Historically, the ID have been the subject of considerable misinformation, causing them to be regarded as major contributors to crime by some past researchers like Selling (1939) and Tutt (1971). Goddard (1920) asserted, “the greatest single cause of delinquency and crime is low grade mentality, much o f it within the limits of feeble-mindedness” (p.47). However, recent research has identified general and sexual crime rates amongst the ID to be in reasonable proportion to population distribution (Lindsay, Marshall, Neilson, Quinn and Smith, 1998). It should however be noted that ID individuals are probably more likely to be apprehended since they have more limited skills in planning, deceiving, etc.
The representation of ID individuals amongst the general offender population is difficult to accurately assess because these individuals may be protected by their families or their activities may be monitored and ‘processed’ through Health or Social
Services instead o f the Criminal Justice System (Thompson and Brown, 1997). This may conceal disproportionately higher prevalence rates amongst ID populations.
ID individuals have been variously eharacterised by the general public as “naïve, sexual innocents and depraved sexual deviants” (p.226) (O’Connor, 1996). As such, it is not surprising that the responses of individuals who find them engaged in inappropriate sexual activity may vary greatly. One individual who intervenes when an ID man indecently assaults a child, may ‘normalise’ this behaviour as sexual exploratory activity amongst individuals at similar developmental levels. However, someone else might report the behaviour o f ‘public masturbation’ by an ID man as a criminal act without any appreciation that this individual, with limited abilities and a
normal sex drive, may not be afforded the privacy and dignity that his non-ID peers
enjoy.
Whilst there is now greater research acceptance that mainstream SO treatment works (Hanson, Gordon, Harris, Marques, Murphy, Quinsey and Seto, 2002), there have been important dissenting voices until recently. Furby, Weinrott and Blackshaw (1989) reported generally poor treatment outcomes, but on examination these findings
related to interventions designed and run in the 1970’s and early 1980’s. These interventions consisted o f a variety o f treatments, including chemical castration, psychoanalysis and purely behavioural techniques focusing only on re-conditioning sexual arousal. In large part these programmes did not identify or address different treatment needs in an effort to tailor the interventions to the circumstances. Also, the methodologies employed in the outcome studies included in their review frequently left much to be desired (Furby et al., 1989). More recently, Quinsey (1996) continued to express considerable scepticism about treatment effectiveness, challenging the view that SO treatment work has a verifiable success record. Quinsey criticised some programmes for discounting data for men who left therapy early or failed to respond to treatment. Marshall, Jones, Ward, Johnston and Barbaree (1999) questioned whether the lack o f treatment effect Quinsey and his colleagues found on their own programmes might relate to the populations he was working with; frequently
offenders in special hospital settings with dual diagnoses, and as such, perhaps more limited in their capacity for responding to treatment.
EVIDENCE OF TREATMENT EFFECTIVENESS
Abel (1999) reported on the substantial treatment improvements that have been demonstrated since CBT programmes have been introduced. An example o f British research indicating treatment effectiveness is that o f Allam (1999). She produced a well-controlled longitudinal study o f reeonviction rates comparing treated and untreated (non-ID) SO’s. The purpose o f this study was to primarily examine the impact of a CBT programme on short-term periods o f recidivism. The subjects in this study were selected on the basis that they had all admitted to sexual offences within the course of criminal proceedings. In all instances, the assigned Probation Officer recommended a community based Probation Order with the requirement to attend a SO treatment programme. In some instances the Court accepted this recommendation and the offender was obliged to partieipate in a Probation SO treatment programme for periods of normally two to three years. The control group consisted o f the men who had been recommended to attend a Probation treatment programme but were given a custodial sentence by the Judge. The custodial sentences for these offences were o f a relatively short duration, often in the region of six months, during which time there will have been no opportunity for the offender to attend a SO treatment programme. The recidivism rates for these men were recorded over a four to five year period for both groups irrespective of quality of involvement for the treated group. Allam (1999) reported that the untreated offenders recidivated at a rate o f approximately three times that o f the men who engaged in the community SO groupwork programme. Other studies have also demonstrated that CBT for SO’s can be effective in reducing recidivism (Dwyer, 1997; Hedderman and Sugg, 1996; Marques, Day, Nelson and West, 1994; Marshall et al., 1999). The majority o f follow up studies examined relatively short period of recidivism risk (generally under five years). However, this still allows for a comparison o f untreated and treated offenders, which demonstrates a positive treatment impact.
In addition to evidence from individual recidivism studies, two meta-analyses have been conducted that provide support for the effectiveness of CBT for SO’s. Hall (1995) conducted a meta-analysis on a number of treatment programmes for SO’s and found that there was approximately one third less recidivism (re-convictions) amongst treated offenders (19% compared to 27%). In particular, community-based programmes were found to be the most effective, as were those adopting a CBT approach. Alexander (1999) in her review of the recidivism literature found a combined sexual recidivism (re-arrests) rate o f 8.1% in treated child sex abusers (CSA’s) compared to a rate o f 25.8% in untreated CSA’s (not including incest abusers) over a five year period at risk. The data are encouraging in that such studies provide evidence that treatment development is moving in the right direction, i.e. the most recently conducted programmes (generally employing CBT groupwork techniques) have been found to be the most effective (Alexander, 1999).
Such well-designed studies have lead to increased acceptanee o f the effieacy o f this treatment approach with non-IDSO’s. However, whilst these findings offer evidenee o f the effectiveness of CBT programmes with mainstream SO’s, it would be inappropriate to simply conclude on this basis that this is the correct treatment approach for working with IDSO’s. Indeed, there is evidence that this treatment approach does not work for at least one type o f Personality Disordered offender, the psychopath. Research reported by Clarke (2000) noted that psyehopaths, individuals with signifieant aggressive, nareissistic features, were actually more likely to be reconvicted following inclusion in prison based cognitive-behavioural social skills training programmes. In view of the significant cognitive and social skill deficits found amongst IDSO’s, it would therefore be most appropriate to base any assessment of treatment success on the analysis o f outeome data for ID offenders exclusively. Unfortunately, relatively few such studies have been undertaken and they have often been hampered by small numbers o f subjects or inadequate controls (O’Connor,
1997).