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Treatment for sexual offenders against children

BMJ 2013; 347 doi: (Published 06 September 2013) Cite this as: BMJ 2013;347:f5397
  1. Jackie Craissati, consultant clinical and forensic psychologist
  1. 1Forensic and Prisons Directorate, Oxleas NHS Foundation Trust, Bracton Centre, Dartford DA2 7AF, UK
  1. jackie.craissati{at}

Progress has been hampered by weak research design, poorly evidenced beliefs, and moral concerns

Substantive evidence exists on the prevalence of sexual abuse in adults and children, the risk of offending, rates of sexual recidivism, and the effectiveness of psychological and pharmacological treatments.1 2 However, no previous systematic reviews have evaluated the effectiveness of interventions for identified perpetrators or those at risk of committing sexual offences against children specifically.

In the linked systematic review, Långström and colleagues (doi:10.1136/bmj.f4630) assess the effectiveness of current medical and psychological interventions for individuals at risk of sexual abuse against children.3 The authors included eight randomised controlled trials and prospective observational studies that met methodological criteria. They found insufficient evidence about the benefits and risks of psychological treatment and pharmacotherapy for adults and for children with sexual behavioural problems. Only one trial for adolescent offenders receiving multisystemic therapy provided limited evidence for reducing reoffending. The authors conclude that the evidence base is weak and further controlled studies are needed.

Given the poor evidence base, health professionals may question why they need to engage with the challenge of treating sex offenders at all, especially given the robust approach to offence focussed interventions …

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