Inappropriate Sexual Behavior and Sexual Offending

Abstract

There is no consistent scientific information regarding the relative prevalence of sex offenders with intellectual and developmental disabilities (IDD) but there is no doubt that it is a significant clinical problem. Research investigating etiological factors has found a weak but significant link with sexual abuse in childhood, and more robust links with lower levels of impulsivity, anxiety, aggression, and substance use. It is puzzling that reports of behavioral treatments remain sparse despite years of availability but cognitive behavioral treatment reports, including mindfulness, are more numerous and suggest that procedures might be effective. However, there are a large number of individual treatment reports, case series and treatment trials but none fulfil the requirements of a well-established, effective treatment. One of the difficulties is that a social validity requirement of any treatment for inappropriate sexual behavior is that follow-up lasts many years and that incidents are reduced to zero. There is now robust research on the assessment of cognitive distortions that support inappropriate sexual behavior, other personal factors, and sexual knowledge and attitudes that can guide treatment. I present a case study that illustrates the way in which all the research conducted underpins every procedure in a treatment program from assessment to follow-up. These include attention to quality of life that, under the guise of the good lives model, has become a fundamental strand of treatment addressing attachments, relationships, housing, occupation, and leisure pursuits.