Men with learning disabilities at
risk of sexual offending: the
effectiveness of treatment
Glynis Murphy
Institute for Health Research
University of Lancaster
The plan
What is known about non-disabled sex
offenders
Treatment for non-disabled sex offenders:
what it consists of and whether it works
What is known about sex offenders with
learning disabilities
Treatment for sex offenders with learning
disabilities
Effects of sexual abuse on
victims
 Not all studies use good samples, standardised
measures or control groups (see Browne & Finklehor,
1986; Tufts 1984; Russell, 1986)
 Initial effects (within 2yrs): 40-60% have sleeping &
eating problems, fears & phobias, guilt & shame, anger,
disruptive behaviour & aggro (kids), sexualised
behaviour (kids), running away (kids)
 Long-term effects: ~25% have depression; many show
anxiety attacks, sleeping difficulties, feeling stigmatised,
low self-esteem, fear of intimacy, sexual problems &
they are more likely to be abused again.
 Worse if longer, if perpetrator is father &/or is older, if
force used, if penetration occurs, if victim is prepubertal.
Sexual offending by
non-disabled men
 Grossly under-reported to police (fewer than 10% sex
crimes lead to conviction)
 Victim surveys suggest very high rates (eg 50% women
victims of exhibitionism; USA study of college students
showed 15% women victims of rape; further 12%
victims of attempted rape)- see Marshall, 1999.
 > 95% of sex offenders are men
 Offenders often engage in grooming & stalking of
victims; may do complex planning of offending
 Used to be thought sex offenders usually have one
paraphilia (deviant sexual interest), only target 1 age
group, and target either inside or outside family. Recent
data challenges these views.
Sexual offending by
non-disabled men
 Most studies look at convicted men (biased samples),
interviewed in CJS settings, where men reveal only 5%
of offences (Kaplan, 1985)
 Abel & Rouleau (1990): sample of 561 men, voluntary,
anonymous, confidentiality guaranteed
 Age: mean 32yrs (range 13-76yrs)
 All socioeconomic groups represented; 67% working
 Often early onset: Over 50% said they had one or more
deviant sexual interest before age 18yrs
 Of these 50%, on average they had committed 380
offences by the time they were adult
Abel & Rouleau data
Paraphilia
No. of acts committed
Paedophilia – F.
No. men
asked
224
5,197
Total
victims
4,435
Paedophilia – M.
153
43,100
22,981
Paedophilia – F. I.
159
12,927
286
Paedophilia – M. I.
44
2,741
75
Rape
126
907
882
Exhibitionism
142
71,696
72,974
Voyeurism
62
29,090
26,648
Frottage
62
52,669
55,887
Treatment for non-disabled sex
offenders: recent years
1960s & 1970s: Sexual abuse seen as result
of deviant sexual interests & arousal (there
was also some occasional recognition of role
of poor social skills)
Led to techniques such as aversion therapy,
orgasmic reconditioning & covert sensitisation
- basically behavioural techniques
Considerable belief in medical model & antiandrogens
Little evidence of effectiveness
Under-provision of treatment
Wolf’s (1985) model of cycle of
offending
The role of cognitions
1980s: Recognition of role of cognitions &
cognitive distortions in sexual offending
(denial, victim blaming, minimisation, etc) eg Finklehor, Abel, Marshall
Denial: ‘It wasn’t me, they’ve got wrong guy’
Victim blaming: ‘He led me on all the time’,
‘She wanted me to’
Minimisation: ‘It’s good for children to learn
about love this way’ or ‘I didn’t hurt her - it
was just a bit of fun’
Importance of peer challenges in changing
these distortions
Finklehor’s 4
pre-conditions
1. Offender must be motivated to offend
2. He must overcome internal inhibitions
(e.g. by telling himself it is just a bit of
fun)
3. He must overcome external obstacles to
offending (eg by finding privacy & victim)
4. He must overcome the victim’s resistance
(eg by ‘befriending’ them)
Marshall’s model of sex
offending
Insecure
attachment
Emotional
loneliness
Hostility to
those seen
as rejecting
Seeking
intimacy
thru sexual
acts
Components of cognitive
behavioural treatment
Enhancing self-esteem
Challenging & changing cognitive
distortions
Developing victim empathy
Developing social functioning
Modifying sexual preferences
Ensuring relapse prevention
See Marshall et al.’s book for an excellent guide
But does it work?
(Hanson et al, 2002)
Meta-analysis of 43 studies of sex offender
treatment (over 9,000 participants overall)
Sexual offence recidivism rate: 12% for
treated men vs 17% for untreated men
General offence recidivism rate: 28% for
treated men vs 39% for untreated men
Early forms of treatment ineffective; but
current cognitive-behavioural treatment
seems effective: 10% vs 17% treated vs
untreated recidivism
Men with learning disabilities at
risk of sexual offending: numbers
Methodological difficulties: different samples
(prison, hospital, community); ignoring filtres &
diversion in CJS; suggestibility & evasion issues
Early studies: ? high prevalence of offending but
v. poor methodology (eg. prison studies; &
Walker & McCabe (1973) study)
50% of perpetrators of sexual abuse in LD
services themselves have LD (Brown et al,
1995)
Susan Hayes (1991): Prison survey found 4% of
offenders with LD had been convicted of a sex
offence (& ditto for non-LD)
Men with learning disabilities at
risk of sexual offending
Recidivism: Klimecki et al (1994) found
recidivism rate was 31% in men with LD
convicted of sex offences (Austr.) - about 2-3 X
as high as that of non-disabled men
Types of offence: all kinds, but maybe fewer
penetrative offences – Murrey et al, 1992 (or
more often caught early because more closely
supervised?)
History of abuse: Lindsay et al (2001) found
38% of sex offenders with LD had been abused
c.f. 13% non-sex offenders with LD
Men with learning disabilities at
risk of sexual offending (cont’d)
Victims mainly children or other people with LD
(less often non-disabled adults)
Victims very likely to be known to the
perpetrator
Offences more opportunistic & less planned
(less grooming & stalking)
Often long history of sexual problems & multiple
placements
Often ‘offences’ not reported to police
Even when reported, men mostly not
prosecuted nor treated
Cognitive behavioural treatment
for men with & without LD in UK
For men without LD, group CBT recognised as
the leading method of treatment (Hanson et al)
Beckett et al. have evaluated: CBT for convicted
sex offenders in prison sentenced to 4yrs+
(SOTP) & community-based programmes
(STEP), run by probation, clinical psych & SW
Men with LD mostly excluded from these:
group CBT in few places only - some prisons
(ASOTP), Janet Shaw clinic in Solihull (ASOTP),
Northgate hosp programme near Newcastle, Bill
Lindsay’s programme in Scotland
Does group CBT work for
men with LD?
Lindsay et al (1998a, b) showed some
improvements in 6 men with LD & paedophilic
offences & 4 men with LD & exhibitionism, after
CBT
Lindsay & Smith (1998): showed 2 years CBT
was more effective than 1 yr CBT for men with
LD on probation
Rose et al (2002): CBT 2hrs/week for 16 weeks,
for 5 men; found reduced (improved) scores but
changes not significant
SOTSEC-ID
Sex Offender Treatment Services Collaborative Intellectual Disability
About 12 sets of therapists providing sex
offender treatment for people with intellectual
disabilities in England
Run training & meet about every 6 to 8 weeks
Setting up sex offender treatment groups (last 1
year; 2hr sessions, once per week, closed
groups)
Sharing core assessments measures
Research funded by DoH
Core assessments
Once only: measures of IQ, adaptive behaviour,
language, & autism
Pre & Post group treatment:
- Sexual Knowledge & Attitude Scale (SAKS)
- Victim Empathy scale, adapted (Beckett &
Fisher)
- Sex Offender Self-Appraisal Scale (Bray &
Foreshaw’s SOSAS)
- Questionnaire on Attitudes Consistent with Sex
Offending (Bill Lindsay et al.’s QACSO)
Recidivism
Treatment content
Group purpose, rule setting
Human relations & sex education
The cognitive model
Sexual offending model
General empathy & victim empathy
Relapse prevention
Groups last ~52 weeks; mostly 2 hour
sessions; closed groups
Results: first
5 groups (31 men)
About 60% men offered treatment not required
to come by law (rest on MHA or CRO)
WAIS-R: mean IQ is approx 60
About 30% have Asperger’s syndrome or on
autistic continuum; few with mental illness
Offences: stalking, sexual assault, exposure;
rape; victims kids/adults
Process: Closed groups; met once per week
(2hr session incl. break); over 12 mths; 2
facilitators (m & f)
Cognitive distortions, sexual
knowledge & empathy
Sexual Attitude and Knowledge Scale (SAKS)
Most men near top of scale; significant
increases by end of group
QACSO (Lindsay)
Significant improvements in men’s scores
Sex Offenders Self- Appraisal Scale (Bray)
Reductions in most men’s scores (not signif yet)
Victim Empathy (Beckett & Fisher)
Significant reduction in scores - but big variation
in degree of reduction
Service user views
from first group
Good understanding of basic facts (duration,
venue, facilitators, & rules, e.g. confidentiality
rule)
Good understanding why referred: ‘Because of
my probation because of my sex offence to see
if it would do me any good’
‘To help my sex urges and keep them under
control; to be a better person when meeting
women in the community’
‘To help us stop getting into trouble with the
police; because I go out to masturbate’
Service user views (cont’d)
Most could list some of what they did in group
(not very coherently)
What they learnt:
‘Stopped me touching girls’
‘How people feel about us masturbating’ (in
public)
‘Learnt not to go after women’
‘Learnt .. to put a condom on’
‘Learnt to help other people in the group’
‘What the police do when they arrest you’
Service user views (cont’d)
Best things
 ‘Having support every week’
 ‘We … talked about feelings about things, sorting the
problems out’
 ‘Working together, helping each other’
 ‘We helped each other discuss ... work on ways of
preventing problems in the future’
Worst things
 ‘Telling people very private stuff, keeping people on
trust’
 ‘Some didn’t talk’
Conclusions
Men with learning disabilities do commit
sexual offences
Exact prevalence is not known but seems
to be broadly similar to non-disabled men
Offences more opportunistic but
otherwise similar to non-disabled men
Treatment using cognitive behaviour
therapy really only just getting going –
SOTSEC-ID only controlled trial as yet
Key references
 Browne, A. & Finklehor, D. (1986) Impact of child sexual abuse:
a review of the research. Psychological Bulletin, 99, 66-77.
 Hanson, R.K. et al (2002) 1st report of the collaborative
outcome data project (etc.) Sexual Abuse: Journal of Research
& Treatment, 14, 169-194.
 Journal of Applied Research in Intellectual Disabilities (Several
articles in issue, 15 (2), 2002)
 Lindsay, W. R. (2002) Research & literature on sex offenders
with intellectual and developmental disabilities. Journal of
Intellectual Disability Research, 46, 74-85.
 Marshall, W.L., Laws, D.R., Barbaree, H.E. (1990) Handbook of
Sexual Assault: Issues, Theories & Treatment of the Offender.
NY: Plenum Press
 Marshall, W. L. et al. (1999) Cognitive Behavioural Treatment of
Sexual Offenders. Wiley.