EXHIBIT 8.1
Recommendations for Treatment Pedophilic Sex Offenders

1. Risk assessment using a well-supported measure, for the purpose of triaging individuals in terms of placement, security, and intensity of any treatment and supervision.

2. Education of the client, his spouse or partner, family members, and close friends regarding risky situations and potential precursors for sexual offenses against children (e.g., the offender being alone with a child or consuming alcohol).

3. Behavioral treatments targeting pedophilic sexual arousal, when applicable, with “booster” sessions as needed on an ongoing basis.

4. Monitoring of access to child pornography, unsupervised contacts with children, and alcohol or drug use.

5. Anti-androgen treatments targeting sexual drive for higher-risk individuals who are not suitable for incapacitation. Though the evidence for such treatments is not strong, compliance with the regimen is a positive treatment-related indicator and could be used to adjust the intensity of other interventions.

6. Cognitive-behavioral and behavioral treatments targeting dynamic risk factors for general criminal behavior such as antisocial attitudes and beliefs, association with antisocial peers, and substance abuse.

7. Incapacitation of high-risk pedophilic sex offenders, especially those who have committed many sexual offenses against children or who have committed violent sexual offenses.

Behavioral treatments targeting pedophilic sexual arousal have some support. Because the long-term effects are unknown, ongoing follow-up and “booster” sessions may be necessary. This is not a sufficient treatment on its own, but learning to control their sexual arousal may help individuals who are motivated to refrain from offending. The use of drug therapies has modest empirical support, but treatment using antiandrogens might be justified for high-risk individuals who are not suitable for incapacitation, for two reasons. First, for individuals who believe they need assistance to control their pedophilic sexual interests, administration of these agents can activate a placebo expectancy response that may in fact contribute to their ability to do so. Second, administration of these agents can be viewed as a strict behavioral test of the individual’s motivation and commitment to avoid sexually offending against children, because noncompliance with medication appears to be associated with a worse prognosis. (A similar logic applies for the provisional recommendation regarding the use of behavior therapy, while researchers await longer-term follow-up results). These agents may also possibly reduce sex drive, and this reduction in sex drive may lead to a reduction in likelihood to sexually offend against children for some individuals.

Finally, for pedophilic sex offenders who are at higher risk of antisocial behavior and thus for acting upon their sexual interest in children, cognitive behavioral and behavioral treatments drawn from the correctional literature could have a significant impact on general risk factors, such as antisocial attitudes and beliefs (including permissive attitudes about sex with children), association with antisocial peers (including other persons with pedophilia who endorse and reinforce permissive attitudes about sex with children), and substance abuse (which can lead to disinhibition of behavior). It is unlikely such treatments will be helpful to self-referred pedophilic individuals, who would tend to be low in antisociality because those who are more antisocial are less likely to come forward for help.

Important advances have been made in the understanding of what can reduce the persistence of sexual offending, including treatment that adheres to the RNR framework (Hanson et al., 2009), has a cognitive behavioral orientation, and targets empirically established dynamic risk factors. They need to be responsive to individual learning styles, and they possibly need to do more than target deficits—they need to also build on strengths and offering more prosocial options. When possible, social-ecological factors need to be targeted, which can include parents for adolescents who have sexually offended and possibly partners/spouses and other close people for adult offenders (although little is known about the latter). The encouraging, if not methodologically strong, evidence from Circles of Support and Accountability is in line with the importance of social ties.

1 TL;DR (too long; didn’t read): We don’t need another meta-analysis, we need more primary evaluation studies!