MENU TITLE: Child Sexual Molestation: Research Issues .

Series: NIJ Research Report
Published: June 1997
30 pages
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U.S. Department of Justice
Office of Justice Programs
National Institute of Justice

Research Report
 
Child Sexual Molestation: 
Research Issues
 
------------------------------

U.S. Department of Justice
Office of Justice Programs
633 Indiana Avenue N.W.
Washington, DC 20531
 
Janet Reno
Attorney General
U.S. Department of Justice
 
John C. Dwyer
Acting Associate Attorney General
 
Laurie Robinson
Assistant Attorney General
 
Jeremy Travis
Director, National Institute of Justice
 
Justice Information Center
World Wide Web Site
http://www.ncjrs.org

------------------------------

Child Sexual Molestation: 
Research Issues

Robert A. Prentky, Ph.D.
Raymond A. Knight, Ph.D.
Austin F.S. Lee, Ph.D.

June 1997

------------------------------

U.S. Department of Justice
Office of Justice Programs
National Institute of Justice

Jeremy Travis, J.D.
Director

Christy Visher, Ph.D.
Science Advisor to the Director

------------------------------

Robert A. Prentky, Ph.D., is the Director of
Clinical and Forensic Services at the Joseph J.
Peters Institute in Philadelphia. Raymond A.
Knight, Ph.D., is a professor at Brandeis
University, and Austin F.S. Lee, Ph.D., is a
professor at Boston University.

Opinions or points of view expressed in this
document are those of the authors and do not 
necessarily reflect the official position of the
U.S. Department of Justice.

NCJ 163390

The National Institute of Justice is a component of
the Office of Justice Programs, which also includes
the Bureau of Justice Assistance, Bureau of Justice
Statistics, Office of Juvenile Justice and
Delinquency Prevention, and the Office for Victims
of Crime.

------------------------------

Contents

Executive Summary 

Introduction 

Section 1: Occurrence and Etiology 

 Frequency of Child Sexual Abuse 
 Characteristics of the Offender 

Section 2: Typology and Treatment 
 
 Classification of Child Molesters 
 Clinical Management of Offenders 

Section 3: Reoffense Risk 
  Dispositional Decisions 
  Predictors of Sexual Recidivism 

Section 4: Variability in Child Molester Recidivism

  Survival Analysis 
  Implications  

Conclusion 

------------------------------

Exhibits

Exhibit 1.  Flow Design of the Decision Process for
Classifying Child Molesters on Axis I and Axis II
of MTC:CM3 

Exhibit 2. Hypothetical Profiles of MTC:CM3 Axis II
Types 

Exhibit 3. Variability in Child Molester Recidivism
by Offense Type and Disposition 

Exhibit 4. Child Molester Survival Curves for
Different Dispositions of Sexual Charges 

Exhibit 5. Child Molesters Charged With, Convicted
of, or Imprisoned for a New Sexual Offense 

Exhibit 6. Cumulative Failure Rates for Sexual
Offenses Within Nine Time Gates 

Exhibit 7. Sexual Recidivism of Child Molesters by
Disposition and Length of Followup 

------------------------------

Child Sexual Molestation: Research Issues

Executive Summary

Over the past 25 years, the problem of child sexual
victimization has received significant attention
from researchers, clinicians, and policymakers. Yet
underreporting of sexual offenses against children
has made it impossible to gauge either the
frequency of such incidents or the size of victim
and offender populations. In addition, deficient
research methodologies have yielded incompatible or
contradictory findings with regard to the
characteristics, motivations, and recidivism rates
of offenders. As a result, critical decisions about
offender dangerousness, control, and treatment have
been made in the absence of a sound knowledge base.
In recent years, however, efforts have been made to
(1) develop and validate an empirically based model
of the agents and factors that lead to child sexual
abuse, and (2) design and test statistical methods
for assessing reoffense risk. 

Important findings: 

o The classification, diagnosis, and assessment of
child molesters are complicated by a high degree of
variability among individuals in terms of personal
characteristics, life experiences, criminal
histories, and reasons for offending. There is no
single "profile" that accurately describes or
accounts for all child molesters.

o Sexual focus in child molesters has two
independent dimensions: intensity of pedophilic
interest and exclusivity of the sexual preference
for children. The more an offender's sexual
preference is limited to children, the less
socially competent (as measured by the strength and
range of social and sexual relationships with
adults) he is likely to be.

o Most victims of childhood sexual abuse do not go
on to become child molesters. However, sexual
victimization as a child, if accompanied by other
moderating factors--such as the co-occurrence of
other types of abuse--may contribute to the
child-victim's later emergence as a perpetrator of
child sexual abuse. Similarly, social competence
deficits are clearly significant in child
molestation, but an individual's inadequate social
and interpersonal skills do not, by themselves,
make his sexual abuse of children inevitable. 

o A history of impulsive, antisocial behavior is a
well-documented risk factor for certain predatory,
extrafamilial child molesters; offenders who have
this background and who began their offending
careers in adolescence have also evidenced higher
degrees of nonsexual aggression.

o Early childhood experiences, such as a high
turnover in primary caregivers (which is a strong
predictor of adult sexual violence), may interfere
with the development of viable, age-appropriate
adult relationships, making it more likely that
children are selected as sexual targets. 

o Physiological arousal to children often
accompanies a sexual interest in them. Phallometric
assessment of sexual arousal in response to
depictions of children can differentiate child
molesters from nonmolesters, same-sex molesters
from opposite-sex molesters, and extrafamilial
molesters from incest offenders.

o An empirical classification typology for child
molesters, based on stable traits that have
identifiable roots in childhood, is being developed
by NIJ-supported researchers. Known as MTC:CM3, the
system classifies child molesters according to
variables on two coordinates: the first focuses on
fixation and social competence, and the second
focuses on contact with children, injury to victim,
and sadism. The system is an important first step
in the design of research on etiology, treatment,
disposition, and prognosis. Although further
revision and refinement of the typology are
necessary, studies support the reliability and
validity of the classification structure.

o Recidivism rates across studies are confounded by
differences in legal guidelines and statutes among
States, length of exposure time (i.e., time in the
community, where the opportunity exists to
reoffend), offender characteristics,
treatment-related variables (including differential
attrition rates, amount of treatment, and integrity
of treatment program), amount and quality of
posttreatment supervision, and many other factors.

o A 25-year followup study of 111 extrafamilial
child molesters included extensive data from
criminal justice records and rationally derived
composites of variables. The study demonstrated an
ability (1) to discriminate among offenders who
committed sexual crimes involving physical contact
with a victim, nonsexual crimes involving physical
contact with a victim, and nonsexual crimes in
which no physical contact with a victim occurred
and (2) to predict reoffense probabilities with
reasonable accuracy. If these results can be
replicated in studies of other offenders, use of a
scale based on archival records may represent an
easy, cost-effective, and reliable substitute for
intrusive and time-consuming physiological
assessment. 

o Although optimal treatment interventions have yet
to be identified, the most effective intervention
to date--cognitive behavior therapy and, when
appropriate, antidepressant and antiandrogen
medication--has reduced recidivism among child
molesters.

o Intensive community-based supervision and
management of child molesters are essential to
reduce sexual victimization rates; child abusers
have been known to reoffend as late as 20 years
following release into the community.

------------------------------

Introduction

Few criminal offenses are more despised than 
the sexual abuse of children, and few are so little
understood in terms of incidence (the number of
offenses committed), prevalence (the proportion of
the population who commit offenses), and reoffense
risk. Despite longstanding public concern over the
medical, emotional, and monetary costs associated
with child sexual victimization, rigorous programs
to enhance the accuracy of predictive decisions
involving sexual offenders are of fairly recent
origin. Because of inadequate methodologies,
studies on the psychology, behavior, treatment, and
recidivism rates of child molesters have often
yielded inconsistent findings. The uncertainty of
information about sexual offenders raises questions
about the effectiveness of special commitment
statutes and ad hoc discretionary and dispositional
decisions directed toward this group. 

Before it can combat child molestation effectively,
the criminal justice community must first
understand it. Empirical knowledge of the factors
that lead individuals to sexually abuse children
can support and inform the sentencing,
probationary, clinical, and supervisory decisions
that must be made with regard to child molesters.
This report is divided into four main sections.
Section 1 discusses the frequency of child sexual
molestation and factors leading to sexual deviancy
in individual offenders. Section 2 includes
classification models for typing and diagnosing
child molesters and describes treatment approaches
and strategies for community-based maintenance and
control. Section 3 talks about reoffense risk as it
relates to criminal justice decisions and discusses
predictors of sexual recidivism. To illustrate the
variability of recidivism among child molesters,
section 4 presents the findings of a 25-year
followup study of 115 released offenders. Finally,
some of the shortcomings of current approaches to
reduce child molester reoffense risk are touched on
in the report's conclusion, and an argument is made
for postrelease treatment and aftercare programs. 

The information included in this Research Report
has been distilled from several interrelated
reports and studies sponsored by the National
Institute of Justice (NIJ) to strengthen the
efficacy of intervention and prevention strategies
and ultimately reduce child sexual victimization
rates.  

Section 1. Occurrence and Etiology

Frequency of Child Sexual Abuse

The assumption that sexual crimes against children
and teenagers are underreported is now commonly
accepted. Sexual offenses apparently are more
likely than other types of criminal conduct to
elude the criminal justice system. This inference
is supported by the reports of both sex offenders
and sexually abused children. Offenders report
vastly more victim-involved incidents than those
for which they were convicted (see "Adult Reports
of Child-Focused Sexual Behavior").[1] It is
impossible to determine how representative these
anonymous self-reporting offenders are, compared to
all of the nonincarcerated and unidentified sex
offenders in the population. 

A telephone survey of a national probability sample
of 2,000 children between the ages of 10 and 16
revealed that 3.2 percent of girls and 0.6 percent
of boys had suffered, at some point in their lives,
sexual abuse involving physical contact. If one
infers that those statistics can be generalized to
the rest of the country, children have experienced
(but not reported) levels of victimization that far
exceed those reported for adults.[2] This finding
is consistent with a recent report indicating that
teenagers are at greater risk than adults for
rape.[3] 

In addition to underreporting, incidence estimates
are also affected by a number of methodological
problems. Although research on criminal conduct 
of any type may be hampered by these difficulties,
sexual crimes seem to be especially susceptible.
For instance, sexual offenses involve behavior that
is not as clear-cut as that occurring in nonsexual
crimes (such as robbery, burglary, or auto theft)
because they often include nonsexual offenses
(e.g., kidnaping, breaking and entering, or simple
assault) as well as a variety of different sexual
violations. The criminal charges springing from
such a litany differ from one jurisdiction to
another, and the resulting conviction may be for a
"lesser," that is, nonsexual, offense (e.g.,
pleading out to simple assault). Given this
unevenness in legal system dispositions, it is not
surprising to find wide variations among--and wide
ranges within--incidence/prevalence estimates. 

Characteristics of the Offender

The sexual abusers of children are highly
dissimilar in terms of personal characteristics,
life experiences, and criminal histories. No single
"molester profile" exists. Child molesters arrive
at deviancy via multiple pathways and engage in
many different sexual and nonsexual "acting-out"
behaviors. 

Sexual focus. Evidence shows that sexual focus in
child molesters comprises two separate components.
The first is intensity of pedophilic interest,
i.e., the degree to which offenders are focused or
"fixated" on children as sexual objects. The second
component involves the exclusivity of their
preference for children as sexual objects. The
second component is inversely related to social
competence, as measured by the extent and depth of
adult social and sexual relationships, and it is
independent of the intensity of pedophilic
interest. 

Physiological arousal. Logic suggests that a
behavioral dimension of sexual interest in children
would be accompanied by varying degrees of
physiological arousal to them. Plethysmographic
assessment (i.e., measurement of penile volume
changes [phallometry] in response to sexual
stimuli) has demonstrated an ability to
discriminate between child molesters and comparison
groups of nonmolesters,[4] as well as among
subgroups of child molesters defined by victim
gender preference (same sex vs. opposite sex) and
by relationship to victim (incest vs. nonincest).
For example, exclusive incest offenders demonstrate
far less sexual arousal in response 
to children than do extrafamilial child molesters.
Offenders with strong pedophilic interest show more
sexual arousal to depictions of children than their
low-fixated counterparts.

Victimization of offenders as children. Some
support exists for the notion that child
molestation may be related to an offender's
restaging or recapitulation of his own sexual
victimization. Tests of the recapitulation theory
on a sample of 131 rapists and child molesters
revealed that child molesters who committed their
first assault when they were 14 or younger were
sexually victimized at a younger age than offenders
who committed their first assault in adulthood;
they also experienced more severe sexual abuse than
offenders with adult onset of sexual aggression.[5]
No evidence of recapitulation of sexual abuse among
rapists was found in this study. It should be
pointed out, however, that regardless of whether or
not they were sexually abused (and, if so, by whom
and at what age), all offenders in the sample went
on to commit sexual offenses.

By itself, sexual victimization is too narrow a
factor to explain child molestation. No inexorable
link exists between experiencing sexual abuse as a
child and growing up to be a child molester; the
"outcome" of child molestation is a much more
complex phenomenon. Most victims of childhood
sexual abuse do not go on to become perpetrators.
As is true for other kinds of maltreatment,
childhood sexual victimization becomes a critical
element in the presence or absence of a variety of
other factors (e.g., co-occurrence of other types
of abuse, availability of supportive caregivers,
ego strength of child-victim at the time of abuse,
and treatment), all of which moderate the
likelihood of becoming a child molester. In
addition, the severity of the long-term effects of
childhood sexual abuse is influenced by clear
morbidity factors (e.g., age at onset of abuse,
duration of abuse, the child's relationship to the
perpetrator, and invasiveness and/or violence of
the abuse). The weight and significance of having
been sexually abused are specific to the individual
child molester. 

Social competence. A variety of studies have
documented the inadequate social and interpersonal
skills, underassertiveness, and poor self-esteem
that, in varying degrees, characterize individual
offenders.[6] Social competence deficits are
pervasive among child molesters and must be
considered clinically significant. As is true for
sexual abuse suffered by offenders during
childhood, however, social competence deficits
constitute but one important factor in the complex
etiology of child molestation.

Impulsive, antisocial personality. Research shows
that child molesters who committed their first
sexual offense in adolescence had histories of
being disruptive in school (verbally or physically
assaulting peers and teachers), showed high levels
of juvenile antisocial behavior, and, as adults,
manifested a greater degree of nonsexual
aggression. For some types of child molesters,[7]
sexual offenses are part of a longer criminal
history, reflecting an antisocial lifestyle and
impulsive behavioral traits that probably had been
present from childhood.[8] A history of impulsive,
antisocial behavior is a well-documented risk
factor associated with some child molesters.

Developmental influences. Recognition of the
multiple factors that determine child molestation
has led clinicians and investigators to examine the
antecedent and concurrent experiences that place
sexual abuse in a developmental context. One
variable, "caregiver inconstancy," measures the
frequency of changes in primary caregivers and the
longest time spent with any single caregiver; it
reflects the permanence and consistency of the
child's interpersonal relationships with
significant adults. Caregiver inconstancy, a
powerful predictor of the degree of sexual violence
expressed in adulthood,[9] interferes with the
development of long-term supportive relationships,
increasing the likelihood of an attachment
disorder. Attachment disorders may be characterized
by intense anxiety, distrust of others, insecurity,
dysfunctional anger, and failure to develop normal
age-appropriate social skills. Thus, specifiable
early childhood experiences may lead to
interpersonal deficits and low self-esteem that
severely undermine development of secure adult
relationships. Individuals having these
interpersonal and social shortcomings are more
likely than others to turn to children to meet
their psychosexual needs. 

------------------------------

Section 2. Typology and Treatment

Classification of Child Molesters

Diagnosis and assessment. Just as the childhood and
developmental experiences, adult competencies, and
criminal histories of child molesters differ
considerably, so do the motives that underlie the
behavior patterns that characterize their sexual
abuse of children. Thus, informed decisions about
these offenders require some understanding of the
dimensions believed to be important in
discriminating among them. Diagnosis aims to reduce
this diversity by assigning the offender to a class
or group of individuals with similar relevant
characteristics. Identifying and measuring these
relevant characteristics is the task of assessment.

A reliable, valid classification system can improve
the accuracy of decisions (1) in the criminal
justice system (where dangerousness and reoffense
risk are assessed and resources are allocated), (2)
in the clinical setting (where a more informed
understanding of particular classes of offenders
can be used to optimize treatment plans), and (3)
in the design of more effective primary prevention
strategies. A classification model may also help in
deciphering critical antecedent factors that
contribute to different outcomes (i.e., different
"types" of child molesters).

DSM-IV classification. The 1994 edition of the
Diagnostic and Statistics Manual of Mental
Disorders (DSM-IV) places pedophilia under the
heading, "Sexuality and Gender Identity
Disorders."[10] According to DSM-IV, the onset of
pedophilia "usually begins in adolescence," and its
course is "usually chronic." Specific behavioral
criteria for diagnosing pedophilia are listed, as
follows:

o The subject has experienced, for at least 6
months, recurrent intense sexual urges or fantasies
involving sexual activity with a prepubescent child
(age 13 or younger). 

o The subject has acted on these urges or is
markedly distressed by them.

o The subject is at least 16 years old and at least
5 years older than the victim. (Late adolescent
subjects who are involved in ongoing relationships
with 12- or 13-year- old youngsters are excluded.)

Three other specifications figure in this
classification system: (1) whether the client is
sexually attracted to males, females, or both; (2)
whether the offenses are limited to incest; and (3)
whether the client is an "exclusive" (attracted
only to children) or "nonexclusive" type.

Although the DSM-IV classification system may
succeed in isolating the "pedophilic" child
molester, it fails to capture those incest and
extrafamilial offenders without known 6-month
histories of sexualized interest in children.
Requiring evidence that an individual has met the
first (and critical) diagnostic criterion dealing
with "recurrent intense sexual urges or fantasies"
involving children will inevitably screen out a
large number of child molesters.

Sex-of-victim model. Classification of child
molesters on the basis of their victims' sex--
same-sex, opposite-sex, or mixed-group offenders--
has shown stability over time.[11] In addition, it
has demonstrated predictive validity as well as
some concurrent validity (e.g., it corresponds as
expected with penile plethysmographic
responsiveness to stimuli depicting specific ages
and sexes).[12] Many reports have suggested that,
among extrafamilial offenders, same-sex 
child molesters are at highest risk to reoffend and
opposite-sex child molesters are at lowest risk.
However, the sex-of-victim distinction has not
received consistent support. In contrast to the
typical finding, at least four recent studies found
either no differences in recidivism rates among
groups or differences that were opposite to
prediction.[13] 

The reasons for discrepant findings based on the
sex-of-victim distinction are unclear, although
several possibilities come immediately to mind:

o The large number of unreported sexual assaults on
children.

o Possible biases against reporting 
homosexual encounters.

o Situational factors that might lead to assaults
on the less-preferred sex.

o Incarceration after a single assault.

Further, some studies do not distinguish between
incest offenders, who are almost exclusively
heterosexual in their choice of victims, and
nonincest offenders. Assuming that "true" incest
offenders (that is, those whose offenses are
exclusively intrafamilial) constitute a clinically
and theoretically meaningful group of child
molesters, the proportion of such cases in any
particular sample might affect the differences
found between same- and opposite-sex offenders.

Clinically derived multidimensional systems. In the
earliest taxonomic systems for child molesters,
which were based exclusively on clinical
experience, three subtypes consistently appeared: 

o Offender with an exclusive and longstanding
sexual and social preference for children (Common
Type 1).

o Offender whose offenses are seen as a shift or
regression from a higher, adult level of
psychosexual adaptation, typically in response to
stress (Common Type 2). 

o Offender who is a psychopath or sociopath with
very poor social skills and who turns to children
largely because they are easy to exploit--not
because they are preferred or even desired partners
(Common Type 3).

The most historically important of these
hypothetical subtypes are the "fixated" and the
"regressed" (Common Types 1 and 2, respectively).
Implicit or explicit in the various systems that
attempted to define fixated and regressed types was
an assessment of achieved level of social
competence. In addition to being described as
having more intense pedophilic interest, fixated
offenders were also typically differentiated from
regressed offenders by marital status, number and
quality of age-appropriate heterosexual
relationships, and achieved educational and
occupational levels. The fixated child molester was
hypothesized to have a negligible history of dating
or peer interaction in adolescence and adulthood,
and, if married, the quality of his relationship
was considered to be poor.

Regressed offenders, in contrast, were described 
as more likely to have been married and to have
developed appropriate heterosexual relationships
prior to their "regressive" sexual offenses. Thus, 
the construct of social competence was clearly
involved in the distinction between fixated and
regressed types, but, when empirically tested,[14]
this distinction was found to be flawed. Results
showed that the two groups were not homogeneous.
Indeed, social and interpersonal competence were
found to be independent of fixation.[15] 

The MTC:CM3 model. To meet the need for a clearly
operationalized, reliable, valid taxonomic system
for child molesters, researchers at the
Massachusetts Treatment Center (MTC) for Sexually
Dangerous Persons developed MTC:CM3, a two-axis
typology (see exhibit 1). On Axis 1, fixation and
social competence are completely independent
dimensions, and each has distinct developmental
antecedents and adult adaptations.[16] The concept
of regression was dropped in developing MTC:CM3,
and a newly defined fixation dimension (i.e.,
"intensity of pedophilic interest") was crossed
with a dimension of social competence, yielding
four independent types: 

o High fixation, low social competence (Type 0).

o High fixation, high social competence (Type 1).

o Low fixation, low social competence (Type 2).

o Low fixation, high social competence (Type 3).

A new behavioral dimension ("amount of contact with
children") was added on a separate coordinate (Axis
II) and became a powerful discriminator with
respect to reoffense risk. In addition, the degree
of violence employed by an offender was
differentiated into dimensions of physical injury
(high/low) and sadism (present/absent), yielding
six distinct Axis II subtypes whose hypothetical
characteristics are shown in exhibit 2. Exclusive
incest offenders were omitted in the design of
MTC:CM3; including such offenders in this system
would require considerable reconceptualization and
revision. Although further revision of MTC:CM3,
including integration of Axis I (fixation and
social competence) and Axis II (amount of contact
with children, degree of injury to victim, and
sadism), is necessary, validity studies conducted
thus far clearly support the primary structural
changes in this model.[17]

Course and prognosis among child molesters. Among
child molesters, both the course (progression of
symptoms associated with the condition) and 
the prognosis (forecast of the probable course and
likelihood of recovery) vary considerably. For
example, onset ranges from early adolescence to
middle adulthood (as in the case of some exclusive
incest offenders), and the prognosis ranges from
cases of lifelong, intractable pedophilic interest
that is resistant to treatment to isolated
instances of incest in adults with a sexual
preference for peers, ample remorse and victim
empathy, and a high likelihood of "recovery."

Clinical Management of Offenders

Treatment. Over the past decade, the provision of
therapeutic services for sex offenders has
increased significantly. A 1994 survey reported 710
adult and 684 juvenile treatment programs,[18] up
from 1985 survey results that showed 297 adult and
346 juvenile treatment programs.[19] Broadly
speaking, sex offender treatment programs employ
four approaches:

o Evocative therapy, which focuses on (1) helping
offenders to understand the causes and motivations
leading to sexually deviant and coercive behavior
and (2) increasing their empathy for the victims of
sexual assault. This approach may include
individual, group, couples/marital, and family
therapy. Group therapy may be eclectic or issue
focused (i.e., specialty groups may target
substance abuse, adult children of alcoholics,
victim empathy, victim survivors, social
skills/assertiveness training, black awareness, gay
identity, or Vietnam veterans). 

o Cognitive behavior therapy, which focuses on
sexual assault cycles and techniques that interrupt
those cycles; altering the beliefs, fantasies, and
rationalizations that justify and perpetuate
sexually aggressive behavior; and controlling and
managing anger. Studies of relapse prevention, the
most commonly employed cognitive behavioral model,
report that, for child molesters, the most
frequently identified experiences prior to
committing an offense were planning the offense (73
percent of sample) and low victim empathy (71
percent of sample).[20] 

o Psychoeducation groups or classes, which use a
more didactic approach to remedy  deficits in
social and interpersonal skills; they teach anger
management techniques,  principles of relapse
prevention, and a range of topics that includes
human sexuality, dating and communication skills,
and myths about sexuality and relationships.

o Pharmacological treatment, which focuses on
reducing sexual arousability and the frequency of
deviant sexual fantasies through the use of
antiandrogen and antidepressant medication. 

These approaches are not mutually exclusive, and
the ideal treatment program (yet to be identified)
would employ combinations of them. State-of-the-art
intervention at this point (cognitive behavior
therapy and, when appropriate, medication) can
effectively reduce reoffense rates. For example,
recidivism rates for new sexual offenses by child
molesters treated under the cognitive behavior
therapy model, with a focus on relapse prevention,
were 4.6 percent in a 3-year followup study [21]
and 3 percent in a 6-year followup study.[22] The
nonvolunteer control group in the 3-year followup
had a sexual recidivism rate of 8.2 percent,
yielding an apparent treatment effect of 3.6
percent.

When these failure rates are compared to those for
Years 3 and 5 in the MTC study (see exhibit 6,
"Cumulative Failure Rates for Sexual Offenses
Within Nine Time Gates," in section 4) of sex
offenders who did not receive cognitive-behavior
therapy, the presumptive effectiveness of treatment
in reducing the probability of sexual reoffense is
between 7 and 15 percent. A recent meta-analysis of
12 sex offender treatment studies (N = 1,313) found
that the overall recidivism rate for untreated sex
offenders was 27 percent, while for treated
offenders it was 19 percent--an apparent treatment
effect of 8 percent.[23] These statistics suggest
that treatment can reduce child molester
recidivism. The wide variability in study findings
on reoffense rates of both treated and untreated
offenders, however, makes efforts to find optimal
treatment interventions as problematic as those to
assess and predict recidivism.

Community-based maintenance and control. 

The vast majority of sex offenders are released
eventually. Thus, community-based clinical
management and control of child molesters are
indispensable parts of any rehabilitation program
if public safety is to be ensured. An effective 
community-based maintenance program for child
molesters should include the following components:

o Coordination by highly trained and
well-supervised parole agents and probation
officers who carry small caseloads (15 to 20
offenders) to ensure intensive
surveillance/supervision.

o Mandatory treatment by therapists trained and
supervised in cognitive behavioral theory with sex
offenders; this is especially critical for
adjustment and maintenance.

o Evaluation for medication.

o Proper monitoring and supervision of vocational,
social, recreational, and leisure activities.

o Confidential notification of local police
departments and/or the district attorney's office. 

Registration with the criminal justice system is a
widely practiced, reasonable procedure that should
be considered a part of an offender's aftercare
plan. Community notification, however, is an
untested management technique--that has at least as
many potential problems as benefits--and must be
empirically evaluated. Indeed, the general
notification of laypersons outside the criminal
justice system may increase, rather than decrease,
the risk of recidivism by placing extreme pressure
on the offender; examples of stressors include
threats of bodily harm, termination of employment,
on-the-job harassment, and forced instability of
residence. 

Continuity of treatment is considered a critical
factor in managing sex offenders. Maintenance is
forever, and relapse prevention never ends.
Community-based clinical management must be
supportive, vigilant, and informed by current
wisdom about maximally effective maintenance
strategies. 

------------------------------

Section 3. Reoffense Risk

Dispositional Decisions 

Recidivism rates are highly variable, making it
impossible to draw any reliable conclusions about
reoffense among child molesters as a group. Most
recent studies have been conducted in order to
evaluate treatment efficacy; consequently, little 
is known about recidivism independent of some
treatment intervention. Moreover, variations in
recidivism rates associated with different
treatment programs are difficult to interpret.
Recidivism rates across studies are confounded by
differences in the statutes and sentencing and
parole guidelines among jurisdictions, duration of
exposure (i.e., time in the community, where the
child molester is at liberty to reoffend), offender
characteristics, treatment-related variables
(including differential attrition rates, program
integrity, and amount of treatment), amount and
quality of posttreatment supervision, and many
other factors. 

The criminal justice system is responsible for
certain discretionary decisions concerning sex
offenders, most of which rest on a presumption
about an individual offender's dangerousness or
reoffense risk. Examples of decisions driven by
underlying assumptions about the probability of
recidivism include:

o Whether to leave an offender in the community on
probation.

o Whether to parole an offender and, if so, the
level/duration of supervision needed.

o Whether to recommend compulsory treatment.

o Whether to require registration with the police.

o Whether to notify the community.

From a forensic standpoint, potential dangerousness
is a question central to the disposition of sex
offenders. Yet there is no reliable body of
empirically derived data that can inform and guide
decisionmaking about reoffense risk--primarily
because of methodological differences in existing
studies (see section 4).

Predictors of Sexual Recidivism

Although ample evidence exists to demonstrate the
predictive superiority of statistical (actuarial)
risk assessment methods over clinical judgment, few
concerted efforts have been made to develop and
empirically test actuarial prediction devices for
sexual offenders. The one obvious exception is the
work of investigators in Canada, who have focused
on psychopathy, measures of prior criminal history,
and phallometric assessment to predict sexual
recidivism.[24] A recent study on risk assessment
among extrafamilial child molesters included three
of the dimensions used in MTC:CM3 (fixation, social
competence, and amount of contact with children).
Study researchers argued that the MTC:CM3
assessment of fixation--a behavioral measure of the
strength of an offender's pedophilic interest--may
serve as a viable substitute for phallometry, which
is intrusive and much more expensive.[25]

Risk assessment study of extrafamilial offenders.
The predictive value of a rationally derived
composite of variables for assessing reoffense
risk, based on archival data (prison and criminal
records), was tested in a followup study of
extrafamilial child molesters who had been
discharged from the Massachusetts Treatment Center
over a period of 25 years. The sample of 111
represents 96.5 percent (N=115) of all child
molesters discharged between 1960 and 1984.

Data reveal differential predictive accuracy
depending on the type of criminal behavior being
examined. Three variables--degree of sexual
preoccupation with children (fixation), paraphilias
(fetishism, transvestism, and promiscuity), and
number of prior sexual offenses predicted sexual
recidivism, while those variables that reflect
impulsive, antisocial behavior predicted recidivism
for nonsexual crimes involving physical contact
with a victim and violent (sexual and nonsexual)
crimes. 

Unlike other recent studies,[26] this study found
no evidence for the utility of alcohol history,
social competence, and sex of child-victim as
predictors of reoffense. In the case of victim sex,
one explanation for these inconsistencies may be
due to sampling differences. The sample of child
molesters examined in this study had an average of
three known sexual offenses prior to release. This
sample had a higher base rate probability of
reoffense than would likely be observed in an
unscreened sample of child molesters recruited from
the general prison population. Among child
molesters who are at higher risk to reoffend, the
victim's sex may be less important to accurate
prediction than such factors as degree of sexual
preoccupation with children and impulsivity.

Predictive accuracy. The variables associated with
reoffense risk among child molesters that were
examined for discriminant validity had reasonable
predictive accuracy with regard to both sexual and
nonsexual reoffending; overall predictive accuracy
was approximately 75 percent. The results of this
study are sample-specific and may not be
generalizable. The potential uniqueness of this
sample is suggested by the study's failure to find
any predictive efficacy for the victim-sex
variable.

Although risk assessment procedures that rely
exclusively on archival data may never achieve the
efficiency of much more time-intensive procedures,
such as the penile plethysmograph or a
comprehensive interview that assesses psychopathy
(e.g., The Hare Psychopathy Checklist-Revised,
PCL-R),[27] the distinct advantages of an archival
scale include its ease of use (i.e., it does not
require the compliance or even the presence of the
offender), cost efficiency, and relatively high
reliability. Despite these presumptive advantages,
the ability of such an archivally based procedure
to reasonably discriminate across samples remains
to be demonstrated.

------------------------------

Section 4. Variability in Child Molester Recidivism

The literature on sex offenders shows considerable
variability in estimates of recidivism rates. A
major reason for this variability, which affects
what is known about the career patterns of sex
offenders, has to do with differences in the
definition of "reoffense," in the type of criminal
offense indexed, and in the length of the exposure
period being considered. For example, if recidivism
is measured by an arrest for any offense within a
2-year period, the frequency of recidivism will be
higher than if recidivism is measured by a new
conviction (or incarceration) for a sexual offense
during the same timeframe. 

Recidivism rates are typically reported as simple
percentages of offenders known to have reoffended
during some finite followup period, such as 2
years. This measurement underestimates recidivism
because it considers only those known to have
reoffended during the study period; it does not
take into account each offender's "window of
opportunity" for reoffense (i.e. exposure time, or
the amount of time each offender has been on the
street and able to reoffend). It stands to reason
that someone who has been in the community for 6
months has had much less opportunity to reoffend
than someone who has been in the community for 10
years.

For example, if a 10-year followup of 100 offenders
reveals that 15 men reoffended, the estimated
recidivism rate based on the percentage of those
who recommitted an offense would be 15 percent.
This figure (15 percent) implies, however, that all
100 men were on the street for 10 years and
therefore had an equal opportunity to reoffend. In
reality, these 100 men had different discharge
dates. Many were not on the street for the full 10
years, and some are likely to reoffend after the
followup study has been concluded.

Survival Analysis

Underestimations resulting from the use of simple
percentages can be addressed by using survival
analysis, which considers both the commission of
subsequent crimes and the length of time between
release and criminal activity. In survival
analysis, recidivism is reported as a "failure
rate" over time. Moreover, survival analysis allows
one to include in a single analysis all offenders
in the sample (those followed until they reoffended
and those followed for the duration of the study
without reoffending). Thus, survival analysis
yields a statistical summary of all cases
regardless of the length of time each was followed
and whether or not a reoffense was committed during
the study period.

To illustrate the variability in estimated
recidivism, researchers used a data set on 251
repetitive sex offenders (136 rapists and 115 child
molesters) released over a 25-year period from the
Massachusetts Treatment Center (MTC) for Sexually
Dangerous Persons. Only the data on child molesters
are presented here. Using simple percentages and
survival analysis, this information was examined
from three measurement perspectives:[28] 

o By categories of criminal offense (sexual 
or not, involving physical contact with a  victim
or not).

o By criminal offense dispositions (i.e., charge,
conviction, or incarceration). In general, analyses
of charges or arrests provide the highest estimates
of recidivism, and those that examine conviction or
incarceration yield the lowest estimates. 

o By exposure time. As noted, the more time spent
on the street, the greater the opportunity to fail
(reoffend). 

Disposition of sexual offenders. Exhibit 3 shows,
by offense type and disposition, the percentage of
actual reoffenses during the study period, the
average exposure time before reoffense, and the
estimate of recidivism based on survival analysis
(referred to as failure rate). Exhibit 4 shows the
survival curve, i.e., the estimated probability
that child molesters would "survive" in the
community without being charged, convicted, or
imprisoned for a sexual offense over the 25-year
study period. 

Of the 115 child molesters, 78 apparently received
no new charges for a sexual offense during the
study period. Of the remaining 37 offenders, 8 were
charged but never convicted, 3 were convicted but
not imprisoned, and 26 were convicted and
imprisoned (see exhibit 5). The corresponding
percentages, with failure rates in parentheses,
were 32 percent (52 percent) for charges, 25
percent (41 percent) for convictions, and 23
percent (37 percent) for incarcerations.
Underestimation of sexual reoffending, as a result
of using the simple percentage, was similar for all
three dispositional categories (38 percent for
charges, 39 percent for convictions, and 38 percent
for imprisonments).  

Exposure time. Nine separate time periods (or 
time gates) over the 25-year study period were
examined (see exhibit 6). The increments in
cumulative failure rates for new sexual charges are
4 percent per year through Year 3, dropping to 3
percent in Year 4 and 2 percent in Year 5. After 
Year 5, the charge rate continues to increase at
noteworthy increments: 11 percent between Year 5
and Year 10, 9 percent between Year 10 and Year 15,
7 percent between Year 15 and Year 20, and 6
percent between Year 20 and Year 25. It is
significant--and should be underscored--that, 10
years after discharge, there was a substantial
reoffense rate (i.e., at Year 10, the recidivism
rate for new sexual charges was 30 percent, and by
Year 25, it had increased to 52 percent). Contrary
to conventional wisdom, most reoffenses do not
occur within the first several years after release;
child molesters in this sample reoffended as late
as 20 years following release.

If followup had been restricted to the conventional
exposure period of 12 to 24 months, approximately
40 to 45 percent of new sexual charges would have
been missed; if followup had been extended to 60
months, 30 percent of new sexual charges would
still have been missed. The rate of recidivism
using conviction or incarceration ranged from 64 to
80 percent of the rate using charge throughout the
study period. By the end of 25 years, the
conviction and incarceration rates were 4l percent
and 37 percent, respectively, compared to the
charge rate of 52 percent (see exhibit 7).

Disposition of all offenses. Examination of
cumulative failure rates for any new offense
revealed a steady increase in charges throughout
the followup period, with an initial rate of 14
percent, increasing to 37 percent at Year 5 and 75
percent at Year 25. The gap between the charge and
conviction rates increased steadily, from 6 percent
in Year 1, to 14 percent by Year 5, to 17 percent
by Year 10, to 18 percent throughout the remainder
of the study. The gap between conviction and
incarceration rates also grew consistently: from 2
percent in Year 1, to 5 percent at Year 5, to 12
percent by the end of the study period. 

Implications

The study reported here addresses the high
variability in sex offender recidivism estimates by
examining several of the critical methodological
differences that underlie this variability. These
include the index criminal offense examined (sexual
or nonsexual, physical contact or no physical
contact with a victim), the dispositional
definition of reoffense used (arrest, charge,
conviction, or incarceration), and the length of
exposure time considered (simple percentage of
crimes committed during the study period or
survival analysis of time-to-reoffense outcomes). 

Because reoffense risk is the primary basis for
sentencing and parole decisions on a convicted
offender's dangerousness, the methodological
inconsistencies of existing studies on child
molester recidivism make it impossible to reach
informed and judicious conclusions in this regard.
Standardized, empirically corroborated risk
assessment conditions and procedures are urgently
needed to enable those making forensic decisions
about child molesters--as well as the attorneys,
probation and parole officers, and clinicians who
service this group of offenders--to proceed with
confidence in the reliability of data and
associated assumptions about recidivism. 

------------------------------

Conclusion

Sexual offenders constitute the one category of
dangerous criminals most subject to either special
commitment statutes or ad hoc discretionary and
dispositional decisions. These laws and the
decisions that they require are often based on
assumptions about sex offenders that are, at best,
misleading and, at worst, erroneous. Given the
serious concerns about sex offenders within the
criminal justice system and society at large, the
need for valid diagnostic and assessment tools is
urgent. Indeed, the most formidable task is to
develop empirically corroborated estimates of
sexual reoffense probabilities for different
subgroups of sex offenders under standardized
operational conditions. 

Practitioners, researchers, and legislators should
be guided by moderation, clear vision, and
empirical evidence. Over the years, many laws
governing sex offenders have been enacted and later
repealed.[29] Two timely examples of presumably
well-intentioned but problematic legislation are
the much-discussed community notification laws and
the new California law requiring repeat sex
offenders to choose between "chemical castration"
(i.e., treatment with antiandrogenic medication) or
surgical castration. The California statute poses
difficulties on several counts:

o From an ethical standpoint, mandating either an
intrusive, irreversible surgical procedure or
treatment with a drug that the U.S. Food and Drug
Administration has not approved for use with sex
offenders is highly questionable.

o From a practical standpoint, sex offenders cannot
be relied on to comply with a drug regimen to which
they have not consented and from which they cannot
withdraw. Moreover, the apparently compliant
offender can easily circumvent the effects of the
drugs or the surgery by buying testosterone
(steroids) on the street.

o From an empirical standpoint, the law makes the
invalid assumption that all sex offenders are
motivated by uncontrollable sexual urges. Chemical
reduction of testosterone is appropriate for some,
but not all, child molesters; when medication is
used, it must be included as one component of a
treatment plan that includes therapy. It is
critical to keep in mind, however, that surgical or
chemical reduction of testosterone will not, by
itself, solve the problem of child molestation. 

Reducing the risk of recidivism among sex offenders
is a problem for which no easy answers or shortcuts
exist. Treatment provided in prison must be
continued after offenders are released into the
community. Reintegration is especially problematic
for child molesters. Detailed aftercare plans,
orchestrated by well-trained and supervised parole
agents and probation officers, are essential to
reducing reoffense risk and should include
consideration of the vocational, psychotherapeutic,
pharmacological, social, and recreational needs of
the offender.

Clearly, the most compelling motive for treating
child molesters is the reduction in victimization
rates that is presumed to result. Society resists
treating sexual offenders, however, because to do
so is perceived as a humane response to intolerable
behavior. If treatment can be demonstrated to
reduce the probability of reoffense, then working
on the development and refinement of treatment
methods and procedures is an essential secondary
intervention.

The criminal justice community faces difficult, but
not insuperable, challenges as it moves to balance
the right of the community to be protected with the
rights of offenders. If those professionals who
deal with the victims and perpetrators of child
molestation are willing to harness their collective
energy, pull in a common direction, and speak with
a single firm voice, properly informed laws can be
enacted that will better control child molesters
and make communities safer for children.

------------------------------

Notes

1. Abel, G.G. and J.L. Rouleau, "The Nature and
Extent of Sexual Assault," in Handbook of Sexual
Assault: Issues, Theories, and Treatment of the
Offender, eds. W.L. Marshall, D.R. Laws, and H.E.
Barbaree, New York: Plenum Press, 1990:9-21; Abel,
G.G., J.V. Becker, M.S. Mittelman, J.
Cunningham-Rathner, J.L. Rouleau, and W.D. Murphy,
"Self-Reported Sex Crimes of Nonincarcerated
Paraphilics," Journal of Interpersonal Violence 2
(1987):3-25.

2. Finkelhor, D. and J. Dziuba-Leatherman, 
"Children as Victims of Violence: A National
Survey," Pediatrics 94 (1994):413-420. 

3. Bureau of Justice Statistics, Criminal
Victimization in the United States, 1993,
Washington, D.C.: U.S. Department of Justice,
Bureau of Justice Statistics, May 1996.

4. The literature on the discriminant and
predictive validity of plethysmographically
assessed sexual arousal in child molesters is
sizable. Among the more recent titles are those
that follow: Barbaree, H.E. and W.L. Marshall,
"Deviant Sexual Arousal, Offense History, and
Demographic Variables as Predictors of Reoffense
Among Child Molesters," Behavioral Sciences & the
Law 6 (1988):267-280; Freund, K. and R. Blanchard,
"Phallometric Diagnosis of Pedophilia," Journal of
Consulting and Clinical Psychology 57 (1989):100-
105; and Quinsey, V.L. and T.C. Chaplin, "Penile
Responses of Child Molesters and Normals to
Descriptions of Encounters With Children Involving
Sex and Violence," Journal of Interpersonal
Violence 3 (1988):259-274. 

5. Prentky, R.A. and R.A. Knight, "Age of Onset 
of Sexual Assault: Criminal and Life History
Correlates," in Sexual Aggression: Issues in
Etiology, Assessment, and Treatment, eds. G.C.N.
Hall, R. Hirschman, J.R. Graham, and M.S. Zaragoza,
Washington, DC: Taylor & Francis, 1993:43-62.

6. Araji, S. and D. Finkelhor, "Explanations of
Pedophilia: Review of Empirical Research," Bulletin
of the American Academy of Psychiatry and the Law
13 (1985):17-37; Marshall, W.L., H.E. Barbaree, and
M. Fernandez, "Some Aspects of Social Competence in
Sexual Offenders," Sexual Abuse: A Journal of
Research and Treatment 7 (1995):113-127; Marshall,
W.L. and A. Mazzucco, "Self-Esteem and Parental
Attachments in Child Molesters," Journal of
Research and Treatment 7 (1995):279-285; Pithers,
W.D., L.S. Beal, J. Armstrong, and J. Petty,
"Identification of Risk Factors Through Clinical
Interviews and Analysis of Records," in Relapse
Prevention With Sexual Offenders, ed. D.R. Laws,
New York: The Guilford Press, 1989:77-87; Segal,
Z.V. and W.L. Marshall, "Heterosexual and Social
Skills in a Population of Rapists and Child
Molesters, Journal of Consulting and Clinical
Psychology 53 (1985):55-63; Segal, Z.V. and W.L.
Marshall, "Discrepancies Between Self-Efficacy
Predictions and Actual Performance in a Population
of Rapists and Child Molesters," Cognitive Therapy
and Research 10 (1986):363-376.

7. See exhibit 1, "Hypothetical Profiles of MTC:CM3
Axis II Types." Type 3, and particularly Types 4,
5, and 6, exhibit the antisocial and impulsive
qualities being discussed. 

8. Prentky and Knight, 1993; Prentky, R.A., R.A.
Knight, and A.F.S. Lee, "Risk Factors Associated
With Recidivism Among Extrafamilial Child
Molesters," Journal of Consulting and Clinical
Psychology (1996, in press); Quinsey, V.L., M.E.
Rice, and G.T. Harris, "Actuarial Prediction of
Sexual Recidivism," Journal of Interpersonal
Violence 10 (1995):85-105.

9. Prentky, Knight, and Lee, 1996. 

10. American Psychiatric Association, Diagnostic
and Statistical Manual of Mental Disorders, DSM-IV,
4th ed., Washington, DC: American Psychiatric
Association, 1994.

11. Fitch, J.H., "Men Convicted of Sexual Offenses
Against Children," British Journal of Criminology 3
(1962):18-37; Langevin, R., S.J. Hucker, L. Handy,
H.J. Hook, J.E. Purins, and A.E. Russon, "Erotic
Preference and Aggression in Pedophilia: 
A Comparison of Heterosexual, Homosexual and
Bisexual Types," in Erotic Preference, Gender
Identity, and Aggression in Men: New Research
Studies, ed. R. Langevin, Hillsdale, New Jersey:
Lawrence Erlbaum Associates, 1985:137-160.

12. Freund, K., "Diagnosing Heterosexual Pedophilia
by Means of a Test for Sexual Interest," Behavior
Research and Therapy 3 (1965):229-234; Freund, K.,
"Diagnosing Homo- and Heterosexuality and Erotic
Age Preference by Means of a Psychophysiological
Test," Behavior Research and Therapy 5 (1967):209-
228; Freund, K., "Erotic Preference in Pedophilia,"
Behavior Research and Therapy 5 (1967):339-348;
Frisbie, L.V., "Another Look at Sex Offenders in
California," California Mental Health Research
Monograph, No. 12, State of California Department
of Mental Hygiene, 1990; Frisbie, L.V. and E.H.
Dondis, "Recidivism Among Treated Sex Offenders,"
California Mental Health Research Monograph, No. 5,
State of California Department of Mental Hygiene,
1965; and Radzinowicz, L., Sexual Offenses, London:
MacMillan, 1957. 

13. Abel, G.G., J.V. Becker, W.D. Murphy, and B.
Flanagan, "Identifying Dangerous Child Molesters,"
in Violent Behavior: Social Learning Approaches to
Prediction, Management and Treatment, ed. R.B.
Stewart, New York: Brunner-Mazel, 1981:116-137;
Abel, G.G., M. Mittelman, J.V. Becker, J. Rathner,
and J.L. Rouleau, "Predicting Child Molesters'
Response to Treatment," in Human Sexual Aggression:
Current Perspectives, eds. R.A. Prentky and V.L.
Quinsey, New York: The New York Academy of
Sciences, 1988:223-234; Langevin, Hucker, Handy,
Hook, Purins, and Russon, 1985; and Marques, J.K.,
How to Answer the Question: Does Sex Offender
Treatment Work?, paper presented at the
International Expert Conference on Sex Offenders:
Issues, Research, and Treatment, Utrecht, The
Netherlands, September 1995.

14. Conte, J.R., "Clinical Dimensions of Adult
Sexual Abuse of Children," Behavioral Sciences &
the Law 3 (1985):341-354.

15. Finkelhor, D. and S. Araji, "Explanations of
Pedophilia: A Four-Factor Model," Journal of Sex
Research 22 (1986):145-161; Araji, S. and D.
Finkelhor, "Explanations of Pedophilia: Review 
of Empirical Research," Bulletin of the American
Academy of Psychiatry and the Law 13 (1985):17-37. 

16. Knight, R.A., D.L. Carter, and R.A. Prentky, 
"A System for the Classification of Child
Molesters: Reliability and Application," Journal of
Interpersonal Violence 4 (1989):3-23.

17. Knight, R.A., "An Assessment of the Concurrent
Validity of a Child Molester Typology," Journal of
Interpersonal Violence 4 (1989):131-150; Knight,
R.A., "The Generation and Corroboration of a
Taxonomic Model for Child Molesters," in 
The Sexual Abuse of Children: Theory, Research, and
Therapy, eds. W. O'Donohue and J.H. Geer,
Hillsdale, New Jersey: Lawrence Erlbaum Associates,
1992:24-70; Prentky, Knight, and Lee, 1996. 

18. Longo, R.F., S. Bird, W.F. Stevenson, and 
J.A. Fiske, 1994 Nationwide Survey of Treatment
Programs and Models, Brandon, Vermont: The Safer
Society Program & Press, 1995.

19. Knopp, F.H., J. Rosenberg, and W. Stevenson,
Report on Nationwide Survey of Juvenile and Adult
Sex-Offender Treatment Programs and Providers,
Syracuse, New York: Safer Society Press, 1986.

20. Pithers, W.D., "Relapse Prevention With Sexual
Aggressors: A Method for Maintaining Therapeutic
Gain and Enhancing External Supervision," in
Handbook of Sexual Assault: Issues, Theories, and
Treatment of the Offender, eds. W.L. Marshall, D.R.
Laws, and H.E. Barbaree, New York: Plenum Press,
1990:343-361; Pithers, W.D., G.R. Martin, and G.F.
Cumming, "Vermont Treatment Program for Sexual
Aggressors," in Relapse Prevention With Sex
Offenders, ed. D.R. Laws, New York: The Guilford
Press, 1989:292-311. 

21. Marques et al., 1993. 

22. Pithers, W.D. and G.F. Cumming, "Can Relapse Be
Prevented? Initial Outcome Data From the Vermont
Treatment Program for Sexual Aggressors," in
Relapse Prevention With Sex Offenders, ed. D.R.
Laws, New York: The Guilford Press, 1989:313-325.

23. Hall, G.C.N., "Sexual Offender Recidivism
Revisited: A Meta-Analysis of Recent Treatment
Studies," Journal of Consulting and Clinical
Psychology 63 (1995):802-809.

24. Quinsey, Rice, and Harris, 1995.

25. Prentky, Knight, and Lee, 1996.

26. For example: Hanson, R.K., R.A. Steffy, and R.
Gauthier, "Long-Term Recidivism of Child
Molesters," Journal of Consulting and Clinical
Psychology, 61 (1993):646-652.

27. Hare, R.D., The Hare Psychopathy
Checklist-Revised, Toronto: Multi-Health Systems,
1991.

28. Prentky, R.A., A.F.S. Lee, R.A. Knight, and D.
Cerce, Long-Term Comparison of Rate and Force of
Recidivism Between Child Molesters and Rapists: A
Methodological Analysis, 1996. Manuscript submitted
for publication.

29. Grubin, D. and R.A. Prentky, "Sexual
Psychopathy Laws," Criminal Behavior and Mental
Health 3 (1993):381-392; Carter, D.L. and R.A.
Prentky, "Forensic Treatment in the United States:
A Survey of Selected Forensic Hospitals.
Massachusetts Treatment Center," International
Journal of Law and Psychiatry 16 (1993):117-132.

------------------------------

The editorial contribution of Gretchen Wiest, Aspen
Systems Corporation, is gratefully 
acknowledged.

-------------------------------

Adult Reports of Child-Focused Sexual Behavior

Perhaps the most dramatic offender self-report data
on victimization rates come from research in which
investigators recruited 561 subjects through a
variety of means (e.g., health care workers, media
advertising, and presentations at meetings).[a] The
offenders were given a lengthy structured clinical
interview covering standard demographic information
as well as history of deviant sexual behavior. The
561 subjects reported a total of 291,737
"paraphilic acts" committed against 195,407 victims
under the age of 18. The five most frequently
reported paraphilic acts involved criminal conduct:

o Nonincestuous child molestation with a female
victim (224 of the 561 subjects reported 5,197 acts
against 4,435 victims).

o Nonincestuous child molestation with a male
victim (153 of the 561 subjects reported 43,100
acts against 22,981 victims).

o Incest with a female victim (159 of the 561
subjects reported 12,927 acts against 286 victims).

o Incest with a male victim (44 of the 561 subjects
reported 2,741 acts against 75 victims).

o Rape (126 of the 561 subjects reported 907 acts
against 882 victims).

The remaining sixteen categories included a wide
range of paraphilias, which may or may not have
involved coercion. The first five categories
included a total of 64,872 acts. The total number
of subjects and victims cannot be determined since
the categories are overlapping (i.e., many subjects
reported multiple paraphilias and hence were
recorded in multiple categories).

[a] Abel, G.G., J.V. Becker, M.S. Mittelman, J.
Cunningham-Rathner, J.L. Rouleau, and W.D. Murphy,
"Self-Reported Sex Crimes of Nonincarcerated
Paraphilics," Journal of Interpersonal Violence 2
(1987):3-25.

------------------------------ 

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