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C 2002) Sexual Abuse: A Journal of Research and Treatment, Vol. 14, No. 2, April 2002 (°
The Relationship Between Static and Dynamic Risk Factors and Reconviction in a Sample of U.K. Child Abusers Anthony Beech,1,4 Caroline Friendship,2 Matt Erikson,2 and R. Karl Hanson
This study examined how well historical information and psychometric data predicted sexual recidivism in a sample of child abusers about to undergo groupbased cognitive behavioral treatment in the community. Static, historical factors, as measured by the Static-99 (R. K. Hanson & D. Thornton, 2000), significantly predicted recidivism over the 6-year follow-up period. High-risk men were over 5 times more likely to be reconvicted for a sexual offence compared to low-risk men. Adding psychometric measures of dynamic risk (e.g., pro-offending attitudes, socio-affective problems) significantly increased the accuracy of risk prediction beyond the level achieved by the actuarial assessment of static factors. This result indicates the importance of considering dynamic risk factors in any comprehensive risk protocol. KEY WORDS: sexual offenders; static risk; dynamic risk; child sexual abusers; recidivism; reconviction.
Cognitive-behavioral therapy (CBT) is now the dominant approach used in the United Kingdom for the treatment of sexual offenders (Beckett, 1998). Although there are some studies supporting the effectiveness of CBT (Alexander, 1999; Nicholaichuk, Gordon, Gu, & Wong, 2000), other studies have found CBT treatment to have little impact on recidivism rates (e.g., Marques, 1998). The variability across studies may be linked to inadequate methods for evaluating offenders and the impact of treatment. It is unlikely that all offenders are equally treatable, 1 University
of Birmingham, United Kingdom. Prison Service, London, United Kingdom. of the Solicitor General of Canada, Ottawa, Canada. 4 To whom all correspondence should be addressed at School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom; e-mail:
[email protected]. 2 HM
3 Department
155 C 2002 Plenum Publishing Corporation 1079-0632/02/0400-0155/0 °
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or that all those who have had therapy actually benefited. Understanding variation in responses to treatment requires improved methods for assessing sexual offenders. So what factors should be considered when examining sexual offenders’ response to treatment? A good starting point for identifying need for treatment would be an offender’s risk level. A great deal of work has taken place in developing risk prediction instruments for sexual offenders (e.g., Sex Offense Risk Appraisal Guide [SORAG], Quinsey, Harris, Rice, & Cormier, 1998; Static-99, Hanson & Thornton, 2000; Sexual Violence Scale [SVR-20], Boer, Hart, Kropp, & Webster, 1997). These instruments have some face validity as measures of the need for treatment and of the intensity of pretreatment problems. Outcome studies, however, have rarely reported offenders’ response to treatment according to risk level. One exception is the study by Friendship, Mann, and Beech (submitted), which reported the relationship between risk level and recidivism for graduates of the U.K. prison-based Sex Offender Treatment Program. They found that high-risk men appeared more difficult to treat than low-risk men, with 26% (13 out of 50) of “treated” high-risk men (as rated on Static-99) being reconvicted for sexual or violence offences within 2 years of leaving prison compared to 2% (5 out of 263) of “treated” low-risk men. Without reconviction data on a matched comparison group, however, it is impossible to tell whether the high-risk offenders were actually less influenced by treatment than the low-risk offenders or whether both high-risk and low-risk offenders experienced the same relative reduction in recidivism rates but started from different preexisting risk levels. Static risk prediction instruments, such as the Static-99, are still fairly crude measures of pretreatment problems and do not take into account dynamic factors, factors which have previously identified as amenable to change (Fisher & Beech, 1998; Marshall, Anderson, & Fernandez, 1999). Among the criminogenic needs commonly targeted in CBT treatment are pro-offending attitudes (e.g., perceiving children as willing to actively engage in sex with adults, lack of insight into the effects of abuse, emotional fixation on children) and socio-affective deficits (e.g., underassertiveness, low self-esteem, and emotional loneliness). Beech (1998) used cluster analysis to group 140 child abusers based on a variety of self-report scales administered pretreatment. He found two main types of offenders, which he labeled High Deviancy and Low Deviancy. Significant differences were found between these two groups on a number of factors including the level of pro-offending attitudes and socio-affective problems. Compared to nonoffender controls, Fisher, Beech, and Browne (1999) found that High Deviancy men had significantly higher levels of cognitive distortions about children, had significantly poorer empathy for victims of sexual abuse, and had significantly higher levels of emotional fixation on children. As well, Fisher et al. (1999) found high levels of the following socio-affective problems in High
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Deviancy men: difficulties forming intimate adult attachments, underassertiveness, and low self-esteem. When compared to nonoffending controls, the Low Deviancy men in Fisher et al.’s study showed poor empathy for victims of sexual assault (like the High Deviancy men; Fisher et al., 1999). However, there were no significant differences between the Low Deviancy men and nonoffending controls in terms of cognitive distortions. Also, the Low Deviancy men did not show the high levels of emotional identification with children found among High Deviancy men. On the contrary, emotional identification with children in the Low Deviancy men was significantly lower than among nonoffender controls. It appeared that the Low Deviancy men had little interest, understanding, or concern about the emotional needs of children. Comparisons between the Low Deviancy men and the nonoffending controls in the socio-affective domain similarly showed mixed results. Fisher et al. (1999) found no difference in assertiveness between these groups; however, the Low Deviancy sexual offenders evidenced significantly higher levels of emotional loneliness and significantly lower levels of self-esteem than the nonoffenders. The socio-affective problems of the Low Deviance group were less marked than the problems noted among the High Deviancy group. Not only did the psychometric responses differ between the two deviancy groups, the groups also differed in terms of offense history. Beech (1998) found that High Deviancy group, compared to the Low Deviancy group, had significantly more victims, were more likely to have a previous conviction for a sexual offence, were more likely to have committed offenses outside the family, and were more likely to have committed offences against boys. Compared to High Deviancy offenders, Low Deviancy offenders were more likely to have committed offences against girls within the family. Critics may argue that the High Deviancy/Low Deviancy distinction is simply a renaming of distinctions previously articulated in the literature, for example, fixated versus regressed (Groth, 1978), preferential versus situational (Howells, 1981), or high and low fixation (Knight & Prentky, 1990). In response to such concerns, it should be noted that nearly a third of the men that would be identified as regressed/situational perpetrators in such classifications (and would by definition be treated as low risk) were found to be classified as High Deviancy in the Beech system. As well, the Beech classification is not redundant with classifications based solely on static risk factors. On an actuarial measure of static risk (Thornton’s Structured Anchored Clinical Judgement Scale: Level 1 [SACJ]; Grubin, 1998) the High Deviancy men had only marginally higher scores than the Low Deviancy group (1.4 vs. 1.0 out of 4). Both groups scored within the Low–Medium range. Consequently, the Beech deviancy classification promises to provide information useful for the measurement of risk and treatment need among sexual offenders. Allam (2000) examined the utility of Beech’s deviancy classification for predicting sexual recidivism in a 2-year follow-up of child molesters referred for
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community treatment. She found that the High Deviancy men were more likely to have reoffended than the Low Deviancy men, and that these differences were still observed when the offenders were matched within each of the four risk levels of Thornton’s SACJ. The aim of the current study was to investigate whether taking into account Deviancy (a measure of dynamic risk) adds to the predictive power of Static-99, a static risk assessment measure (Hanson & Thornton, 2000). The sample consisted of 53 U.K. child molesters followed for an average of 6 years. The specific hypotheses of the study were (1) that level of static risk would be related to level of reconviction, and (2) that level of pretreatment deviancy would make a contribution to the prediction of reconviction rates over and above that made by static risk procedures. METHOD Participants A sample of 140 sexual offenders, who had offended exclusively against children, was used to develop the deviance classification—the same as those examined by Beech (1998). This sample included 59 sexual offenders assessed as part of an evaluation of U.K. probation-led sexual offender treatment programs (Beckett, Beech, Fisher, & Fordham, 1994) plus 81 men assessed in various penal establishments prior to entering a sexual offender treatment program. The average length of sentence of the incarcerated men was 4.9 years (SD = 2.1). The predictive accuracy of the measures was assessed using recidivism information from 53 child abusers in the community sample. Of the original community sample of 59 men reported by Beckett et al., 6 were excluded from the reconviction analysis for the following reasons: still in prison (two cases), returned to Irish Republic—would not show up on criminal history data for England and Wales (three cases), and death (one case). All men in this sample were White. The community sample was recruited from seven short-term programs, the treatment being delivered as 1-week or 2-week intensive programs or as a weekly rolling program. The community sample also included offenders from a residential program where men undertook intensive group therapy every weekday for a number of weeks. Information about the probation, residential, and the combined (“Deviance”) samples is shown in Table I. All of the data shown in Table I were gathered from official sources, except for IQ, which was measured by the Ammons’ Quick Test (Ammons & Ammons, 1962). Offense characteristics of the High and Low Deviancy samples, who are a subset of the men identified in the Beech study (Beech, 1998), are shown in Table II. As Table II documents, the Low and High Deviance groups within this study did not differ in terms of age and IQ.
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Table I. Selected Background Information on the Samples
Sample size Mean age (SD) Mean IQ (SD) Mean number of victims (SD) Victim preference % Boys % Girls % Both Type of offence % Intrafamilial % Extrafamilial % Both % Prior convictions (sexual) % Prior convictions (violence)
Probation
Residential
Deviance sample
37 40.5 (8.2) 101 (10.3) 3.6 (6.8)
16 43.1 (11.1) 105.0 (11.1) 6.8 (5.0)
140a 43.2 (10.6) 100.3 (11.6) 3.0 (2.9)
16 65 19
31 44 25
24 62 14
62 38 — 35 11
37 37 25 63 13
51 39 10 31 11
a This
sample consists of the 53 men who are in the reconviction, the 6 men from the probation sample who were removed from the reconviction analysis, and the 81 men from a separate prison sample of child abusers.
Measures Static-99 (Hanson & Thornton, 2000) Static-99 was designed to measure sexual recidivism risk among sexual offenders. It contains a total of 10 items taken from the Rapid Risk Assessment for Sexual Offender Recidivism (RRASOR; Hanson, 1997) and the SACJ (Grubin, 1998). These items can be grouped into four broad categories: sexual deviance (male victims, single, committed noncontact sex offences), range of potential victims (unrelated victims, stranger victims), persistence (prior sex offences), and antisociality (nonsexual violence, prior sentencing occasions). A final item concerns Table II. Offence Information on the High and Low Deviancy Samples
Sample size Mean age (SD) Mean IQ (SD) Mean number of victims (SD) Victim preference % Boys (or Boys and Girls) % Girls Type of offence % Intrafamilial % Extrafamilial or Both
High Deviancy
Low Deviancy
23 40.8 (9.8) 100.9 (11.5) 5.4 (4.0)
30 41.8 (9.2) 103.2 (10.0) 2.6 (3.4)
61
27
39
73
39
70
61
30
Significance ns (t test) ns (t test) p < .01 (t test) p < .05 (Goodman & Kruskal Tau) p < .05 (Goodman & Kruskal Tau)
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the age of the perpetrator. Scores range from 0 to 12 and can be grouped into the following categories: lower (0, 1 points), medium–low (2, 3), medium–high (4, 5), and high (6 or more points). Questionnaire Measures for Deviance Classification Fourteen scales were used in the deviance classification. Scales 1–4 were used to measure social competence. Scales 5 and 6 were used to measure acceptance of responsibility for behavior in general and offending behavior. Scales 7–10 measure cognitive distortions and justifications for sexual offending. Scales 11–13 measure denial related to sexuality and sexual offending. Scale 14 is a general measure of social desirability, which was used to adjust the scores from the other questionnaires. 1. Short Self-Esteem Scale (Thornton, 1989). Thornton reported the internal consistency of this 8-item scale as .80 (Cronbach’s α). Beech (1998) reported the test-retest reliability of this scale to be .75 in a group of 40 untreated child molesters. 2. UCLA Emotional Loneliness Scale (Russell, Peplau, & Cutrona, 1980). This scale measures the ability to be appropriately intimate with other adults. Russell et al. reported an internal consistency of .91. Beech (1998) reported the test-retest reliability of this scale to be .70 over a 7-month period in a group of 44 treated child molesters. 3. Underassertiveness Scale (from the Social Response Inventory; Keltner, Marshall, & Marshall, 1981). This scale is a self-report measure of underassertiveness. Beech (1998) reported the test-retest reliability of this scale to be .80 over a 7-month period in a group of 44 treated child molesters. 4. Personal Distress Scale (from the Interpersonal Reactivity Index; Davis, 1983). This scale appears to measure the ability to cope with negative feelings (Salter, 1988). Davis reported a coefficient alpha of .78 and a test-retest reliability of .68 in 56 males over a 2.5-month period. 5. Nowicki–Strickland Locus of Control Scale (Nowicki, 1976). This scale measures the extent to which an individual feels that events are contingent upon their own behavior and the extent to which they feel that events are out of their control. Nowicki and Duke (1974) reported test-retest reliability of .83 in 158 participants over a 6-week period. Nowicki and Duke (1982) reported the internal consistency of this scale as .69. 6. Multiphasic Sex Inventory (MSI): Cognitive Distortions and Immaturity Scale (Nichols & Molinder, 1984). Although called a cognitive distortions scale, this scale appears to measure the level of accountability
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8.
9.
10.
11.
12.
13.
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accepted for offending behaviors. Gillis (1991) reported the internal consistency of the scale as .73 (KR20). Simkins, Ward, Bowman, and Rinck (1989) reported the test-retest reliability of this scale to be .84 over a 3-month period. Victim Empathy Distortions (Beckett & Fisher, 1994). This questionnaire measures an offender’s understanding of the effect that his abuses has had on his own victim(s) and how the victim(s) felt about such sexual contact. Beech (1998) reported the internal reliability of this scale to be high (Cronbach’s α = .89) in 140 untreated child molesters and the test-retest reliability to be .95 in 46 untreated child molesters. Cognitive Distortions (from the Children and Sex Questionnaire; Beckett, Beech, & Thornton, in preparation). This scale was designed to measure the extent to which abusers portray their victims as in some way responsible for encouraging or initiating sexual contact. Thornton (personal communication, November 1993) reported the internal consistency to be .90 in a sample of 270 child molesters. Beech (1998) found the test-retest reliability to be .77 in 45 untreated child molesters. MSI: Justifications. This scale addresses the various justifications sexual offenders may use to explain their offenses. Simkins et al. (1989) reported the test-retest reliability to be .78 over a 3-month period. Nichols and Molinder (1984) did not report the internal consistency of this scale. Emotional Identification with Children (from the Children and Sex Questionnaire; Beckett, Beech, & Thornton, in preparation). This scale measures the emotional significance of children to the offender. Thornton (personal communication, November 1993) reported the internal reliability to be .90 in a sample of 270 child molesters. Beech (1998) reported the test-retest reliability to be .63 in 45 untreated child molesters. MSI: Sexual Obsessions. This scale has two purposes: as a measure of sexual obsessions and as a measure of the tendency to exaggerate problems. Nichols and Molinder reported an internal consistency of .65 (KR20). Simkins et al. (1989) reported the test-retest reliability to be .80 over a 3-month period. MSI: Social and Sexual Desirability. This scale purports to measure “normal” sex drives and interests and identifies whether clients are responding in a socially desirable way. Gillis (1991) reported an internal consistency of .87. Simkins et al. (1989) found test-retest reliability to be .84 over a 3-month period. MSI: Sex Deviance Admittance (Child Molest scale). This scale, according to Nichols and Molionder (1984), measures admittance to fantasizing about offending. Simkins et al. (1989) found the test-retest reliability to be .78 over a 3-month period. Nichols and Molinder do not report the internal consistency for this scale.
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14. Social Desirability Scale. In order to address response bias, this scale was derived from items reported by Greenwald and Satow (1970). Beech (1998) reported an internal consistency of .92 for this 12-item scale and a test-retest reliability of .70 over 3–6-month period in a group of 40 untreated child molesters. Procedure Data relating to previous convictions, gender of victims, age of victims, and relationship to victim(s) were obtained from official sources of information (appropriate probation or prison file sources). All of the sample was scored on the Static-99 risk assessment schedule by two of the authors (CF & ME) who have extensive experience in this area. Criminal history data held at New Scotland Yard were used to determine the reconviction rates for the current sample. For the interview and psychometric information, all participants were offered limited confidentiality. They were informed that they would not be named in the research and that any information gathered would not be divulged to anybody engaged in their therapy or anybody making decisions about their future. Furthermore, they were informed that any psychometric information gathered from them would not influence the clinical decision-making process. They were told, however, that if they divulged any information about previously unknown victims or the planning of future crimes then this information would be reported to the appropriate authorities. All questionnaire measures were completed prior to entering treatment. Deviance classification (see Beech, 1998). Deviance (High/Low) was derived by analyzing the mean scores of Scales 1–13 (described above). In order to assess the level of dissembling, test scores for each participant were adjusted for “social desirability response bias” (SDRB), a method described by Saunders (1991). First, the unstandardized regression coefficient was calculated using the standard formula: Y = a X + b, where a is the regression coefficient, X is social desirability scale score (SDRB), and Y is the scale score. Next, the unstandardized regression coefficient became the correction factor so that the derived score for a particular scale was calculated as follows: Y 0 = Y − a × SDRB, where Y 0 is the adjusted score and Y is the original score, and SDRB is the offenders’ score on the social desirability measure. The data for the adjusted scores were then converted into standardized scores. These adjusted scores were analyzed using Ward’s agglomerative method of cluster analysis (Ward, 1963). This analysis forms hierarchical groups of mutually exclusive subsets by using more than one variable. Ward’s method was used because it maximizes the differences between groups, and has been reported as being the most effective clustering methodology (Everitt, 1993). This method is similar to that used in other typological studies of sexual offenders (Hall, Shepherd, & Mudrak, 1992; Knight, 1988).
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The optimal partition of the adjusted data (based on Mojena’s method; Mojena, 1977) produced two groups of child abusers: 59 men labeled as High Deviancy and 81 men labeled as Low Deviancy. Significant differences were found between all of the scales reported above, except for the Interpersonal Reactivity Index: Personal Distress Scale (4) and the MSI: Social and Sexual Desirability Scale (12). Table II presents the static, historical information for the sample used in the recidivism study (n = 23 High Deviancy; n = 30 Low Deviancy). As expected, the High Deviancy men had more victims and were more likely to have unrelated, male victims than were the Low Deviancy men. The groups also differed significantly on mean Static-99 score, t = 3.53, p < .01; High Deviancy mean = 3.39 (SD = 2.27)—Medium–Low to Medium–High range; Low Deviancy mean = 1.43 (SD = 1.59)—Low to Medium–Low range. RESULTS The overall sexual reconviction rate in the sample was 15% (8 out of 53 men) over a 6-year period. Reconviction rates by static risk category were as follows: 40% for High (2 out of 5 men), 31% for Medium–High (4 out of 13 men), 0% for Medium–Low (0 out of 8 men), and 7% for Low (2 out of 27 men). The point biserial correlation between Static-99 score and sexual recidivism was .31 ( p < .05; ROC area of .77; 95% CI of 0.55–0.98). Thirty percent (7 out of 23) of the men classified as High Deviancy were reconvicted for a sexual offense compared to 3% (1 out of 30) of Low Deviancy men, Odds ratio of 12.7, 95% CI of 1.4–112.5; χ 2 (1) = 7.5, with Yates’ correction, p < .01. The point biserial correlation between Deviancy and Static-99 score was .46 ( p < .01). Table III shows reconviction rates according to both static risk level and deviance category. Statistical analysis using logistic regression found that static risk level was significantly related to reconviction, Wald (F) = 4.83, p < .05. Importantly, Deviancy was found to contribute independently to reconviction, once static risk was considered, χ 2 (1) = 4.50, p < .05. As can be seen from Table III, the reconviction rates increased predictably with Static-99 scores for the High Deviancy group. In contrast, almost none of the Low Deviancy group were reconvicted (1 out of 30) over the 6-year follow-up period. Table III. Reconviction Rates in Static-99 Risk and Deviance Categories
High Deviance Low Deviance Total sample
Total sample
High risk Static-99
Medium–high risk Static-99
Medium–low risk Static-99
Lower Static-99
7/23 (30%) 1/30 (4%) 8/53 (15%)
2/4 (50%) 0/1 (0%) 2/5 (40%)
4/9 (44%) 0/4 (0%) 4/13 (31%)
0/2 (0%) 0/6 (0%) 0/8 (0%)
1/8 (13%) 1/19 (5%) 2/27 (7%)
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DISCUSSION The study examined the relationship of static and dynamic factors to the prediction of sexual recidivism. Recidivism was predicted by static, historical factors (as measured by Static-99) as well as by dynamic risk factors measured by psychometric testing (e.g., pro-offending attitudes, socio-affective problems). Both the Static-99 and the psychometrically assessed Deviancy made independent contributions to the prediction of sexual recidivism. The results should be interpreted cautiously, given the small sample size (53 with 8 recidivists). Another concern is the extent to which the supposedly “dynamic” factors are truly changeable. The self-report questionnaires used to assess Deviance addressed factors that should change. Attitudes tolerant of sexual assault, underassertiveness, and victim empathy are all factors commonly targeted in treatment. It is likely, however, that the measures addressed relatively enduring characteristics. The test-retest stability of the individual questionnaires was typically in the .80 range. Most significantly, Deviancy was assessed pretreatment and predicted recidivism up to 6 years later. Further research is required to determine whether changes from High Deviancy to Low Deviancy are associated with reductions in recidivism rates. Nevertheless, the results are encouraging and indicate the usefulness of taking into account psychological problems in any risk assessment protocol. The current research suggests that factors such as low self-esteem, emotional identification with children, and justifications for sexual offending contribute meaningfully to offenders’ risk for sexual recidivism. The methodology used in the current study, however, does not translate directly into an applied risk assessment methodology. All the psychometric information was collected anonymously, and it is unlikely that offenders would be equally forthcoming when serious consequences hinged on their responses. The clustering algorithm used in the current study was complex and dependent on local (sample) mean values. The extent to which it should generalize to other samples is unknown. As well, the large number of factors contributing to the Deviancy classification makes it difficult to determine which of the factors are important for predicting recidivism. Systems for incorporating dynamic variables into sexual offender risk assessments have been proposed by Boer et al. (1997), Dempster and Hart (2001, this issue), Thornton (2001, this issue), and Hanson and Harris (2001). The Sexual Violence Risk – 20 (SVR-20) developed by Boer et al. (1997) lists static and dynamic risk factors to consider before providing an overall evaluation of risk. Many of the variable factors on the SVR-20 overlap with the factors included in the Deviancy classification (e.g., pro-offending attitudes, denial), but both systems contain unique factors. Thornton’s Structured Risk Assessment (SRA; Thornton, 2001, this issue) addresses four Initial Deviance domains: pro-offending attitudes, socio-affective
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problems, deviant sexual interests, and self-management. The first two domains are conceptually equivalent to the two main dimensions assessed in the Deviancy classification. The extent to which the additional two domains, deviant sexual interest and self-management, contribute new information for risk prediction remains to be determined. The extra two dimensions, however, appear from the literature to have strong face validity. Similarly, the Deviancy classification overlaps with the constructs assessed by the Sex Offender Need Assessment Rating (SONAR) developed by Hanson and Harris (2001). In the current version of the SONAR (Hanson, personal communication, May 2001), six dimensions are assessed: negative social influences, intimacy deficits, attitudes tolerant of sexual assault, sexual self-regulation, cooperation with supervision, and general self-regulation. The Deviancy classification used in the current study is most similar to the intimacy deficit and attitudes dimensions of the SONAR, although some correlation with the general self-regulation dimension would also be expected. As with Thornton’s SRA, further research on the SONAR is required to identify which of the various dimensions are most important for the prediction of risk. In summary, this study contributes to a growing body of research on the value of considering dynamic risk factors in the evaluation of sexual offenders. Research has established that static, historical risk factors are related to recidivism, but there is building evidence that comprehensive evaluations should also consider a range of potentially changeable, psychological factors. Further research is required to determine which factors are most important to consider, the extent to which changes in these factors are associated with reductions in recidivism, and how best to integrate dynamic factors into overall risk evaluations. ACKNOWLEDGMENTS We thank Dr Dennis Doren and Dr David Thornton for their encouragement and comments on earlier drafts of this paper. REFERENCES Alexander, M. A. (1999). Sexual offender treatment efficacy revisited. Sexual Abuse: A Journal of Research and Treatment, 11, 101–116. Allam, J. (2000). Community-based treatment for child sex offenders: An evaluation. Unpublished doctoral dissertation, University of Birmingham, Edgbaston, Birmingham, UK. Ammons, R. B., & Ammons, C. H. (1962). Ammons Quick Test. (Available from Psychological Test Specialists) Beckett, R. C. (1998). Community treatment in the U. K. In W. L. Marshall, S. M. Hudson, T. Ward, & Y. M. Fernandez (Eds.), Sourcebook of treatment programs for sexual offenders (pp. 133–152). New York: Plenum Press. Beckett, R. C., Beech, A. R., Fisher, D., & Fordham, A. S. (1994). Community-based treatment for sex offenders: An evaluation of seven treatment programmes: Home Office Occasional
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