BMJ Introduction: Sexual abuse of children is a global problem, and systematic reviews
suggest that 18-20% of women and 7-8% of men in the general population
report being abused before the age of 18.1 2 Rates have not differed substantially in recent decades but might vary across regions.2 [...]
The high prevalence and adverse consequences of sexual abuse
of children warrant increased investment in development of preventive
and therapeutic strategies.14 15 16
Such efforts should directly deal with children, their caregivers, and
their environments to prevent potential abuse and effectively manage
cases of abuse that have already occurred. Interventions for individuals
at risk of sexual abusing children could prevent more children from
being abused.
Society’s response to people who sexually
abuse children has focused largely on punishment and deterrence through
the criminal justice system. Offenders, however, are often directed to
mental health professionals for treatment of disorders related to the
offence (such as sexual compulsivity and paedophilia). Consequently, the
availability of evidence based treatment for this population would be
of considerable interest to medical practitioners. [...]
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.
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.