Showing papers in "Behavioral Sciences & The Law in 2020"

Using algorithms to address trade‐offs inherent in predicting recidivism

Abstract: Although risk assessment has increasingly been used as a tool to help reform the criminal justice system, some stakeholders are adamantly opposed to using algorithms. The principal concern is that any benefits achieved by safely reducing rates of incarceration will be offset by costs to racial justice claimed to be inherent in the algorithms themselves. But fairness trade-offs are inherent to the task of predicting recidivism, whether the prediction is made by an algorithm or human. Based on a matched sample of 67,784 Black and White federal supervisees assessed with the Post Conviction Risk Assessment, we compared how three alternative strategies for "debiasing" algorithms affect these trade-offs, using arrest for a violent crime as the criterion . These candidate algorithms all strongly predict violent reoffending (areas under the curve = 0.71-72), but vary in their association with race (r = 0.00-0.21) and shift trade-offs between balance in positive predictive value and false-positive rates. Providing algorithms with access to race (rather than omitting race or "blinding" its effects) can maximize calibration and minimize imbalanced error rates. Implications for policymakers with value preferences for efficiency versus equity are discussed.

The dark figure of sexual offending: A replication and extension.

Abstract: Studies of the dark figure of sexual offending using federal correctional clients reported significant evidence of previously unknown or hidden sexual violence, often among clients with no official criminal history. Unfortunately, research has produced variable estimates of how large the dark figure is. The current study sought to replicate recent studies of federal sexual offenders about the dark figure of sexual offending. We also extended the knowledge base by providing additional correlational analyses to see whether self-reported and official sexual offending have shared or divergent correlates. Overall, 73.8% of federal sexual offenders reported prior contact victims, which is higher than, but generally consistent with, prior prevalence estimates of 55-69% in studies of federal correctional clients. In the current data, clients convicted of child pornography possession or receipt and who had no official record of sexual abuse nevertheless reported contact sexual offenses in more than 59% of cases.

The effects of essentialist thinking toward biosocial risk factors for criminality and types of offending on lay punishment support.

Abstract: This research uses experimental methods to gauge how different facets of essentialist thinking toward (1) types of offending and (2) biosocial risk factors for criminality predict lay punishment support. A randomized between-subjects experiment using contrastive vignettes was conducted with members of the general public (N = 897). Overall, as hypothesized, aspects of essentialist thinking, particularly informativeness, continuity, immutability, and discreteness, toward both biosocial risk factors and types of offending behavior generally predicted more severe punishments surrounding retribution, incapacitation, and deterrence. Yet, surprisingly, several of the same beliefs, specifically toward discreteness and informativeness, also predicted non-punitive sentiments toward restoration and decreased prison time in some contexts. This work demonstrates that essentialist thinking not only may affect how the public cognitively categorizes biosocial risk factors for criminality and types of offending, but also may have consequences for public support for the punishment of offenders with particular offense records or characteristics.

Why do child sexual abuse victims not tell anyone about their abuse? An exploration of factors that prevent and promote disclosure.

Abstract: Disclosure rates of child sexual abuse (CSA) to both social supports and law enforcement are concerningly low, although more research is needed to understand factors that impact disclosure. Thus, the present study examined rates of informal (i.e., to a social support) and formal (i.e., to law enforcement) disclosure of CSA, as well as victims' self-reported experiences with telling others about their own abuse and their perceptions of the overall advantages and disadvantages of disclosure. In all, 76 undergraduate women (who collectively experienced 105 instances of abuse) participated in a semi-structured interview regarding their history of CSA. Results revealed that approximately 50% of cases involved the victim informally disclosing, and only 10% of cases being formally disclosed to authorities. The quantitative and qualitative data shed light on a number of factors that lead victims to not disclose, as well as the identification of factors that may promote a victim to share their abuse with others. The implications for improved prevention and responses to CSA disclosure are discussed.

An examination of the effects of mental disorders as mitigating factors on capital sentencing outcomes.

Abstract: Mentally ill and emotionally disturbed offenders comprise a significant component of those whose criminal conduct has swept them into the criminal justice system, including a subset who are tried and convicted of capital murder. The present study employs the population of capital cases advanced to penalty phase in the state of North Carolina (1990-2009) to examine whether presentation to the jury of the statutory mitigators of extreme mental and emotional disturbance and capacity impaired, and specific mental illness diagnoses, often referred to as mental disorders, at the sentencing phase mitigate against a sentence of death. Mental disorders included mood disorders, psychotic disorders, anxiety disorders, brain disorders, multiple mental illness diagnoses, learning disabilities, and personality disorders. Results from these 835 cases indicate that with the exception of one, the diagnosis of a learning disability, the capital jury's acceptance of various mental health conditions does not effectively mitigate against a capital sentence. In addition, jury rejection of a diagnosis of mental illness or the two mental health statutory mitigators, capacity impaired and extreme emotional disturbance, as a mitigating factor has a counter-mitigating effect in that it significantly increases the odds of a death penalty recommendation by about 85-200%.

Motivational pathways underlying the onset and maintenance of viewing child pornography on the Internet

Abstract: The staggering rate at which incidents of child pornography (CP) are increasing highlights the need for proactive approaches to this problem. Improving the efficacy and accessibility of interventions designed for individuals who view CP provides one means of addressing this growing concern. This article explores the self-identified motivations underlying the onset and maintenance of viewing Internet-based CP among a sample of 20 men receiving treatment for this behavior. Our findings suggest two primary motivational pathways, namely a desire to achieve sexual gratification and/or an attempt to avoid emotional pain. We propose a behavioral facilitation process, initiated by extensive exposure to Internet pornography, to explain the use of CP in men without a sexual interest in children. We also discuss factors that appeared to facilitate the maintenance of this behavior. Our findings indicate that social skills deficits, maladaptive coping strategies, and a lack of sexual education require further investigation regarding their role in promoting or precluding desistance from viewing CP.

Risk assessment savvy: The imperative of appreciating accuracy and outcome.

Abstract: This article focuses on two aspects of actuarial risk at sentencing, the accuracy of the instrument and the outcome it predicts. For theoretical reasons rooted in the cognitive decision-making and sentencing literature, there is a danger that judges and other practitioners might come to overly rely on a "high risk" label or designation without appreciating the accuracy of the prediction or the actual outcome being predicted. Using sentencing and recidivism data from Pennsylvania (n = 10,000), two simple risk instruments are constructed to illustrate the critical importance of understanding accuracy and outcome before relying on the risk tool information.

Understanding expert testimony on child sexual abuse denial after New Jersey v. J.L.G.: Ground truth, disclosure suspicion bias, and disclosure substantiation bias

Abstract: The New Jersey Supreme Court held in New Jersey v. J.L.G. (2018) that experts can no longer explain to juries why sexually abused children might deny abuse. The court was influenced by expert testimony that "methodologically superior" studies find lower rates of denial. Examining the studies in detail, we argue that the expert testimony was flawed due to three problems with using child disclosure studies to estimate the likelihood that abused children are reluctant to disclose abuse: the ground truth problem, disclosure suspicion bias, and disclosure substantiation bias. Research identifying groups of children whose abuse can be proven without reliance on disclosure reveals that denial of sexual abuse is common among abused children.

Judicial gatekeeping on scientific validity with risk assessment tools.

Abstract: Risk assessment tools driven by algorithms offer promising advantages in predicting the recidivism risk of defendants. Jurisdictions are increasingly relying upon risk tool outcomes to help judges at sentencing with their decisions on whether to incarcerate or whether to use community-based sanctions. Yet as sentencing has significant consequences for public safety and individual rights, care must be taken that the tools relied upon are appropriate for the task. Judges are encouraged to act as gatekeepers to evaluate whether the forensic risk assessment tool offered has a sufficient level of validity in that it is fit for the purposes of sentencing, provides an acceptable level of accuracy in its predictions, and achieves an adequate standard of reliability with regard to its outcomes.

The compelling case for low‐violence‐risk preclusion in American prison policy

Abstract: This article recommends the development of broad policies of preclusion regarding the use of incarceration for offenders who are highly unlikely to commit a violent crime in the future. The proposal builds on the new Model Penal Code: Sentencing's provision on the limited utilitarian purposes of incarceration. Such low-violence-risk-preclusion strategies (LVRPs) would stand on the most powerful predictive capabilities of today's risk assessment technology. If implemented properly, there is reason to believe that substantial drops in prison rates could be realized in most states. The preclusion groups would include defendants who should not be sent to prison or jail by sentencing judges even though the law allows for such penalties; those serving prison sentences who should be released by parole boards or other releasing authorities at the earliest opportunity; and probation and parole violators who should not be revoked to prison or jail. The strongest objection to the LVRP proposal is the fear of racial or other unacceptable biases in its apportionment of reduced-incarceration benefits. Given current high levels of disproportionality in prison and jail populations, however, there is reason to think that the benefits of LVRP would be especially pronounced in disadvantaged communities.

Detecting children's true and false denials of wrongdoing: Effects of question type and base rate knowledge.

Abstract: One common and unfortunately overlooked obstacle to the detection of sexual abuse is non-disclosure by children. Non-disclosure in forensic interviews may be expressed via concealment in response to recall questions or via active denials in response to recognition (e.g., yes/no) questions. In two studies, we evaluated whether adults' ability to discern true and false denials of wrongdoing by children varied as a function of the types of interview question the children were asked. Results suggest that adults are not good at detecting deceptive denials of wrongdoing by children, even when the adults view children narrate their experiences in response to recall questions rather than provide one word answers to recognition questions. In Study 1, adults exhibited a consistent "truth bias," leading them toward believing children, regardless of whether the children's denials were true or false. In Study 2, adults were given base-rate information about the occurrence of true and false denials (50% of each). The information eliminated the adults' truth bias but did not improve their overall detection accuracy, which still hovered near chance. Adults did, however, perceive children's denials as slightly more credible when they emerged in response to recall rather than recognition questions, especially when children were honestly denying wrongdoing. Results suggest the need for caution when evaluating adults' judgments of children's veracity when the children fail to disclose abuse.

Applicability of two violence risk assessment tools in a psychiatric prison hospital population

Abstract: The risk of violent behavior is known to be higher for patients who suffer from a severe mental disorder. However, specific prediction tools for clinical work in prison psychiatry are lacking. In this single-center study, two violence risk assessment tools (Forensic Psychiatry and Violence Tool, "FoVOx," and Mental Illness and Violence Tool, "OxMIV") were applied to a prison hospital population with a primary psychotic or bipolar disorder and subsequently compared. The required information on all items of both tools was obtained retrospectively for a total of 339 patients by evaluation of available patient files. We obtained the median and inter-quartile range for both FoVOx and OxMIV, and their rank correlation coefficient along with 95% confidence intervals (CIs)-for the full cohort, as well as for cohort subgroups. The two risk assessment tools were strongly positively correlated (Spearman correlation = 0.83; 95% CI = 0.80-0.86). Such a high correlation was independent of nationality, country of origin, type of detention, schizophrenia-spectrum disorder, previous violent crime and alcohol use disorder, where correlations were above 0.8. A lower correlation was seen with patients who were 30 years old or more, married, with affective disorder and with self-harm behavior, and also in patients without aggressive behavior and without drug use disorder. Both risk assessment tools are applicable as an adjunct to clinical decision making in prison psychiatry.

Open risk assessment.

Abstract: As criminal justice actors increasingly seek to rely on more evidence-informed practices, including risk assessment instruments, they often lack adequate information about the evidence that informed the development of the practice or the tool. Open science practices, including making scientific research and data accessible and public, have not typically been followed in the development of tools designed for law enforcement, judges, probation, and others. This is in contrast to other government agencies, which often open their processes to public notice and comment. Lack of transparency has become pressing in the area of risk assessment, as entire judicial systems have adopted some type of risk assessment scheme. While the types of information used in a risk tool may be made public, often the underlying methods, validation data, and studies are not - nor are the assumptions behind how a level of risk gets categorized as "high" or "low." We discuss why those concerns are relevant and important to the new risk assessment tool now being used in federal prisons, as part of the First Step Act. We conclude that a number of key assumptions and policy choices made in the design of that tool are not verifiable or are inadequately supported, including the choice of risk thresholds and the validation data itself. Unfortunately, as a result, the federal risk assessment effort has not been the hoped-for model for open risk assessment.

Denial and minimization among sex offenders

Abstract: A review of empirical studies of offenders-particularly sex offenders, and more particularly those who offend against children-demonstrates that denial of offenses and minimization of offending behavior are quite common at every stage of the criminal justice process. This is true during police interviews, during pretrial and presentencing mental health evaluations, among incarcerated offenders, among offenders seeking treatment, among offenders facing parole review, and among offenders already released into the community. This review highlights gaps in the research literature arising from inconsistencies in the definitions and measurement of denial and minimization, from the stage of adjudication or treatment at which measurements are made, and from the use of polygraphy to increase disclosures. Despite these limitations on the generalizability of empirical findings, it appears beyond dispute that many sex offenders maintain their innocence in the face of evidence to the contrary or even criminal conviction, and that many are able to recite additional crimes they have committed when they believe it is in their self-interest to do so.

Illuminating the dark figure of sexual recidivism

Abstract: Detected or reported ("observed") rates of sexual reoffending have long been recognized as underestimating the occurrence of actual sexual recidivism. Past attempts to bridge the gap between the two rates have been unsuccessful. Scurich and John try to reverse this course by presenting a simulation model to estimate the predicted actual sexual recidivism rates among individuals convicted of sexual offenses based on three parameters; they also apply these data to calibrate the sexual recidivism rates from four sexual recidivism studies. The accuracy of the predicted actual sexual recidivism rates is wholly dependent upon the reliability of the inputs to the model. This analysis relies upon scientific studies and literature to delve into the precision of the parameters of Scurich and John in relation to the accuracy of their predicted actual sexual recidivism rates and the validity of the calibration process. The results reveal that some of the assumptions by Scurich and John about the parameters are supported empirically, while others are not. Overall, the simulation model parameters suffer from significant deficiencies that likely produce inaccurate predicted actual sexual recidivism rates. Moreover, the methodologies of the comparison studies used in the calibration process do not actually meet the requirements of the analytic strategy of Scurich and John, which effectively invalidates their findings. Until computational strategies are employed that account for linear and nonlinear effects of model parameters, closing the gap between observed and actual sexual recidivism rates will remain elusive.

Alibi believability: Corroborative evidence and contextual factors

Abstract: A disbelief in alibis is one contributor to wrongful convictions. One reason that triers-of-fact may disbelieve alibis is that they lack evidence to corroborate the whereabouts of the suspect at the time of the crime. Contextual factors, such as when the alibi was disclosed and what was the nature of the crime, can also affect alibi believability. This paper outlines two studies where mock jurors evaluated an investigation and trial description online and rated alibi believability, defendant character trait ratings, and verdicts. Both studies examined the impact of corroborative alibi evidence and the timing of the alibi disclosure. In addition, Study 1 included the type of crime and Study 2 included the number of alibi corroborators as additional independent variables. We hypothesized that alibis would be viewed more positively when they were disclosed earlier rather than later, were corroborated by strong physical evidence and multiple corroborators, and involved less violent offenses. As hypothesized, in both studies, alibis with strong physical evidence were thought to be more believable than those with no physical evidence but the number of corroborators and type of crime did not affect any dependent measures. Delayed timing had some negative effects on views of the defendant's character. Corroborative physical evidence affected alibi believability consistently, and contextual factors mattered less. Both implications and suggestions for future research are further discussed.

Lost in translation: “Risks,” “needs,” and “evidence” in implementing the First Step Act

Abstract: In this article, we focus on two highly problematic issues in the manner in which the First Step Act of 2018 is being implemented by the Bureau of Prisons: an uncritical separation of "dynamic risks" and "criminogenic needs"; and a spurious reliance on "evidence-based" interventions to reduce recidivism risk. We argue that if the Act is to live up to its promise of being a game-changing development in efforts to reduce crime while simultaneously shrinking mass incarceration, "needs assessment" must be subject to vastly increased empirical attention, variable and causal risk factors must be identified and validly assessed, and interventions to reduce risk must be rigorously evaluated both for their fidelity of implementation and impact on recidivism. Rather than further proliferating programs that ostensibly reduce risk, we believe that serious consideration should be given to the Bureau of Prisons offering one signature, well-established cognitive-behavioral program that can simultaneously address multiple risk factors for moderate and high-risk prisoners.

The admissibility of other specified paraphilic disorder (non-consent) in sexually violent predator proceedings

Abstract: Following the advent of sexually violent predator (SVP) legislation in the early 1990s, forensic evaluators began to apply diagnostic labels related to a paraphilic interest in rape as a mental condition predisposing individuals convicted of sexual offenses to recidivate. The most recent iteration of the concept, other specified paraphilic disorder (non-consent) (OSPD (non-consent)), is a commonly utilized diagnostic entity in SVP proceedings. Research on paraphilic interest in coercive sex has failed to define a valid methodology or set of criteria to make a diagnosis of OSPD (non-consent) and has repeatedly demonstrated that the diagnostic construct has poor interrater reliability. The state of the science pertaining to OSPD (non-consent) thus raises serious concerns regarding its admissibility in SVP proceedings. Indeed, there are recent cases in which courts have deemed it inadmissible. The forensic expert involved in SVP proceedings should understand admissibility concerns related to OSPD (non-consent) and how to address them in court.

Analyzing the scientific foundation of Child Sexual Abuse Accommodation Syndrome: A reply to Lyon et al.

Abstract: The issue before the New Jersey Supreme Court in the Frye hearing New Jersey v. J.L.G. (2018) was whether the scientific community agreed that Summit's (1983) Child Sexual Abuse Accommodation Syndrome rested on a firm scientific foundation. Lyon et al. (this issue) critique our approach to describing child sexual abuse disclosure, which involved extrapolating rates from children who came to the attention of authorities. Lyon et al. claim that our conclusions are marred by sampling biases resulting from what they term the ground truth problem, suspicion bias and substantiation bias. The points Lyon et al. claim we "fell victim to" were the very points we acknowledge are inherent difficulties in estimating the extent to which children will come forward to tell others about sexual maltreatment. Lyon et al. offer an alternative solution to the inherent difficulties in studying a difficult-to-identify population, relying in large part on 21 papers published mostly in the 1960s and 1970s. We argue that the method they propose has more flaws than the one it is intended to replace. Points of agreement and disagreement, along with suggestions for future research, are discussed. Moving forward, we argue that studies are needed that embrace both validity and generalizability in order to foster data-driven theories rather than invoking the intuitive suppositions of Summit's (1983) syndromal evidence.

Comparison of outcome in men and women after treatment in psychiatric security hospitals in Germany.

Abstract: Previous research has shown that forensic psychiatric treatment reduces reoffending, rehospitalization and premature mortality. Treatment outcome varies with diagnosis, but little is known about the influence of sex, psychosocial adjustment and aftercare. To assess these variables, we interviewed male and female patients discharged from three psychiatric security hospitals in Germany in the years 2010-2017. Participants were interviewed at discharge (n = 609) and 1 year later (n = 366) about reoffending, readmissions, substance use and psychosocial adjustment. Among patients with substance use disorder (SUD), 14% reoffended, 20% were re-hospitalized and 60% maintained abstinence. Among patients with severe mental disorder, 5% reoffended and 13% were re-hospitalized. Significant sex differences were found in offenders with SUD. The results suggest that sociodemographic and disorder-related risk factors are associated with treatment success and that female patients with SUD might need a specific treatment approach. Sex-specific aspects, diagnosis and psychosocial adjustment should be considered in forensic psychiatric treatment and risk assessment.

Actuarial risk assessment at sentencing: Potential consequences for mass incarceration and legitimacy.

Abstract: The growing utilization of actuarial risk assessment instruments (RAIs) in the American criminal justice system may potentially lead to more restrained, better-targeted uses of incarceration. However, critics have raised a variety of concerns regarding RAIs and suggested, among other things, that their incorporation into court procedures may tend to dehumanize defendants and exacerbate, rather than alleviate, mass incarceration. In response to such concerns, this article offers recommendations for policy and practice that may help an increasingly risk-focused criminal justice system to achieve decarceration goals - and to do so without undermining its own legitimacy in the eyes of defendants or the public at large. These recommendations are aimed particularly at judges, in their roles as sentencers and makers of courtroom and courthouse policy.

An exploratory examination of intellectual disability and mental illness associated with alleged false confessions.

Abstract: The National Registry of Exonerations tracks cases of individuals who have been wrongly convicted and exonerated since 1989. Their most recent report revealed that 12% of those exonerated gave false confessions. The current study used data from the National Registry of Exonerations and focused on a sample of 2,378 individuals convicted of felonies with a focus on sexual offenses, as such crimes tend to be viewed as particularly heinous with increased consequences for those convicted. After examining various legal and extralegal factors, the results showed that those accused of sexual offenses, particularly sexual murders, had a greater likelihood of giving a false confession than those accused of non-sexual offenses. The likelihood of falsely confessing was higher among juveniles, those with mental illness and intellectual disabilities, and cases with multiple suspects. Females had a greater odds of falsely confessing to murder than males. Implications and recommendations are discussed.

Risk assessment in sentencing and plea bargaining: The roles of prosecutors and defense attorneys.

Abstract: Research on risk assessment in sentencing has focused heavily on the role of judges. Ignoring the role of other courtroom actors in the sentencing process, however, leaves unexamined the potentially significant effects on judicial decision making of arguments made by prosecutors and defense attorneys at sentencing hearings. Unduly focusing on judges also overlooks the vast majority of sentences arrived at through negotiated guilty pleas. We explored the extent to which considerations of risk are made among prosecutors and defense attorneys when advocating for given sentences in open court or during plea negotiations. We surveyed all prosecutors and defense attorneys in 14 judicial circuits in Virginia and found that most prosecutors and defense attorneys at least "sometimes" explicitly invoked actuarial risk estimates both at sentencing hearings and during plea negotiations. However, defense attorneys were much more likely than prosecutors to be averse to the use of risk assessment in either form of case disposition.

Competency to stand trial evaluations: A state-wide review of court-ordered reports.

Abstract: Competence to stand trial (CST) evaluations are a critical part of certain criminal proceedings, and competence-related evaluation and treatment are an increasing part of public mental health services. Whereas more research describes the defendants undergoing competence evaluations, less research has examined the actual reports detailing those competence evaluations. This study reviewed 3,644 court-ordered CST evaluation reports submitted by 126 evaluators in Virginia since Virginia initiated an oversight system allowing for comprehensive review. The base rate of incompetence opinions was 38.8%, but these rates varied significantly across evaluation type (initial versus post-restoration efforts) and evaluators (ranging from 9.1% to 76.8% incompetence rate). Results suggest generally strong compliance with state statutes guiding CST evaluations, but also highlight marked variability in forensic conclusions and reveal a few areas in which some reports fell short of statutory requirements and practice guidelines.

Advances in juvenile adjudicative competence: A 10-year update

Abstract: This article provides a comprehensive review of juvenile adjudicative competence (AC) literature published between 2010 and 2019. Publications included in this article are peer-reviewed and disseminate original research or provide new commentary on forensic evaluation, policy, or theory. The review is organized in the following sequence: (i) factors associated with juvenile AC, (ii) evaluating juvenile AC (assessment tools and techniques, quality of evaluations, evaluation recommendations), (iii) remediation (remediation recommendations), (iv) systemic issues (inconsistency in statutes and court processes, defense attorneys' concerns about AC, age-related issues, developmental immaturity), and (v) special topics (special populations, international research). Systemic processes and variability in statutes have contributed to current concerns regarding reliability of juvenile AC evaluation and remediation. Clear and consistent standards must be developed to address these problems. Continued research is necessary to clarify how to accurately assess juvenile AC and appropriately remediate those adjudicated incompetent. Practice and policy implications as well as future directions for research are discussed.

Examining jurors' ability to meet the constitutional requirement of narrowing in capital sentencing.

Abstract: The US Supreme Court has required that death penalty schemes narrow the class of persons eligible for a death sentence. Through the selection requirement, juries must use mitigating and aggravating evidence jointly to select the offenders engaged in the worst of the worst crimes. This study utilized between-subjects experimental design to test juror's ability to narrow directly. Utilizing the vignette approach, with brief descriptions of capital trials nested in self-administered questionnaires, we experimentally manipulated aggravating and mitigating evidence presented to mock jurors and examined their sentencing decisions in two independent samples. While mock jurors were able to identify offenders they considered to be engaged in serious crimes and offenders with diminished culpability, mitigating evidence and aggravating evidence did not interact and there was considerable inconsistency in the effects of mitigating evidence within and between samples. Implications for the constitutionality of the death penalty are considered.

Sex and genes, part 2: A biopsychosocial approach to assess and treat challenging sexual behavior in persons with intellectual disabilities including fragile X syndrome and 22q11.2 deletion syndrome.

Abstract: Individuals with intellectual disabilities (IDs) - and specifically those with genetic disorders - are more prone to medical and psychological challenges that affect their sexual development, experiences, and fertility. In this review paper we first provide an overview of the biopsychosocial (BPS) model and then explain how the model can guide and improve the assessment and treatment of challenging sexual behaviors by persons with IDs. We discuss two genetic conditions - fragile X syndrome and 22q11.2 deletion syndrome - in case studies, showing how the BPS model can be used to assess and treat the sexual problems of individuals with various types of ID. We conclude with BPS-formulated treatment considerations in three key domains: biomedical treatment (e.g., medication side effects; stopping or changing medications), psychological treatment (e.g., providing psychological therapies), and socio-environmental interventions (e.g., providing socio-sexual education and staff training). Together, these treatment interventions can aid clinicians to prevent and/or treat problematic sexual behaviors of people with IDs.

A qualitative study of forensic patients' perceptions of quasi-coercive offers of biological treatment

Abstract: At various points in the trajectory through the criminal justice system, a person may be encouraged by the hope of legal benefit to consent to medical treatment. This benefit may consist of diversion from prosecution, a favorable sentence, or parole. This form of legal encouragement has been referred to as legal leverage, quasi-coercive, or quasi-compulsory treatment. In this article, we analyze interviews with 15 men convicted of sexual offenses to explore their reactions to two hypothetical scenarios involving men consenting to a range of treatments intended to reduce risk of recidivism. In particular, we explore their reactions to quasi-coercive treatment using both real and hypothetical forms of biological therapy (e.g., drugs, brain stimulation, surgery), as opposed to psychological counselling. Here, we consider the extent to which these individuals perceive the situation to be coercive, the factors affecting these perceptions, and the ways in which physicians may mitigate perceived coercion. We found there is usually some degree of coercion identified when treatment consent is given in exchange for potential legal benefit, although this fact alone did not necessarily render the practice unacceptable. The degree of concern expressed over this potential coercion was related to the invasiveness and/or permanence of the treatment, and all participants highlighted the necessity of obtaining fully informed consent in the context of legally motivated treatment offers.

Use of penile plethysmography in the court: A review of practices in Canada, the United Kingdom and the United States.

Abstract: Penile plethysmography (PPG) is an objective measure of male sexual arousal in response to the presentation of a series of erotic and neutral stimuli. This measure is now widely recognized as the most reliable means of objectively measuring male sexual arousal to specific stimuli. Many clinicians and researchers consider PPG to be a vital contribution to the assessment and treatment of adult men with paraphilic interests and men who have committed sex crimes. PPG contributes to the clinical assessment of paraphilic interests, appraisal of risk of recidivism, and provides an objective measurement of changes in sexual arousal in response to treatment. There is strong support for the utility of PPG within clinical and legal contexts. This article addresses ways in which PPG has been utilized in the courts as part of expert clinical opinion. History of its use, details regarding admissibility in court, and case law are explored within the legal systems of Canada, the UK and the USA. Support for the inclusion of PPG as expert evidence is provided and judicial misunderstandings on the rationale for PPG use and its clinical utility in forensic assessments are discussed.