Preventing sexual abusers of children from reoffending: systematic review of medical and psychological interventions

BMJ   Introduction: Sexual abuse of children is a global problem, and systematic reviews suggest that 18-20% of women and 7-8% of men in the general population report being abused before the age of 18.1 2 Rates have not differed substantially in recent decades but might vary across regions.2 [...]

The high prevalence and adverse consequences of sexual abuse of children warrant increased investment in development of preventive and therapeutic strategies.14 15 16 Such efforts should directly deal with children, their caregivers, and their environments to prevent potential abuse and effectively manage cases of abuse that have already occurred. Interventions for individuals at risk of sexual abusing children could prevent more children from being abused.

Society’s response to people who sexually abuse children has focused largely on punishment and deterrence through the criminal justice system. Offenders, however, are often directed to mental health professionals for treatment of disorders related to the offence (such as sexual compulsivity and paedophilia). Consequently, the availability of evidence based treatment for this population would be of considerable interest to medical practitioners. [...]

Objective To evaluate the effectiveness of current medical and psychological interventions for individuals at risk of sexually abusing children, both in known abusers and those at risk of abusing.

Results After review of 1447 abstracts, we retrieved 167 full text studies, and finally included eight studies with low to moderate risk of bias. We found weak evidence for interventions aimed at reducing reoffending in identified sexual abusers of children. For adults, evidence from five trials was insufficient regarding both benefits and risks with psychological treatment and pharmacotherapy. For adolescents, limited evidence from one trial suggested that multisystemic therapy prevented reoffence (relative risk 0.18, 95% confidence interval 0.04 to 0.73); lack of adequate research prevented conclusions about effects of other treatments. Evidence was also inadequate regarding effectiveness of treatment for children with sexual behavioural problems in the one trial identified. Finally, we found no eligible research on preventive methods for adults and adolescents who had not sexually abused children but were at higher risk of doing so (such as those with paedophilic sexual preference).

Conclusion There are major weaknesses in the scientific evidence, particularly regarding adult men, the main category of sexual abusers of children. Better coordinated and funded high quality studies including several countries are urgently needed. Until conclusive evidence is available, realistic clinical strategies might involve reduction of specific risk factors for sex crimes, such as sexual preoccupation, in abusers at risk of reoffending.