures (Morgan & Ricker., 2016) including speed of info processing, attention, language, memory and executive functions
Child sex offender show pronounced deficits in neuropsychological functioning compared to controls (Adjorlolo & Ebenya., 2016; Joyal, Beaulieu-Plante & de Chaterac., 2014))
The impairements according to Adjorlolo and Ebenya (2016) include working memory, verbal abilities, cognitive flecibility, attention and concentration, visual/spatial abilities, abstract reasoning, response and behavioural inhibition and planning
According to Ward and Beech (2006) deviant sexual offending is a result of certain clinical symtpoms or state factors which in turn are generated through ongoing interactions of biological factors (genetics and brain development) and environmental factors (social, cultural and personal circumstances) and neuropsychological functioning which are the interlocking systems
Motivation/emotion system= responsible for the creation of certain goals and values to adjust the motivation state to changing environmental circumstances. Perception and memory= to process sensory info and create representations readily available for working memory. And action selection and control= responsible for planning, implementing and evaluating action plans to control behaviour, thoughts and emotions (Turner & Rettenberger., 2020)
If someone isn't caught first time for their offence this could lead to the perception that child sex offending doesn't have reprocussions, leading to further disinhibition in the action selection and control system, leading to the maintenance of offence supportive behaviours (Ward & Beech., 2006)
Neuropsychological dysfunctions are seen as a central part of the etiology of a sexual offence but also the development of paraphillic sexual interests (Tost et al., 2004)
Neuropsychological deficits in pedophillic sex offenders
Hucker et al (1986) found that paraphillic sex offenders performed significantly worse compared to health controls on neuropsych tests tapping into their left frontal and temporal brain functioning
Child sex offenders showed more impairments in inhibition, processing speed and verbal functioning in the review of 15 studies conducted by Turner & Rettenberger (2020. Cohen et al (2020) compared 51 child sex offenders with 53 male and female opiate addicts and 84 male and female healthy controls. CSA had superior planning skills compared to opiate addicts but had slower processing speeds
Eastvold et al (2011) found that both CSA groups performed significantly worse on inhibition but had significantly superior performance in abstraction compared to non sex offenders. Additionally, pedophillic sex offenders performed sig better on planning than non pedophillic sex offenders
Cantor et al (2004) showed that pedophillic CSA showed poorer verbal concept formation than sex offenders against adults, and pedophillic and hebophillic child sex offenders showed poorer functioning in semantic knowledge, working memory and immediate delayed recall concerning visuaospatial and verbal memory than sex offenders against aduts
Although a large amount of neuropsychological functioning is determined by the individuals genetic makeup, CBT can help improve neuropsych functioning (Anastopoulos et al., 2018), programmes addressing the enhancement of neuropsychological functioning will not only decrease the risk of reoffending but also the risk of maladaptive psychosocial outcomes such as poor physical health (Miller, Barnes & Beaver., 2011)
Although treated within society as one group, child sex offenders differ from eachother as there are non paedophillic sex offenders and paedophillic sex offenders (Dillien, Goethals, Sabbe & Brazil., 2020). Only 40-50% of the child sex offenders have a preference for childen and seek sexual gratification from molesting them. When faced with negative emotions the remaining 50-60% turn to children for non sexual reasons when the opportunity presents itself (Seto., 2008), and there are intrafamilial and extrafamilial child sex offenders
Why else does the sex offence occur?
The maintenance of the behaviour has been linked to the etiology of sex offending, the maintenance factors include sexual deviance, general antisociality, impulsivity and self regulation deficits (Hanson & Morton-Bourgon., 2005; Thakker & Ward., 2012)- these maintenance factors are linked to the descriptions of clinical symtomatology according to the ITSO. However the ITSO doesn't explain the mechanisms that are involved in this maintenance behaviour so its harder to know how to target them in treatments (Szumski, Bartels, Beech & Fisher., 2018)
According to Seto (2019) in the Motivation-Fascilitation Model of sexual offending, the motivation to commit a sexual offence against a child is necessary but insufficient to produce a sex offender, and a sex offence will only be committed if behavioural control is low and self regulatory mechanisms fail to suppress the desire to sexually abuse a child (Dillien et al., 2020), the breakdown in self regulation can be due to proximal factors such as alcohol but it can also be due to distal trait like factors
Reduced grey matter was found in the right amygdala and in closely related structures such as the hypothalamus and the septal region in pedophillic sex offenders (Schiltz et al., 2007)
As noted by Vess and Skelton (2020) when neuropsychological impairments present themselves they have important clinical implications as they may explain why child sex offenders show poor treatment response and fail to obtain therapeutic results. Those child sex offenders with impaired neuropsychological functions may struggle to benefit from treatments, pedophillic CSOs with attention deficits may benefit from having the length of the session reduced (Manning et al., 2009)
Neurobiological- Normal brain function is highly dependent on appropriate communication within and across neural structures (Kargel et al., 2017). Cantor et al (2008, 2015) reported a partial disconnectivity of regions that were identified to be reliably responsive to visual sexual stimuli (Poeppl et al., 2014)
The frontal and temporal lobes affect pedophillic sexual preference expression and its behaviours differently, the frontal lobe (orbitalfrontal and dorsolateral prefrontal cortices) accounting for committing the offence against children and the temporal lobe (amygdala and hippocampus) accoutning for the sexual preoccupation with children often seen in pedophilic men (Seto., 2008)
Cognitive flexibility makes it possible for individuals to change behaviour to adapt to changing environments (Lezak et al., 2012), a lack of cognitive flexibility is seen as a risk factor and prevent individuals from discovering and adopting socially appropriate ways to respond to sexual needs. This lack of cognitive flexibility in pedophiles may prevent them from being able to shift their interests from children to adults
Distal factors constitute a pre dispositional vulnerabilit causal factors that emerge from both developmental experiences and genetic inheritance, these predisposing factors make a person vulnerable to offending sexually once triggering and situational factors are present. Proximal factors are triggering processess or events that emerge from the functioning of vulnerability factors, the failure to deal with these increases the chances of a sexual offence if the opportunity arises (Ward & Hudson., 2001)
Finkelhor notes that it is important to explain why individuals who are unable to have their emotional needs met by adults turn to children for sex and not just look for support or friendship
Marshall and Barbaree (1990) propose that sexual abuse of children occurs as a consequence of a number of interacting distal and proximal factors-people experiencing poor parenting, physical and sexual abuse arelikely to exhibit distorted internal working models of relationships, especially with respect to sex and aggression, resulting in poor social and self regulation skills from an early age
According to Marshall and Barbaree (1999) sex and aggression originate from neural substrates (hypothalamus, amygdala, septum etc) if an individual comes from a negative background and is therefore already predisposed to behaving in an antisocial manner, the pubertal release of hormones may serve to fuse sex and aggression and to enhance already acquired sexually abusive tendencies (Beech & ward., 2004)
If an individual has a lack of effective social and self regulation skills then it is more likely that relationships or attempted relationships with women will be met with rejection leading to lowered self esteem and negative attitutides towards females, these negative emotions may fuel the intensity of sexual desires and the development of deviant sexual fantasies, future sexual offences may become planned through mental rehearsals (Beech & Ward., 2004)
Cognitive distortions are considered an important factor in the etiology and maintenance of sexual offending behaviour in males (Szumski et al., 2018)
Abel et al (1984) proposed that cognitive distortions are caused by an altered belief system that is supportive of offending behaviour, this distortion causes a change in someones beliefs and alleviates tension caused by the discrepency between an offence related sexual interest and ones cultural/social norms and this distortion can be argued to play a role in the etiology of sexual offending, they then added that cog distortions help sex offenders justify their ongoing behaviour to protect them from shame and guilt (Abel et al., 1989)