part0018

One of the complications in reviewing and synthesizing the literature on pedophilia is that different definitions and assessment methods are used. I review these different approaches to assessing pedophilia and hebephilia in the following sections. Each has its advantages and disadvantages, but at this time, my opinion is that evidence-based clinical assessment should rely on self-report, behavioral history, and phallometric testing of sexual arousal patterns. I go into detail about assessment methods because good assessment is essential to explaining sexual offending (see Chapter 4 , this volume), understanding the etiology of pedophilia (see Chapter 5 ), carrying out risk assessments (see Chapter 7 ), and assessing needs for intervention (see Chapters 8 and 9 ).

The simplest way to assess pedophilia is to ask, through interviews or questionnaires, relevant questions about sexual thoughts, fantasies, urges, arousal, and behavior. However, because of the stigma associated with pedophilia and the stigma and illegality of sexual offending involving children, some individuals who are pedophilic will understandably minimize or deny their sexual interest in children, especially if serious stakes are involved, as when assessments are conducted as part of criminal justice proceedings and may influence sentence length or whether someone is released from custody (Jahnke, Imhoff, & Hoyer, 2015).

Almost all assessments of pedophilia begin with self-report. This includes anonymous online surveys for research purposes and interviews or questionnaires for clinical purposes. Simply asking about sexual interest in children is usually not sufficient for ascertainment of pedophilia or hebephilia, or the diagnosis of pedophilic disorder, per the Diagnostic and Statistical Manual of Mental Disorders (fifth ed. [ DSM–5 ]; American Psychiatric Association, 2013), because questions about persistence, recurrence, intensity, and duration need to be asked as well. As mentioned in the previous chapter , the absence of these kinds of qualifying questions is one of the reasons for the continued lack of strong epidemiological data regarding the prevalence of pedophilia and hebephilia in the general population.

Because the relevant questions are highly sensitive, great care is needed to ask questions in a nonjudgmental way, as part of a comprehensive sexual history, including questions about sexual feelings and experiences with adults and questions about other atypical sexual interests. Context is important because questions about children need to be understood relative to the rest of someone’s sexuality. Someone who admits to a few sexual fantasies about prepubescent children would probably not qualify for the pedophilia designation, whereas someone with recurrent and intense sexual urges regarding children, with sexual arousal when fantasizing about children, and who seeks out child pornography is very likely to have pedophilia.

Questions about adult sexual and relationship history are useful because sexual contacts with adults and someone’s sexual arousal to children has an inverse relationship when assessed in a laboratory (Blanchard, Klassen, Dickey, Kuban, & Blak, 2001). Early self-report surveys found that many self-identified persons with pedophilia had never been married and that if they had ever been married, they reported having poor sexual relationships with their spouses (Bernard, 1979/1985; Rouweler-Wuts, 1976). One obvious explanation is that pedophilic (and hebephilic) individuals would be less interested in adults and therefore less likely to have satisfying sexual or romantic relationships with adults. Another possible explanation is that some pedophilic men avoided marriage to avoid having or being around children, thereby reducing their perceived risk to sexually offend. Knowing about the adult sexual relationships of people with pedophilia can also shed light on whether someone might have a nonexclusive or exclusive form of pedophilia.

Even with the caveats about lying or other self-report biases, many studies have shown that self-reports can provide reliable and valid information. Worling (2006) showed that self-reported sexual interests correlated with unobtrusively recorded viewing time (see the section below) and distinguished groups of adolescents as one would expect, for example, distinguishing those who sexually offended against children from those who offended against peers or adults, and distinguishing those with only boy victims from those with only girl victims. In our meta-analysis of studies comparing adolescents who had sexually offended with those who had committed nonsexual offenses, self-reported sexual interests distinguished the two groups (Seto & Lalumière, 2010). Among adults, self-reported sexual interest in children is correlated with victim age selection and with phallometrically assessed sexual arousal to children (Seto, Stephens, Lalumière, & Cantor, 2017; Stephens, Seto, Goodwill, & Cantor, 2017b). Other research also shows self-reported sexual interests distinguishes adult offenders against children from others (Holland, Zolondek, Abel, Jordan, & Becker, 2000; Laws, Hanson, Osborn, & Greenbaum, 2000).

In addition to questions about sexuality, it can be helpful to ask broader questions about the extent of social involvement with children and work-related contact with children because of occupation or volunteerism. Involvement with children might be evidence regarding someone’s emotional congruence with children, that is, the extent to which someone is more comfortable and feels they have more in common with children than with adults. Emotional congruence with children is a relevant treatment and supervision target for some sex offenders against children (McPhail, Hermann, & Nunes, 2013). This information might be relevant for assessing risk to sexually offend, because access to potential victims is an important situational factor both theoretically (see Chapter 4 , this volume) and empirically (see Chapter 7 ). Consistent with my conceptualization of pedophilia as a sexual orientation for age, similar in respects to sexual orientation for gender, pedophilia is expressed not only in sexual interests or behavior but also in romantic and social choices (Seto, 2012, 2017b). This varies across individuals: Some are interested only in sex, others are interested only in intimacy, but many are interested in both.

Comprehensive clinical interviews are also helpful to rule out alternative explanations for what may at first appear to be sexual interest in children. For example, some individuals with obsessive–compulsive disorder may report substantial distress about sexual thoughts regarding children; the differential diagnosis relies on knowing whether these thoughts are associated with feelings of disgust or shame, or with feelings of sexual arousal. In other circumstances, the sudden onset of sexual interest in children after many years without any evidence of pedophilia or hebephilia might suggest the emergence of a brain tumor or similar neurological condition (e.g., Burns & Swerdlow, 2003).

Although it is integral to any comprehensive assessment of pedophilia, self-report alone is usually not sufficient because of lying, recall, and other self-report biases, as well as the specific challenges for talking about a highly stigmatized condition (Jahnke, Imhoff, & Hoyer, 2015) or admitting illegal behavior that might result in prosecution and punishment. Many jurisdictions where research has taken place have mandatory reporting laws regarding suspicion or evidence of child sexual abuse, a topic I return to in Chapter 9 . The existence of these laws can inhibit disclosure out of anxiety that admissions might be used against respondents in legal proceedings.

It is easy to lie because the nature of the relevant questions is obvious, and thus it is no surprise that many offenders will minimize or deny pedophilic sexual interests and behavior (Ware & Mann, 2012). These limitations of self-report are not unique to sex offenders or even to offenders more generally. Questions about sexuality are among the most sensitive kinds of questions, and self-report can be affected as a result. For example, Halpern, Udry, Suchindran, and Campbell (2000) found that male adolescents were more willing to disclose undetected criminal acts than the fact that they masturbated, even though masturbation is very common, usually healthy, and legal.

One way to reduce the reluctance of individuals to disclose sensitive sexual interests or behavior in face-to-face interviews is to administer questionnaires. For example, Koss and Gidycz (1985) found that men were more likely to admit to sexually coercive behavior through questionnaires than through interviews. Another advantage of questionnaires is that they are structured and can be administered using computers so that important questions are not inadvertently missed or incorrectly recorded. A number of different measures are available (see Table 2.1 for a list of the more commonly used measures). Some, but not all, of these measures include validity scales to check what is reported. The measures vary in the amount of evidence regarding their reliability and validity, particularly in independent validation research.