Effects of multisystemic therapy through midlife: A 21.9-year follow-up to a randomized clinical trial with serious and violent juvenile offenders.

Objective: Although current evidence suggests that the positive effects of multisystemic therapy (MST) on serious crime reach as far as young adulthood, the longer term impact of MST on criminal and noncriminal outcomes in midlife has not been evaluated. In the present study, the authors examined a broad range of criminal and civil court outcomes for serious and violent juvenile offenders who participated on average 21.9 (range = 18.3–23.8) years earlier in a clinical trial of MST (C. M. Borduin et al., 1995). Method: Participants were 176 individuals who were originally randomized to MST or individual therapy (IT) during adolescence and averaged 3.9 arrests for felonies prior to treatment. Arrest, incarceration, and civil suit data were obtained in middle adulthood when participants were on average 37.3 years old. Results: Intent-to-treat analyses showed that felony recidivism rates were significantly lower for MST participants than for IT participants (34.8% vs. 54.8%, respectively) and that the frequency of misdemeanor offending was 5.0 times lower for MST participants. In addition, the odds of involvement in family-related civil suits during adulthood were twice as high for IT participants as for MST participants. Conclusions: The present study represents the longest follow-up to date of an MST clinical trial and demonstrates that the positive impact of an evidence-based youth treatment such as MST can last well into adulthood. Implications of the authors' findings for policymakers and service providers are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A randomized clinical trial of multisystemic therapy with juvenile sexual offenders: Effects on youth social ecology and criminal activity.

A randomized clinical trial evaluated the efficacy of multisystemic therapy (MST) versus usual community services (UCS) for 48 juvenile sexual offenders at high risk of committing additional serious crimes. Results from multiagent assessment batteries conducted before and after treatment showed that MST was more effective than UCS in improving key family, peer, and academic correlates of juvenile sexual offending and in ameliorating adjustment problems in individual family members. Moreover, results from an 8.9-year follow-up of rearrest and incarceration data (obtained when participants were on average 22.9 years of age) showed that MST participants had lower recidivism rates than did UCS participants for sexual (8% vs. 46%, respectively) and nonsexual (29% vs. 58%, respectively) crimes. In addition, MST participants had 70% fewer arrests for all crimes and spent 80% fewer days confined in detention facilities than did their counterparts who received UCS. The clinical and policy implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multisystemic therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial.

Despite the serious and costly problems presented by juvenile sexual offenders, rigorous tests of promising interventions have rarely been conducted. This study presents a community-based effectiveness trial comparing multisystemic therapy (MST) adapted for juvenile sexual offenders with services that are typical of those provided to juvenile sexual offenders in the United States. Youth were randomized to MST (n = 67) or treatment as usual for juvenile sexual offenders (TAU-JSO; n = 60). Outcomes through 12 months postrecruitment were assessed for problem sexual behavior, delinquency, substance use, mental health functioning, and out-of-home placements. Relative to youth who received TAU-JSO, youth in the MST condition evidenced significant reductions in sexual behavior problems, delinquency, substance use, externalizing symptoms, and out-of-home placements. The findings suggest that family- and community-based interventions, especially those with an established evidence-base in treating adolescent antisocial behavior, hold considerable promise in meeting the clinical needs of juvenile sexual offenders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploring differences in youth and parent reports of antisociality among adolescent sexual and nonsexual offenders.

This study examined the extent of, and explored several possible explanations for, the discrepancies found between adolescent and parent reports of conduct problems in adolescent sexual and nonsexual offenders. We found that adolescent sexual offenders scored lower on measures of conduct problems than did nonsexual offenders, whether on the basis of adolescent or parent report, though the difference was much larger for parent reports. Examining this discrepancy more closely, we found that parents of sexual offenders reported less antisocial behavior than did their sons, whereas parents of nonsexual offenders reported more antisocial behavior than did their sons. The same pattern of results was obtained for reports on impulsivity, but much less so with respect to antisocial personality traits such as narcissism and callousness. Measures of family functioning were generally not related to these parent–adolescent discrepancies in reports of conduct problems, but these discrepancies were positively correlated with parental reports of stress. The implications of these findings for the interpretation of research on adolescent sexual offenders and comparisons of sexual and nonsexual offenders are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Comparing indicators of sexual sadism as predictors of recidivism among adult male sexual offenders.

Objective: In this longitudinal study, the predictive validity of a psychiatric diagnosis of sexual sadism was compared with three behavioral indicators of sadism: index sexual offense violence, sexual intrusiveness, and phallometrically assessed sexual arousal to depictions of sexual or nonsexual violence. Method: Five hundred and eighty six adult male sexual offenders were assessed between 1982 and 1992, and these offenders were followed for up to 20-years postrelease via official criminal records. Assessment information included the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis, offense characteristics, phallometric assessment results, and an actuarial risk measure (the Sex Offender Risk Appraisal Guide). Results: Predictive validity was demonstrated in univariate analyses for the behavioral indicators of sexual sadism (area under the curve [AUCs] from .58 to .62) but not psychiatric diagnosis (AUC = .54). Cox regression analyses revealed that phallometrically assessed sexual arousal to violence was still significantly associated with violent (including sexual) recidivism after actuarially estimated risk to reoffend was controlled. A psychiatric diagnosis of sexual sadism, in contrast, was unrelated to recidivism. Conclusions: The results support the use of more behaviorally operationalized indicators of sexual sadism, especially phallometric assessment of sexual arousal, and suggest the DSM criteria for sexual sadism require further work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quantitative reanalysis of aggregate data on IQ in sexual offenders.

General intelligence has been the most commonly studied neuropsychological characteristic of sexual offenders for over 70 years. Results, however, have been highly inconsistent. To assess whether sexual offenders score lower in IQ than nonsexual offenders and to explore which sexual offense characteristics relate to IQ, the authors reanalyzed all reports providing sufficient information. Data spanned 236 samples, comprising 25,146 sexual offenders and controls. The literature contained sufficient information to permit comparison of adult versus juvenile sexual offenders, offenders targeting children versus adults, offenders targeting their own versus unrelated children, and offenders targeting boys versus girls. Results confirm the association between IQ and sexual offending and suggest that previous discrepancies are attributable to how many pedophilic individuals were in each sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of treatment outcome from relationship variables in child and adolescent therapy: A meta-analytic review.

Results from 23 studies examining associations between therapeutic relationship variables and treatment outcomes in child and adolescent therapy were reviewed with meta-analytic procedures. Results indicated that the overall strength of the relationship-outcome associations was modest and quite similar to results obtained with adults. This modest association was moderated by 1 substantive factor, type of patient problem, and 5 methodological factors, timing and source of relationship measurement, type and source of outcome, and shared versus cross-source measurement of relationship and outcome variables. Type, mode, structure, and context of treatment did not moderate associations between relationship variables and outcomes. Findings indicated that the association between the therapeutic relationship and treatment outcome was consistent across developmental levels and across diverse types and contexts of child and adolescent therapy. Recommendations for future process research on the therapeutic relationship in child psychotherapy are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The accuracy of recidivism risk assessments for sexual offenders: A meta-analysis of 118 prediction studies.

This review compared the accuracy of various approaches to the prediction of recidivism among sexual offenders. On the basis of a meta-analysis of 536 findings drawn from 118 distinct samples (45,398 sexual offenders, 16 countries), empirically derived actuarial measures were more accurate than unstructured professional judgment for all outcomes (sexual, violent, or any recidivism). The accuracy of structured professional judgment was intermediate between the accuracy found for the actuarial measures and for unstructured professional judgment. The effect sizes for the actuarial measures were moderate to large by conventional standards (average d values of 0.67–0.97); however, the utility of the actuarial measures will vary according to the referral question and samples assessed. Further research should identify the psychologically meaningfully factors that contribute to risk for reoffending. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapeutic responses of psychopathic sexual offenders: Treatment attrition, therapeutic change, and long-term recidivism.

The authors examined the therapeutic responses of psychopathic sex offenders (≥25 Psychopathy Checklist—Revised; PCL–R) in terms of treatment dropout and therapeutic change, as well as sexual and violent recidivism over a 10-year follow-up among 156 federally incarcerated sex offenders treated in a high-intensity inpatient sex offender program. Psychopathy and sex offender risk/treatment change were assessed using the PCL–R and the Violence Risk Scale—Sexual Offender version (VRS–SO), respectively. Although psychopathic participants were more likely than their nonpsychopathic counterparts (     

Mediators of physical activity behavior change: A multivariate approach.

Objective: Using a multivariate extension of the Baron and Kenny (1986) mediation framework, we examined the simultaneous effect of variables hypothesized to mediate the relationship between a motivationally tailored physical activity intervention, and 6-month physical activity behavior in 239 healthy, underactive adults (M age = 47.5; 82% women). Design: Participants were randomly assigned to (a) print-based feedback; (b) telephone-based feedback; or (c) contact control. Main Outcome Measures: Psychosocial variables, including self-efficacy, decisional balance, and processes of change. Results: All mediation criteria were satisfied for both intervention arms. A moderate indirect effect of print (0.39, 95% CI = 0.21, 0.57) was found due to increases in behavioral processes (0.54, 95% CI = 0.29, 0.80) being attenuated by decreases due to cognitive processes (-0.17, 95%CI = 0.31,-.03). A moderate indirect effect was observed for telephone (0.47, 95% CI = 0.28, 0.66), with increases due to behavioral processes (0.61, 95% CI = 0.34, 0.87) attenuated by decreases due to cognitive processes (0.15, 95% CI = -0.27, -0.02); self-efficacy and decisional balance mediational paths did not attain statistical significance. Conclusions: These findings highlight the importance of studies that deconstruct the theoretical components of interventions to determine which combination produces the greatest behavior changes at the lowest cost. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Individual and familial influences on the onset of sexual intercourse among urban African American adolescents.

A sample of 198 African American families, living in urban poverty, participated in a longitudinal study of adolescent sexual development beginning when children were in the 4th or 5th grade. Self-reports of family conflict and pubertal development and videotaped family interaction data were collected at 2 time points approximately 2 years apart. Youths reported on sexual debut at each time point. More boys than girls reached sexual debut early. Greater levels of family conflict predicted early sexual debut. Observational data indicated more developed preadolescents with greater family conflict and less positive affect were least likely to delay debut. Changes in pubertal development and observed family conflict were associated with early debut. Possible mediating mechanisms and implications for preventive interventions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Initial empirical and clinical findings concerning the change process for ex-gays.

Despite the controversy surrounding sexual reorientation, there are only a few published empirical reports concerning the experiences of ex-gays. Summarizing these reports, this article describes the role of religious variables in the change process. Some kind of change appears to occur for many who identify themselves as ex-gay. Although sexual orientation is not an easily defined or measured phenomenon, change over time is not theoretically unfounded or empirically unprecedented. Many of the individuals who report efforts to become ex-gay feel that the efforts were helpful, and a small percentage feel the efforts were harmful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The transportability of multisystemic therapy to Sweden: Short-term results from a randomized trial of conduct-disordered youths.

This randomized clinical trial assessed the effectiveness of multisystemic therapy (MST) for 156 youths who met the diagnostic criteria for conduct disorder. Sweden's 3 largest cities and 1 small town served as the recruiting area for the study. A mixed factorial design was used, with random allocation between MST and treatment as usual groups. Assessments were conducted at intake and 7 months after referral. With an intention-to-treat approach, results from multiagent and multimethod assessment batteries showed a general decrease in psychiatric problems and antisocial behaviors among participants across treatments. There were no significant differences in treatment effects between the 2 groups. The lack of treatment effect did not appear to be caused by site differences or variations in program maturity. MST treatment fidelity was lower than that of other studies, although not clearly related to treatment outcomes in this study. The results are discussed in terms of differences between Sweden and the United States. One difference is the way in which young offenders are processed (a child welfare approach vs. a juvenile justice system approach). Sociodemographic differences (e.g., rates of poverty, crime, and substance abuse) between the 2 countries may also have moderating effects on the rates of rehabilitation among young offenders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Federal standards for community registration of juvenile sex offenders: An evaluation of risk prediction and future implications.

The enactment of the Adam Walsh Child Protection and Safety Act in 2006 is an extension of current protective legislation aimed at establishing stricter sanctions for community-released sexual offenders. What largely separates the Adam Walsh Act from previous registration and notification laws is the crossing of traditional jurisdictional boundaries between adult and juvenile courts at the federal level. This article addresses several key concerns relating to the application of these federal standards to adolescent offenders. In addition to a review of the extant literature, we present findings from an exploratory evaluation that examines the ability of the Adam Walsh Act's classification system to predict future offending among a sample of 112 adjudicated juvenile sex offenders over a 2-year outcome period. Results indicate that offenders who met criteria for registration did not reoffend (sexually or nonsexually) at a significantly higher rate than those who did not meet registration criteria. Implications regarding appropriate risk assessment and management of youth sexual offenders are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Rejoinder: The challenges of reconciling family theory with method.

Reply by Carlson and Grotevant regarding comments of their original article (see record 1988-17683-001). We appreciate the thoughtful and relevant comments concerning our review of family rating scales provided by Cowan, Coyne, and Fisher. There are many points in their comments with which we agree and that nicely complement the points of emphasis in our article. There are two key issues about which we would like to provide further comment. The first concerns choosing between rating scales and microanalytic interaction coding schemes. The second concerns the links between family theory and measurement and the implications of theory for the level of analysis at which family processes are examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving health outcomes among youth with poorly controlled type I diabetes: The role of treatment fidelity in a randomized clinical trial of multisystemic therapy.

The purpose of the study was to assess whether therapist treatment fidelity was a predictor of treatment outcome in a randomized clinical trial of multisystemic therapy with 10- to 16-year-old youths with chronically poorly controlled Type I diabetes (N = 40). Treatment fidelity was assessed by objective ratings of therapy sessions and questionnaires completed by caregivers and by therapists. Relationships between fidelity measures were assessed. Structural equation modeling (SEM) was used to test whether high fidelity would lead to improved regimen adherence and to improved metabolic control outcomes via regimen adherence. Objective ratings of treatment fidelity were significantly related to therapist-reported but not to caregiver-reported treatment fidelity. SEM results supported a completely mediated pathway between treatment fidelity and metabolic control, with regimen adherence mediating the relationship. Results suggest that conducting complex behavioral interventions with a high degree of fidelity can improve treatment outcomes among youths with chronic illnesses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment techniques and outcomes in multidimensional family therapy for adolescent behavior problems.

The link between treatment techniques and long-term treatment outcome was examined in an empirically supported family-based treatment for adolescent drug abuse. Observational ratings of therapist interventions were used to predict outcomes at 6 and 12 months posttreatment for 63 families receiving multidimensional family therapy. Greater use of in-session family-focused techniques predicted reduction in internalizing symptoms and improvement in family cohesion. Greater use of family-focused techniques also predicted reduced externalizing symptoms and family conflict, but only when adolescent focus was also high. In addition, greater use of adolescent-focused techniques predicted improvement in family cohesion and family conflict. Results suggest that both individual and multiperson interventions can exert an influential role in family-based therapy for clinically referred adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' sexual values for self and clients: Implications for practice and training.

Therapists may be confronted with clients whose sexual values and behaviors are different from their own. To understand more about therapists' sexual values and how these values may affect therapy, the current study assessed therapists' sexual values for both themselves and their clients in the areas of premarital, casual, and extramarital sex, open marriages, sexual orientation, and sex in adolescence and late adulthood. Therapists differed selectively in their sexual values depending on their gender, religious involvement, and political affiliation. Therapists appeared comfortable working with a variety of sexual issues in therapy, and it appears that training in sexual issues is helpful in clinical work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of sexual abuse allegations in child custody cases.

Family courts frequently rely on the expertise of mental health professionals to assess allegations of sexual abuse within the context of child custody evaluations. Such evaluations are complex and require knowledge of techniques used in sexual abuse and sexual offender evaluations, as well as knowledge of child custody practices. Preliminary findings from a national survey of 84 psychologists indicated that respondents tend to adhere to the child custody guidelines of the American Psychological Association. However, few practitioners followed formal models, protocols, or guidelines when evaluating alleged victims or alleged perpetrators of sexual abuse in conjunction with child custody disputes. Implications for professional practice are discussed, along with a proposed comprehensive model for assessing sexual abuse allegations in child custody cases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The state of the art and the progression of science in family therapy research.

Review of books: (1) Handbook of Psychotherapy and Behavior Change, (3rd Ed.), New York: Wiley, 1986, S. L. Garfield and A. E. Bergin (Eds.); (2) Patterns of Change: Intensive Analysis of Psychotherapy Process, New York: Guilford, 1984, L. N. Rice and L. S. Greenberg (Eds.); (3) The Psychotherapeutic Process: A Research Handbook, New York: Guilford, 1986, L. S. Greenberg and W. M. Pinsof (Eds.); (4) Integrating Research and Clinical Practice, 1985, Rockville, MD: Aspen Systems, L. L. Andreozzi (Ed.); and (5) The State of the Art in Family Therapy Research: Controversies and Recommendations, 1988, New York: Family Process Press, L. C. Wynne (Ed.). Reviewed by Varda Shoham-Salomon and Deborah Bice-Broussard. (PsycINFO Database Record (c) 2010 APA, all rights reserved)