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


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.

Design Systematic review of interventions designed to prevent reoffending among known abusers and prevention for individuals at risk of sexually abusing children. Randomised controlled trials and prospective observational studies were eligible. Primary outcomes were arrests, convictions, breaches of conditions, and self reported sexual abuse of children after one year or more.

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.

Source: BMJ


Sexual abuse linked to obesity in children, teens with mental illnesses.

Researchers reported that a history of sexual abuse increased the risk for obesity among children and adolescents who had significant psychiatric illnesses.

“Considering that children with mental illness are already at risk for weight problems and will continue to be at increased risk as they move toward adulthood, recognition of this association is important to consider when clinicians are developing appropriate treatment plans or are evaluating potential adverse effects from current treatment regimens,” Brooks R. KeeshinMD, with the Mayerson Center for Safe and Healthy Children at Cincinnati Children’s Hospital Medical Center, said in an interview.

Keeshin and colleagues analyzed medical charts of 1,434 youth admitted to a Midwestern inpatient psychiatric facility during a 10-month period. The researchers compared rates of physical and sexual abuse in youth with a normal BMI percentile and youth whose BMI percentiles were greater than 85, which in the study was considered to be overweight or obese.

Of the entire cohort, 14.7% reported physical abuse, 16.6% reported sexual abuse and 5.4% reported both.

Controlling for age, race, gender and antipsychotic treatment, Keeshin and colleagues found that youth who reported a history of sexual abuse were at greater odds of being overweight/obese (BMI percentiles 85 to 99) than having a healthy BMI (adjusted OR=1.41; 95% CI, 1.01-1.98). Physical abuse was not associated with an increase in BMI percentile.

Female gender and antipsychotic use were associated with overweight/obesity, although fewer girls (29.2%) than boys (38.6%) were prescribed antipsychotic medication. The researchers said being prescribed antipsychotics was the only significant predictor of “significant obesity,” defined as a BMI percentile greater than 99 (aOR=2.59; 95% CI, 1.57-4.28).

“These data suggest that, in youth with a significant mental illness, sexual abuse is significantly and independently associated with obesity, a finding that may prompt increased attention to weight gain by pediatricians who care for youth with a history of sexual abuse and suffer from mental illness,” the researchers concluded.

Source: Endocrine Today


Physical punishment in childhood increased odds for CVD, obesity in adulthood.

Children who were punished with pushing or hitting, independent of severe child abuse, may have increased odds for developing adult CVD, arthritis and obesity, according to researchers.

In a recent study conducted by Tracie Afifi, PhD, of the departments of community health sciences, psychiatry and family social sciences at the University of Manitoba in Winnipeg, Canada, potential associations between harsh physical punishment (i.e., pushing, grabbing, shoving, slapping and hitting) independent of severe child maltreatment (i.e., physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect and exposure to intimate partner violence) and various health conditions were examined.

 “The findings from the current study are novel and support the hypothesis that harsh physical punishment in the absence of child maltreatment is associated with higher odds of several adult physical health conditions,” researchers wrote.

They extracted 2004 and 2005 data from the National Epidemiologic Survey on Alcohol and Related Conditions (n=34,226) which represented US adults aged 20 years or older.

According to data, harsh physical punishment was associated with greater probability of developing CVD with borderline significance, arthritis andobesity. These associations were consistent after adjustments for sociodemographic variables, family history of dysfunction and Axis I and II mental disorders, with odds ratios ranging from 1.20 to 1.30.

“Child maltreatment compared with no harsh physical punishment or child maltreatment was associated with high odds of all physical health outcomes,” researchers wrote. “Notably, when harsh physical punishment and child maltreatment categories were compared, no statistically significant differences were found for any of the eight physical conditions.”

According to researchers, these findings are consistent with the current literature. Afifi and colleagues recommend positive parenting approaches and nonphysical disciplinary methods to promote healthy child development.


Source: Endocrine Today