Table of contents for Pedophilia and sexual offending against children : theory, assessment, and intervention / by Michael C. Seto.

Bibliographic record and links to related information available from the Library of Congress catalog.

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Contents
Preface
Acknowledgments
Chapter 1: Introduction
Chapter 2: Assessment Methods
Chapter 3: Different Approaches to Studying Pedophiles
Chapter 4: Origins of Sexual Offending Against Children
Chapter 5: Etiology of Pedophilia
Chapter 6: Incest
Chapter 7: Risk Assessment
Chapter 8: Intervention
Epilogue
References
Appendix A
Appendix B
Appendix C
Preface
Pedophilia, defined as a persistent sexual interest in prepubescent children, is an emotional and controversial topic. For many people, the mention of pedophilia brings images to mind of sexual predators1 who pursue and violate unknown children, though the reality is that most perpetrators are known to their victims, sexual offenses typically involve fondling rather than intercourse, and the use of threat or force is uncommon. These public¿s perceptions of sexual offenses against children are influenced by media stories focusing on sensational cases that involve child abductions, killings, or individuals with long histories of sexually offending against many children (see Cheit, 2003; Jenkins, 1998).
Parents are understandably worried about the safety and well-being of their children, and many others are concerned that children they know might be exploited or harmed by adults. In this preface, I discuss the social, political, and legal contexts for studying pedophilia, in order to provide readers a framework for understanding the social, legal, and political responses to pedophilia and the associated problem of sexual offending against children.
Scope Of The Problem
Child sexual abuse2 is a wide-spread social problem. In the United States, there were approximately 89,500 cases of substantiated child sexual abuse in 2000 (Finkelhor & Jones, 2004). A nationally representative survey of children and adolescents between the ages of 2 and 17 found that approximately 1 in 12 reported (parents responded for younger children) being sexually abused in the study year (Finkelhor, Ormrod, Turner, & Hamby, 2005). Finkelhor (1994) reviewed international surveys of adults and found a wide range of prevalence rates for child sexual abuse (likely reflecting differences in survey methodology and definition of sexual abuse, rather than true variations in prevalence). Data were available from 19 countries, including 10 national probability samples from Belgium, Canada, Denmark, Finland, Great Britain, The Netherlands, Norway, Spain, Sweden, and the United States. The average rate of childhood sexual abuse recalled by adult respondents was approximately 20% for women and 10% for men. Across these international surveys, females were more likely to have been sexually abused than males, females were more likely to be abused by relatives than males, and the perpetrators were usually male.
Official crime data indicate that the majority of incidents of child sexual abuse are committed by someone known to the child, and the majority of offenses involve sexual touching (Snyder, 2000). Although incidents in which children are kidnapped or killed by pedophiles are thankfully rare, those incidents that do occur are widely publicized in media coverage (Cheit, 2003) and appear to have had a tremendous influence on the social, legal, and political responses to pedophilia and sexual offending against children. 
Social Context
Public attitudes are extremely negative towards pedophiles and individuals who sexually offend against children. Sexual offenses against children are viewed as very serious crimes, ranking even higher than intentional homicide in one study of perceived moral wrongfulness (Lieberman, personal communication, February 19, 2003; Lieberman, Tooby, & Cosmides, 2003). Rosenmerkel (2001) also found that sexual offenses against children ranked higher in wrongfulness than felony homicide and other violent offenses in another survey of college students, and received the second highest rating for overall seriousness, after homicide.
Calls for lifetime imprisonment, castration, and capital punishment have been made for convicted sex offenders against children (see Jenkins, 1998, for a historical account of the shifting attitudes and laws about sexual offenses involving children). Being identified as a pedophile could jeopardize one¿s relationships, employment, home, and even physical safety. Although incidents are rare, vigilantes have burned houses and assaulted suspected or known sex offenders against children (see Freeman-Longo, 1996, for a description of several incidents in the United States). A recent and highly publicized case involved the murder of two registered sex offenders in Maine, by a young Canadian man who killed himself after his bus was stopped by police; a similar case involved two sex offenders against children in Washington, killed by a man who found their addresses on an online sex offender registry (retrieved on November 14, 2006, from http://www.cbc.ca/world/story/2006/04/17/maineshooting20060417.html). An English tabloid newspaper News of the World began publishing the names of convicted sex offenders as part of a ¿Name and Shame¿ campaign following the murder of Sarah Payne, an eight-year-old girl, in the summer of 2000. Following this campaign, a pediatrician was forced to flee her home after a group mistook her professional title for the word pedophile and spray-painted her front door (Salon.com article retrieved on December 3, 2004 from HYPERLINK "http://archive.salon.com/sex/world/2000/09/26/vigilante/" http://archive.salon.com/sex/world/2000/09/26/vigilante/).
I include the story about the harassment a pediatrician to illustrate how fear and outrage about child sexual abuse and the individuals who commit such crimes can lead to what Jenkins (1998) has described as a moral panic: times in history when child sexual abuse has been seen as endemic, devastating, and an overwhelming menace to society. Jenkins argues that social views of child sexual abuse and sex offenders against children have been quite different in the past, when sexual offenses against children were considered to be unlikely to lead to serious consequences for the child if a proportionate response was made. There was a dramatic shift in such views in the 1980s and early 1990s, with extensive coverage of child sexual abuse rings and dramatic stories of satanic rituals involving child sexual abuse; 20 years later, many of these convictions have been overturned and there is little, if any, evidence that satanic ritual child abuse ever took place (Jones, 2004; Snedeker & Nathan, 2001). Currently, there is increasingly strong rhetoric about the dangers of the Internet, including claims of a large and profitable child pornography industry, many so-called Internet predators who use email, chat, and other technologies to communicate with potential child victims, and vast online networks of pedophiles, child pornography offenders, and sex offenders against children. There is little research, however, to support the rhetoric or to guide the major policy and legal changes that are taking place as a result.
Political Context
Given the public¿s attitudes about sex offenders against children and their crimes, it is not surprising that political views can be similarly emotional and strong. A recent example was the political response to the publication of a meta-analysis that concluded the average effect of childhood sexual contact with an adult was generally small (but still negative) among college students (Rind, Tromovitch, & Bauserman, 1998). Rind et al. did not argue or suggest in their paper that adults should not be held legally or morally responsible for sexual offenses against children, and in fact made a specific point of distinguishing between the results they obtained and the legal or moral implications of their findings. Nonetheless, there was a media outcry that then led to an extraordinary vote by the United States Congress to censure the American Psychological Association (the publisher of the journal in which the Rind et al. article appeared, and the publisher of this book), for allegedly publishing nonscientific research findings that did not conclude that child sexual abuse was tremendously and irreversibly harmful. This censure led the American Psychological Association to conduct an intense internal inquiry (see the March 2002 issue of the American Psychologist for a thorough overview from the journal editors, American Psychological Association officers, and additional commentators).
The political censure was alarming because of its implications for academic freedom, journal independence, and the relationship between public policy and science. The censure was also strange, to me, because the legal and moral prohibitions of adult-child sex do not require serious harm to occur for justification3. An internally consistent philosophical rationale can be made in terms of children¿s rights, uncertainty about children¿s ability to provide consent given their stages of cognitive and emotional development, and asymmetry in the potential benefits versus potential risks of sexual contact for the adults and the children. One can ask the following questions in this analysis: How many children have advocated for the decriminalization of adult-child sex, compared to the number of adults who have done so? What are the motivations of the adults who advocate for the decriminalization of adult-child sex? I assume in this book that the legal and moral prohibitions against adult-child sex will continue. 
Legal Context
Jenkins (1998) also reviewed the history of laws regarding sexual offenses against children in the United States. These laws have varied greatly in the 20th century, reflecting public and political views about sex with children. The current views are highly restrictive, singling out sex offenders from nonsexually violent offenders in the scope of legal controls that are possible. Though there is also a great deal of public and professional concern about gun-related crimes, gang-related crimes, and domestic violence, no other group of offenders is specifically subject to laws involving community notification when moving into a neighborhood, lifetime registration with police, rules about where sex offenders can live, and potential civil commitment to a secure treatment facility upon completion of a criminal sentence.
In the United States, two child victims of sexual offenses are memorialized in federal legislation. The Jacob Wetterling Act, which requires sex offenders to register with local law enforcement agencies, is named after a 11-year-old boy who was kidnapped while on his way home from a convenience store with his younger brother and a friend, by a masked man who threatened the children with a firearm. No arrest has been made, and Jacob Wetterling has not been found. Megan¿s Law, which requires community notification of sex offenders living in the area, is named after a 7-year-old New Jersey girl named Megan Kanka. On July 29, 1994, she was lured to a neighbour¿s residence and raped and murdered by a previously convicted sex offender. As a result of this crime, New Jersey and eventually the federal government of the United States passed laws requiring community notification about sex offenders when they move into a neighborhood. Jurisdictions in many states have also begun to legislate where sex offenders can live by requiring them to live a minimum distance from areas where children may congregate, including schools, parks, day care centers, and school bus stops (Levenson & Cotter, 2005). More detailed information about state and federal legislation pertaining to sex offenders is provided by Doren (2002a), Matson and Liebe (1996), Prentky, Janus, and Seto (2003), and LaFond (2005). A national sex offender public registry, administered by the United States Department of Justice, provides access to state sex offender registry websites ( HYPERLINK "http://www.nsopr.gov" www.nsopr.gov). 
Other legislative responses includes the civil commitment of dangerous sex offenders after they have served their prison sentences (see Doren, 2002). A 2002 survey found that 2,478 sex offenders were in civil commitment facilities at that time: 1,632 offenders were committed and the remainder were awaiting a hearing. Approximately half (49%) of the civilly committed sex offenders had a diagnosis of pedophilia (Fitch, 2003); pedophilic sex offenders are more likely to be recommended for civil commitment (Levenson, 2004a). Finally, some countries have begun to introduce extraterritorial jurisdiction over sexual contacts with children, because of concerns about their citizens travelling to other countries in order to engage in sex tourism and prostitution of minors. The scope of such sex tourism and prostitution is unknown, but it is widely perceived to be a major problem (see Chapter 3). 
Goal for This Book
This book was written to address the following questions: Is pedophilia a human universal that has appeared across cultures and across times? How can pedophilia be detected? What is the relationship between pedophilia and sexual offending against children? How do pedophilic and nonpedophilic sex offenders against children differ? What explains pedophilia and sexual offending against children? How do we assess risk to sexually offend? Finally, what do we know about interventions to reduce the occurrence of sexual offenses against children?
My hope is that public policy and clinical practice can be informed by our scientific knowledge regarding these topics, in order to prevent the sexual victimization of children. There is a major gap between our scientific understanding of these topics, and the practices and policies that have been developed in response to the problem of child sexual abuse. Much of what laypeople and professionals believe about pedophiles and sexual offending against children ¿ and the policies and laws that are implemented as a result ¿ is not supported by empirical evidence. I believe this has been to the detriment of children, offenders, their respective families, and the mental health and criminal justice systems that deal with sex offenders against children; children have been placed at undue risk because of suboptimal decisions made about offender sentencing or release from custody, offenders have not been suitably matched to intervention according to the risk they pose for recidivism, and the mental health and criminal justice systems have not been able to efficiently allocate their resources. 
Though much remains to be discovered, there is scientific knowledge to guide policies and practices. In particular, major advances have been made in the assessment of sex offender risk to reoffend; this information should be systematically involved in decisions about offender sentencing, placement, release, and supervision or treatment. Though accurate estimates of risk to reoffend are increasingly available, many decisions involve extraneous factors that are brought in as a result of subjective judgment. The importance of accurate risk assessment is underlined because there is, as yet, no effective treatment to reduce sexual recidivism among sex offenders. The studies that are often proferred as support for the efficacy of sex offender treatment are methodologically weak, while the best randomized clinical trial of psychological treatment that has been reported so far found no significant effect of treatment among adult sex offenders against children (Marques, Wiederanders, Day, Nelson, & van Ommeren, 2005). In contrast, two small randomized clinical trials of multi-systemic therapy have both shown a significant reduction in the recidivism of adolescent sex offenders, suggesting we might benefit from putting more resources into earlier intervention, before criminal attitudes, beliefs, associations, and behaviors become entrenched. I conclude by proposing that innovative treatments are needed, and that the null results for current treatments suggest such programs could be considered ¿treatment as usual¿ in a future randomized clinical trial. I also argue for increased attention to prevention efforts, including school-based sexual abuse prevention programs, support and treatment for pedophiles before they have initiated sexual activities with children, and public education campaigns to speed disclosure and help responsible adults to protect children. Resources could also be shifted to treatment of children with sexual behavior problems and adolescent sex offenders, and to increasing disclosures of sexual offenses against children and apprehension and prosecution of adult sex offenders.
We know less about pedophilia than we know about sexual offending against children. Much of what we know about pedophilia has come from studies of clinical or correctional samples of men who have committed sexual offenses against children. More research is needed on pedophiles outside of these settings, especially self-identified pedophiles who have no known history of sexual contacts with children. Such research is very difficult to conduct in the current social, political, and legal climates, but it is necessary if we are to fully understand pedophilia. Because pedophilia appears to be a stable sexual preference ¿ akin to heterosexual or homosexual orientation in the sense that it manifests early in life and directs a person¿s entire sexuality ¿ it is highly unlikely that any treatment can change it, just as no treatments have successfully changed homosexual (or heterosexual) orientation (Shidlo & Schroeder, 2002; October 2003 issue of Archives of Sexual Behavior). Instead, successful interventions are likely to come from teaching effective self-management skills, teaching children how to avoid or disclose sexual abuse, and decreasing the perceived benefits and increasing the perceived risk of having sexual contact with children through situational crime prevention efforts. New research on the causes of pedophilia and sexual offending against children will be critical to the development of effective prevention programs.
I am writing this book because I want to help prevent children from becoming victims of sexual offenses. Members of advocacy organizations such as the North American Man Boy Love Association or of online message boards like Girlchat and Boychat have argued that children are capable of giving consent to sex, repression of pedophiles and adult-child sex constitute violations of children¿s rights, and children are more likely to be harmed by the negative reactions of their families and society than by adult-child sex. Such arguments do not recognize that children are less cognitively and emotionally developed than adults, so there is a large asymmetry in their ability to consent to sexual contact. There is also a large asymmetry in the benefits and risks for children and adults; the benefits for adults who are sexually interested in children are obvious, while the benefits for children are unclear, and there is some risk of harm, even though the magnitude of harm may be small for many sexually abused children (Rind et al., 1998). In my opinion, the arguments of many adult-child sex advocates are self-serving, and adult-child sex is a moral wrong. In order to prevent this wrong, I believe pedophiles need to be supported and encouraged to avoid acting upon their sexual interests in children, and sex offenders against children should be treated and managed in a manner that is consistent with what we know about risk to reoffend and effective intervention. I hope that this book contributes to these efforts.
Footnotes
Terms such as pedophile, child molester, sex offender, and sexual predator are often used interchangeably in public and professional discussions. Having pedophilia is not a crime, whereas having sexual contact with a child when one is an adult is. In this book, I will repeatedly distinguish between what we know about pedophiles and what we know about individuals who have committed sexual offenses against children. Though these two groups overlap, they are not synonymous. I will use the terms pedophile or pedophilia to refer to individuals who have a sexual preference for prepubescent children, whether or not they have acted upon this preference. I will use the term sex offender against children to refer to individuals who have engaged in sexual contact with a child, whether or not they are pedophiles.
My use of the term sexual abuse in this context is controversial. The term is not a good scientific term because it is not behavioral and it is emotionally- and morally loaded, implying harm to the child and the intent to exploit or harm on the part of the adult. It may not adequately describe sexual contacts between children and adults in which the child is not seriously harmed (Rind et al., 1998, found that many children are resilient to the experience of sexual contact with an adult), the adult believes the sexual contact is part of a ¿loving and caring¿ relationship rather than an attempt to exploit the child, or incidents in which a child initiates the sexual contact (which of course does not obviate the adult¿s legal and moral responsibility to refrain from responding). A more neutral substitute could be ¿childhood sexual contact with a much older youth or adult¿ but this is cumbersome to use. I use the term sexual abuse because it is widely used in scientific and nonscientific writings, and it is probably much more familiar to the readers of this book.
Some people might be heartened to learn that many children are resilient to the experience of sexual abuse.
Acknowledgements
This book would not be possible without the many colleagues and collaborators I have been lucky enough to have for the past 15 years. These individuals include Howard Barbaree, Ray Blanchard, Stephen Butler, James Cantor, Meredith Chivers, Angela Eke, Kurt Freund, Grant Harris, Michael Kuban, Martin Lalumière, Niklas Långström, Calvin Langton, Ed Peacock, Vern Quinsey, Marnie Rice, Tracey Skilling, and Scott Woodside. I want to particularly mention Vern Quinsey for his mentorship, Martin Lalumière and Grant Harris for our rich history of collaboration and friendship (and for being such good fishing buddies), and Kurt Freund, who I had the privilege of collaborating with for several years before his death in 1997. Kurt was one of the great pioneers in the scientific study of pedophilia, and was an important role model for me as someone who could be both a serious scientist and a compassionate clinician.
I greatly benefited from conversations with many different people in the course of preparing this book. I do not have the space to thank all of them here, but I hope they know they are appreciated. I would like to specifically acknowledge Ray Blanchard, James Cantor, Meredith Chivers, Dennis Doren, Karl Hanson, Grant Harris, Martin Lalumière, Janice Marques, Vern Quinsey, and Marnie Rice for their very helpful comments on draft chapters. Meredith, Karl, Grant, and Martin went above and beyond by reading and commenting on the entire book. 
I want to thank Lansing Hays, then senior acquisitions editor with the American Psychological Association, for inviting me to write this book in the Fall of 2002, and Emily Leonard, development editor, for the fantastic help she has provided me during this process. Locally, I have benefited from the speedy and friendly library assistance from Robyn Mound and Zahra Akhavian at the Centre for Addiction and Mental Health from 2003 to 2006, and Shawn Lawson of the Kinsey Institute, during my visit to Indiana University in July, 2003. I would also like to thank the many talented research assistants who have helped me in my program of research on pedophilia and sexual offending against children: Michelle Adams, Lina Barkas, Teresa Grimbos, Madalyn Marcus, Alexandra Maric, Jennifer McCormick, Tara Watson, and Jennette Williams. Teresa Grimbos further assisted me by collating and organizing the references cited in this book.
I would like to thank Peter Pollard and Stop It Now! for giving me permission to use photographs from media campaigns that were run in Minnesota and Virginia, and Gerard Schachter, Klaus Beier, the other members of the Berlin Prevention Project, and the Scholz and Friends agency for their permission to use their media campaign photographs. 
Chapter 2 adapts material from an article I published in The Journal of Forensic Psychology Practice in 2001 and a chapter I published in the proceedings of a 2003 sexual psychophysiology conference at the Kinsey Institute of Research on Sex, Gender, and Reproduction (The Psychophysiology of Sex, Seto, in press-a). Chapter 8 adapts material from a chapter published in the proceedings of a 2002 sex offender treatment conference at Cambridge University¿s Institute of Criminology and a chapter published in Treatment of DSM-IV-TR Psychiatric Disorders (Seto, in press-b). I would like to thank the American Psychiatric Press, Haworth Press, Indiana University Press, and Willan Publishing for their permission to adapt these copyrighted texts. The entire book grew from a broad overview of the literature on pedophilia and sexual offending that I prepared for the Annual Review of Sex Research (Seto, 2004). 
Last, but foremost, I want to thank my wife, Meredith Chivers, for all of her love and encouragement, both in writing this book and in all the other aspects of my life. She is wonderful, and I am full of wonder.

Library of Congress Subject Headings for this publication:

Pedophilia.
Child sexual abuse.
Pedophilia.
Child Abuse, Sexual.
Crisis Intervention.