part0028

This resource provides additional information about assessment methods, including sources of questionnaires and the scoring guidelines for the Screening Scale of Pedophilic Interests (SSPI). I have no financial interest in any of these measures or in any of the commercial organizations mentioned here; the SSPI is publicly available and free to use.

The following questions are given as examples of questions that can help elucidate a person’s sexual thoughts, fantasies, urges, arousal, and behavior regarding prepubescent children. These questions would normally be included in an interview that covers other aspects of the person’s history, including current living circumstances, relationships, and reasons for the referral. Possible follow-up questions are also provided, but the set of questions provided here is not exhaustive. Training in interviewing techniques is required. The wording of questions should be changed to match the age and education level of the interviewee. Questions can be repeated at different times during an interview or set of interviews as a check of response consistency.

An open, nonjudgmental manner and clear, direct questions are more likely to produce honest responses. Sexuality is an uncomfortable topic for many people, and as a result, questions about sex can produce brief or misleading responses because of embarrassment or shame. Because of mandatory reporting requirements regarding child sexual abuse and the fact that many assessments occur under the auspices of the criminal justice system, it is important that the client be thoroughly informed of legal or professional reporting obligations, other limits to confidentiality, and how the information will be used. Depending on the circumstances, I will advise clients not to provide specific details about previously unreported sexual contacts they have had with children because doing so would trigger mandatory reporting requirements, and I believe the information that I can otherwise obtain is clinically important.

3. Have you ever masturbated? How old were you the first time you masturbated? What were you thinking about at the time? What do you typically think about when masturbating? How frequently do you masturbate? What is the most times you have ever masturbated in a week? How old were you at that time?

6. How many female sexual partners have you had? What proportion would you consider to be casual or short term (e.g., one night stands or short flings)? What is the longest sexual relationship you’ve had with a woman? What is the shortest?

7. How many male sexual partners have you had? What proportion would you consider to be casual or short term (e.g., 1-night stands or short flings)? What is the longest sexual relationship you’ve had with a man? What is the shortest?

8. Did you ever cheat on a steady sexual partner (i.e., had sex with someone else without the partner’s knowledge or permission)? How many times? Have you ever been involved in multiple sexual relationships at the same time?

11. Have you ever had sexual contact with a girl who was below the age of 14 [or the legal age of consent in the local jurisdiction]? How old were you at the time? How old was she? What kind of sexual behaviors took place?

12. Have you ever had sexual contact with a boy who was below the age of 14 [or the legal age of consent in the local jurisdiction]? How old were you at the time? How old was he? What kind of sexual behaviors took place?

13. How often do you sexually fantasize in a typical day? What do you fantasize about? Do you masturbate when you fantasize? What proportion of the times you masturbate involve fantasies?

14. Do you ever have sexual fantasies about prepubescent girls? Teenage girls who are under the legal age but sexually maturing? How long have you been having these fantasies? How often do you have these fantasies? What are the arousing or attractive features of the girls in these fantasies?

15. Do you ever have sexual fantasies about prepubescent boys? Teenage boys who are under the legal age but sexually maturing? How long have you been having these fantasies? How often do you have these fantasies? What are the arousing or attractive features of the boys in these fantasies?

16. Do you ever have sexual fantasies about uncommon or unusual activities (e.g., bondage, spanking, masochism, exhibitionism, or voyeurism)? How often do you have these fantasies? Have you ever engaged in these activities? How old were you the first time? How often?

17. Do you ever have sexual fantasies about unusual kinds of persons or objects (e.g., amputees or fetishism)? Have you ever engaged in sexual behaviors involving these persons or objects? How old were you the first time? How often?

21. How frequently do you want to have sex with another person? How frequently do you actually have sex with another person? How satisfied are you with this level of sexual activity?

22. Do you ever use pornography (sexually explicit pictures, videos, or text)? How often? Since what age? What kinds of pornography? How do you access pornography? How much do you spend on pornography in a typical month? Have you ever used child pornography?

The Clarke Sex History Questionnaire for Males—Revised is commercially available from Multi-Health Systems (Langevin & Paitich, 2001; see http://www.mhs.com ). It is designed for use with adult men and requires approximately 60 to 90 minutes to complete. It contains 23 scales, including 2 validity scales, with items pertaining to a variety of different aspects of a person’s sexual history, including paraphilic fantasy and behavior, sexual abuse history, sexual dysfunctions, and exposure to pornography. Other self-report measures that could be useful in the assessment of pedophiles or sex offenders against children are reported in Table A.1 .

The SSPI was originally developed using a sample of over 1,000 men who had been convicted of at least one sexual offense involving children (Seto & Lalumière, 2001). Its criterion-related validity has since been replicated in two separate samples of adult sex offenders, and it has been shown to be significantly associated with recidivism in those two samples (Seto, Harris, Rice, & Barbaree, 2004). There were 40 adolescent sex offenders against children in the Seto and Lalumière (2001) sample; this group was combined with two other samples of adolescent sex offenders in Seto, Murphy, Page, and Ennis (2003). I am not aware of any data, unpublished or published, on the validity of the SSPI for female sex offenders.

The SSPI items are scored as present or absent on the basis of information about child victims. File information on sexual offense history from sources such as police synopses or probation or parole reports are preferred over the offender’s self-report, unless the offender reports sexual offenses that were not officially recorded. The items are shown in Table A.2 . The age of consent in Canada at the time the SSPI was developed was 14, so all child victims were under the age of 14; sexual offenses against older minors would result in different criminal charges. Unrelated victims are defined as children who were not the offender’s son or daughter, stepson or stepdaughter, or a member of his extended family (referring to nieces or nephews, grandchildren, or cousins).

Guidelines and additional information about phallometric testing have been presented in a variety of documents (e.g., Association for the Treatment of Sexual Abusers [ATSA], 1993; Langevin, 1989; Murphy & Barbaree, 1988; Roys & Roys, 2001). Additional information is available in Appendix A of the 2005 version of the ATSA practice standards and guidelines (ATSA, Professional Issues Committee, 2005), and from Lalumière and Harris (1998). Phallometric equipment and training can be obtained through commercial enterprises such as Behavioral Technology Inc. (http://www.btimonarch.com ) and Limestone Technologies (http://www.limestonetech.com ).

Because readers of this book may not be familiar with the details of phallometric testing, I describe in detail the phallometric procedure used at the Kurt Freund Laboratory at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada, the same laboratory where much of my own research, and the research of my colleagues Howard Barbaree, Ray Blanchard, James Cantor, and Kurt Freund was conducted. The phallometric testing conducted by the Kurt Freund Laboratory has good sensitivity and specificity and has been subjected to peer review. The following description of the apparatus and procedure is taken from Blanchard, Klassen, Dickey, Kuban, and Blak (2001, pp. 120–121).

A photograph and schematic drawing of the volumetric apparatus are given in Freund, Sedlacek, and Knob (1965). The major components include a glass cylinder that fits over the penis and an inflatable cuff that surrounds the base of the penis and isolates the air inside the cylinder from the outside atmosphere. A rubber tube attached to the cylinder leads to a pressure transducer, which converts air-pressure changes into voltage-output changes. Increases in penile volume compress the air inside the cylinder and thus produce an output signal from the transducer. The apparatus is calibrated so that known quantities of volume displacement in the cylinder (e.g., 2 cc) correspond to known changes in transducer voltage output. The apparatus is very sensitive and can reliably detect changes in penile blood volume much less than 1 cc.

The examinee puts the glass cylinder over his penis, according to instructions from the test administrator. He then sits in a reclining chair, which faces three adjacent projection screens, and puts on a set of headphones. After the setup is complete, the examinee’s lower body is covered with a sheet to minimize his embarrassment or discomfort. During the test, the examinee’s face is monitored by a low-light video camera to detect stimulus avoidance strategies such as closing the eyes or averting them from the test stimuli….

The stimuli are audiotaped narratives presented through the headphones and accompanied by slides shown on the projection screens. There are seven categories of narratives, which describe sexual interactions with prepubescent girls, pubescent girls, adult women, prepubescent boys, pubescent boys, and adult men, and also solitary, nonsexual activities (neutral stimuli). All narratives are written in the second person and present tense and are approximately 100 words long. The following sample narrative, which describes sexual interaction with a prepubescent girl, is typical in tone and style:

You are babysitting a five-year-old girl for the evening. She is taking a bath before she gets ready for bed. Through the open bedroom door, she calls you to come in and scrub her back. You strip off your clothes and get into the bathtub with her. Your naked bodies slide against each other in the hot, soapy water. You take a washcloth and gently begin to rub the smooth, dimpled mound between her legs. She asks for the washcloth and you let her soap up your penis and testicles.

The narratives describing heterosexual interactions are recorded with a woman’s voice, and those describing homosexual interactions are recorded with a man’s voice. Neutral stimuli are recorded with both [either voice].

Each test trial consists of one narrative, accompanied by photographic slides on the three adjacent screens, which simultaneously show the front view, rear view, and genital region of a nude model who corresponds in age and gender to the topic of the narrative. Each trial includes three such models, each presented for 18 s. Therefore, the total duration of a trial is 54 s, during which the examinee views a total of nine slides, three at a time. Neutral narratives are similarly accompanied by slides of landscapes.

The full test consists of four blocks of seven trials, with each block including one trial of each type in fixed pseudorandom order. Although the length of the trials is fixed, the interval between trials varies, because penile blood volume must return to its baseline (flaccid) value before a new trial is started. The time required to complete a test is usually about 1 hr.

This detailed excerpt from Blanchard et al. (2001) is included here because deviations from validated phallometric assessment procedures may decrease test reliability or validity. Phallometric assessments are not necessarily interchangeable, and users should be aware of the current research on optimal methods and stimulus set characteristics.

Different viewing time measures are commercially available. The Abel Assessment for Sexual Interest (Abel Screening, Inc., 2006) is a computerized measure that consists of an objective task involving looking at slides and a questionnaire on sexual interests and behavior, including allegations, arrests, and convictions for sexual offenses. A viewing time measure is also commercially available as the Affinity computer program (Pacific Psychological Assessment Corporation, 2006; see http://www.pacific-psych.com ) or as part of the Preftest Suite computer program (Limestone Technologies, 2006; see http://www.limestonetech.com ).