Download powerpoint Table 1 Characteristics of individual studies included in systematic review of offender oriented interventions aimed at reducing sexual offending and reoffending against children View this table: View inline Table 2 provides brief descriptions of examined treatments. Manual based group therapies specify an ordered sequence of content to be covered in the group sessions and directions for maintaining a productive therapeutic climate.
We did not include any studies of testosterone inhibiting drugs because all identified controlled primary studies had high overall risk of bias. Table 2 Characteristics of treatment provided in individual studies included in systematic review of offender oriented interventions aimed at reducing sexual offending and reoffending against children View this table: View inline Table 3 summarises the effects of interventions.
No scientific evidence was available to determine if psychological interventions other than cognitive behavioural therapy or if pharmacological treatment reduce sexual reoffending among adult child abusers no studies.
Neither did we find evidence to determine if psychological or pharmacological methods of treatment could prevent sexual offending among adults who have not sexually abused a child but are at risk of doing so no studies. Table 3 GRADE based summary of evidence from systematic review of offender oriented interventions aimed at reducing sexual re offending against children View this table: View inline For adolescent sexual offenders who primarily target other children or adolescents , limited evidence one randomised controlled trial with moderate study quality 33 suggested that multisystemic therapy could be effective in preventing sexual reoffending among moderate risk adolescent sex offenders relative risk 0.
No evidence was available to determine the effect of cognitive behavioural therapy on sexual reoffending among adolescent sex offenders with low or high risk of reoffending. Neither did we find scientific evidence to determine the effectiveness of other methods psychological or pharmacological aimed at preventing sexual reoffending in adolescent sex offenders. Finally, evidence was lacking to determine the effectiveness of methods aimed at preventing sexual offending in adolescents who have not sexually abused a child but are at risk of doing so.
For children under the age of 13 with sexual behaviour problems towards other children, we found insufficient evidence one high quality randomised controlled trial 35 to determine if cognitive behavioural therapy combined with parental support was more effective than standard treatment in preventing sexual offending. No scientific evidence was available to determine the effectiveness of other preventive interventions for children with sexual behaviour problems.
Information concerning adverse outcomes of treatment other than criminal reoffending was not available. Discussion Despite severe consequences for victims and society, this systematic review identified remarkably little research of acceptable quality on individual-level prevention of child sexual abuse. We found only three randomised controlled trials: Public debate on sexual offences against children usually centres on how to punish the perpetrator.
The public commonly demands that sexual abusers of children receive interventions that can be administered only by physicians, such as chemical castration. The four included observational studies also had limitations that ruled out reliable conclusions about cognitive behavioural therapy. Although the included randomised controlled trial was small, it provided limited scientific evidence that multisystemic therapy—a community based programme based on social learning, social ecological theory, and systematic family therapy—reduces sexual reoffending among sexually abusive adolescents.
One limitation is that the effectiveness of this therapy seems to be reduced when it is implemented by non-researchers outside the settings in which it was originally developed. Carpentier and colleagues randomised such children to either cognitive behavioural therapy or a control group who received group based play therapy.
Albeit otherwise well executed, this study was also underpowered and the results not significant. Hence, the scientific evidence is insufficient to determine if cognitive behavioural therapy or any other intervention is effective in preventing future sexual offences in children with sexual behavioural problems. Hence, risk should be balanced against the relatively low base rate of future sexually abusive behaviour among children with sexual behavioural problems.
If these children are subjected to excessively intense or inappropriate therapy, this could increase the risk for future antisocial behaviour. An important evidence based alternative to treating such children would be to provide structured training or education for the primary caregivers to improve their parenting skills, as has been successful with parents of children with conduct disorder.
The lack of randomised controlled trials can also be attributed to the logistic, legal, and ethical challenges faced by those wanting to conduct high quality research on sensitive social issues. Currently, many correctional systems require that sexual abusers of children receive treatment as a condition of release or community supervision.
Withholding treatment could interfere with the expected progression of offenders through correctional systems and would introduce unknown risks to public safety by deliberately releasing people with sexually deviancy who did not receive what is considered to be best current treatment. Professional opinion, however, is no substitute for evidence. When we consider the overall unimpressive treatment effects presented here, it should be acknowledged that psychological interventions, like pharmacotherapy, might also have negative side effects.
Under certain circumstances, with some people and some interventions, treatment could increase the risk of sexual reoffending. We also searched for studies evaluating interventions aimed at individuals at higher risk of sexually abusing children but who had not committed any such offence.
Unfortunately, we found no such completed studies and only one study in progress. Research on sex offenders in general that is, not only those who sexually abuse children suggests that treatment is more successful if it adheres to the risk, needs, and responsivity RNR principles for effective treatment of offenders.
Offenders with a low risk of reoffending should receive less intensive and shorter interventions and not be grouped with higher risk offenders. Moreover, treatment should target causal risk factors driving sex crimes, adhere to the principles of social learning theory, and be adapted to the learning style of the individual.
Although no specific research affirms that these principles also apply to sexual abusers of children, it is usually perceived as unethical to deny treatment, hence reflecting a fundamental dilemma.
We suggest that while we wait for better evidence from research, treatment of offenders who have sexually abused children should be based on the risk, needs, and responsivity principles and the effects carefully documented. Strengths and limitations This review is a comprehensive synthesis of current research examining interventions for individuals at risk of sexually abusing children. The methods used for research synthesis are widely accepted, allowing for direct comparison with the quality of evidence available for other medical interventions.
In terms of limitations, we used only one procedure to rate bias and summarise the evidence. Different methods of rating study quality can lead researchers to different conclusions.
It is unlikely, however, that we failed to include higher quality studies. A recent Cochrane review examining a broader population sexual offenders and broader outcome criteria any clinically relevant measure similarly concluded that there was not enough research. One challenge for evaluation research is that the observed rate of reoffence for sexual abusers of children is low for example, As most states and countries are too small to overcome these intrinsic problems with evaluation on their own, larger multinational randomised controlled trials should be conducted.
This convention creates an obligation to offer effective treatment to sexual abusers of children, individuals at higher risk of committing such offences, and children with sexual behaviour problems.
Furthermore, the convention implies that those joining should also assess the effects of initiated programmes. Countries joining the convention should therefore share a common interest in developing effective methods to prevent sexual offences against children and support research to determine the effectiveness of implemented programmes. We suggest that these countries initiate collaborative research to bridge the major knowledge gaps.
The introduction of intervention programmes in jurisdictions previously lacking established programmes provides a unique opportunity for strong research designs. When the capacity for treatment is less than demand, random assignment is a fair method of allocating resources.
Furthermore, the collective obligation among EU countries to implement programmes at this time should motivate member states to collaborate on the development of promising programmes worthy of implementation and evaluation.
The precise nature of a model of the best programme is yet to be established. For adult sexual abusers of children in particular, no single programme has sufficient research credentials to distinguish it from others. Those charged with developing model programmes, however, should ensure that the model complies with the risk, need, and responsivity principles of effective correctional treatment.
SW and JL managed data. The Swedish Government, Department of Social Affairs commissioned the systematic review and funded some of the work. The funder had no influence on the process or conclusions of the present work. The views expressed are those of the authors and not necessarily those of Public Safety Canada or the Swedish Prison and Probation Administration.
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LexisNexis Matthew Bender, Grading quality of evidence and strength of recommendations. Effects of a relapse prevention program on sexual recidivism: The Rockwood Preparatory Program for sexual offenders: Cognitive-behavioral treatment of sex offenders: A five year outcome evaluation of a community-based treatment programme for convicted sexual offenders run by the probation service.