Aggression and Violent Behavior 54 (2020) 101405

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Aggression and Violent Behavior

journal homepage: www.elsevier.com/locate/aggviobeh

Neuropsychological functioning in child sexual abusers: A systematic review T

a,⁎ b,c
Daniel Turner , Martin Rettenberger
a
Department of Psychiatry, University Medical Center Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany
b
Department of Psychology, Johannes Gutenberg-University Mainz (JGU), Binger Straße 14-16, 55122 Mainz, Germany
c
Centre for Criminology (Kriminologische Zentralstelle – KrimZ), Viktoriastraße 35, 65189 Wiesbaden, Germany

A R T I C LE I N FO A B S T R A C T

Keywords: Impairments in neuropsychological functioning are emphasized among the core components in etiological
Executive function models about sexual offending against children. In order to distinguish those neuropsychological deficits that can
Inhibition specifically be found in child sexual abusers, the present systematic review summarizes all studies published
Set-shifting between 1980 and 2019 comparing neuropsychological functions of child sexual abusers with different control
Pedophilia
groups. The databases PubMed, Google scholar, and PsycInfo were used to find relevant studies. After applying
Sex offender
Neuropsychology
certain inclusion criteria (e.g., at least one comparison group), 25 studies were identified as being relevant for
the present review. Most evidence exists about the assumption that child sexual abusers have more deficits in set-
switching, inhibition, and verbal functioning compared to healthy controls. When comparing child sexual
abusers to non-sexual offenders or sexual offenders against adults, no distinct differences were found. Single
studies indicate that pedophilic child sexual abusers tend to have superior abstraction and planning abilities
compared to non-pedophilic child sexual abusers. Impairments in executive functioning could lead to more self-
regulatory deficits thereby increasing the likelihood of committing sexual offences. The findings of the present
review indicate that classifying child abusers based on their motivation to offend might help to dissolve some of
the existing empirical inconsistencies.

1. Introduction
Deficits in neuropsychological functioning are highly relevant in
theories about the development of sexually aggressive behaviors (Tost
et al., 2004; Turner et al., 2018; Ward & Beech, 2006). The term
‘neuropsychological functioning’ covers a wide range of cognitive
abilities that are under the control of specific brain structures (Morgan
& Ricker, 2016), including speed of information processing, attention,
language, memory, and executive functions. Until today, executive
functions have received the most attention when it comes to the re-
lationship with criminal behaviors (Ogilvie, Stewart, Chan, & Shum,
2011).
Executive functioning is a multifaceted neuropsychological con-
struct referring to a set of top-down mental processes enabling an in-
dividual to self-regulate and self-direct behavior towards a certain goal
(Diamond, 2013; Snyder, Miyake, & Hankin, 2015; Suchy, 2009). Al-
though there is no unifying theory about executive functioning the
approach proposed by Miyake et al. (2000) is among the most cited.
They suggested that there are three main executive functions: inhibi-
tion, updating, and shifting (Friedman et al., 2008; Friedman & Miyake,
2004; Miyake et al., 2000). Inhibition (synonym: response inhibition,
interference inhibition, behavioral inhibition) refers to the ability to
suppress a prepotent, activated or already ongoing action or impulse
that interferes with reaching a higher-level goal (Miyake et al., 2000;
Stahl et al., 2014). Updating describes the ability to continuously
monitor the information stored in one's working memory, to adapt the
working memory contents according to changing circumstances, and to
shield the working memory contents from distraction (Hofmann,
Schmeichel, & Baddeley, 2012; Kane, Bleckley, Conway, & Engle, 2001;
Miyake et al., 2000). Finally, shifting (synonym: set-shifting, task-
switching, cognitive flexibility) describes the ability to shift between
multiple tasks or mental sets subserving the same goal or the ability to
switch between multiple equivalent goals (Hofmann et al., 2012;
Miyake et al., 2000; Monsell, 2003).
Executive functions are to a large part genetically determined
(Barnes, Dean, Nandam, O'Connell, & Bellgrove, 2011; Friedman et al.,

Abbreviations: CSA, child sexual abusers; HC, healthy controls; NSO, non-sexual offenders; COWAT, Controlled Word Association Test; MFFT, Matching Familiar
Figures Test; WAIS, Wechsler Adult Intelligence Scale; WMS, Wechsler Memory Scale; CBT, Corsi Block Tapping test; RNTB, Reitan Neuropsychological Test Battery;
LNNTB, Luria-Nebraska Neuropsychological Test Battery; CANTAB, Cambridge Neuropsychological Test Automated Battery
⁎
Corresponding author at: Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Straße 8, 55131 Mainz, Germany.
E-mail address: daniel.turner@unimedizin-mainz.de (D. Turner).

https://doi.org/10.1016/j.avb.2020.101405
Received 22 January 2019; Received in revised form 31 May 2019; Accepted 23 March 2020
Available online 20 April 2020
1359-1789/ © 2020 Elsevier Ltd. All rights reserved.
D. Turner and M. Rettenberger
2008; Lee et al., 2012). However, an individual's executive functioning
can also strongly be influenced by psychiatric conditions, for example,
affective disorders or attention-deficit/hyperactivity disorder (Konrad
& Eickhoff, 2010; Snyder, 2013), specific personality traits like im-
pulsivity or hostility (Coolidge, Thede, & Jang, 2004), or traumatic
childhood experiences such as physical, emotional or sexual abuse
(Gould et al., 2012; Navalta, Polcari, Webster, Boghossian, & Teicher,
2006). Due to their outstanding importance for goal-directed behaviors,
already more than 50 years ago researchers have discovered the sig-
nificance of neuropsychological and executive dysfunctions for the ex-
planation of sexual offending (see, for example, Lang, 1993, for a more
detailed description). In the meantime, a considerable amount of re-
search addressing neuropsychological functioning in sexual offenders
has accumulated.
1.1. The current state of research concerning neuropsychological
functioning of sexual offenders
The current state of research is quite ambiguous and previous re-
searchers have criticized that most studies used relatively hetero-
geneous experimental and control groups (Adjorlolo & Egbenya, 2016;
Joyal, Beaulieu-Plante, & de Chantérac, 2014). Summarizing the main
results of previous reviews, it can be noted that sexual offenders in
general seem to have significant deficits in neuropsychological func-
tioning compared to healthy controls (HCs) and non-sexual offenders
(NSOs; e.g., Adjorlolo & Egbenya, 2016; Joyal et al., 2014; Joyal, Black,
& Dassylva, 2007).
Impairments could be found in most neuropsychological functions
such as verbal abilities, working memory, cognitive flexibility, atten-
tion and concentration, visual/spatial abilities, abstract reasoning, re-
sponse and behavioral inhibition, and planning (Adjorlolo & Egbenya,
2016). Sexual offenders against adults and sexual offenders against
children have not explicitly been compared yet. Based on these findings
different etiological theories and models acknowledging the relevance
of neuropsychological dysfunctions in the development of sexually of-
fensive behaviors have been published (e.g., Cohen et al., 2002; Flor-
Henry, 1987; Tost et al., 2004; Ward & Beech, 2006).
1.2. Theoretical approaches concerning sexually offensive behaviors
In their Integrated Theory of Sexual Offending Ward and Beech (2006,
2016) described sexual offending as a result of certain clinical symp-
toms or state factors, for example, deviant sexual arousal, emotional
problems, social difficulties, or cognitive distortions. These clinical
symptoms, in turn, are generated through the ongoing interaction of
biological factors (e.g., genetic inheritance and brain development),
environmental factors (e.g., social, cultural, and personal circum-
stances), and neuropsychological functioning. According to Ward and
Beech (2006, 2016) there are three interlocking neuropsychological
systems: a motivational/emotional system, a perception and memory
system, and an action selection and control system.
The motivational/emotional system is responsible for the creation
of goals and values and to adjust the motivational state to changing
environmental circumstances and is comparable to the concept of set-
shifting. The perception and memory system's responsibility is to pro-
cess sensory information and to create representations of objects and
events and to have these representations readily available for working
memory. The perception and memory system is comparable to the
concept of updating. Finally, the action selection and control system is
responsible for planning, implementing, and evaluating action plans,
and to control behavior, thoughts, and emotions; this system is com-
parable to the concept of inhibition (Ward & Beech, 2006, 2016). Ac-
cording to this theory the commission of a sexual offence could lead to
the maintenance or escalation of offence-supportive neuropsychological
deficits (Ward & Beech, 2006). For example, a first undetected sexual
offence could lead to the perception that sexual offending is not
2
Aggression and Violent Behavior 54 (2020) 101405
followed by legal consequences resulting in a further disinhibition
within the action selection and control system.
Neuropsychological dysfunctions are not only seen as a central part
in the etiology of sexual offending in general but also in the develop-
ment of paraphilic sexual interests (Flor-Henry, 1987; Tost et al., 2004).
The starting point of these theoretical assumptions was the finding that
individuals suffering from bilateral lesions of the medial temporal lobe
(Klüver-Bucy syndrome) are frequently characterized by hypersexual
behaviors or the tendency to seek sexual stimulation from unusual or
inappropriate objects (e.g., children; Marlowe, Mancall, & Thomas,
1975; Ott, 1995). Building upon these findings, early neuropsycholo-
gical studies found that paraphilic sexual offenders performed sig-
nificantly worse compared to HC on neuropsychological tests tapping
into left frontal and temporal brain functioning (e.g., tests of verbal
learning or set-shifting; Hucker et al., 1986; Yeudall & Fromm-Auch,
1979, 1982). Furthermore, sexual offenders showed significant EEG
alterations especially over left hemispheric and interhemispheric re-
gions (Flor-Henry, 1987; Flor-Henry, Lang, Koles, & Frenzel, 1991).
Combining these findings Flor-Henry (1987; see also Flor-Henry et al.,
1991) hypothesized that a pathological neural organization of the left
(dominant) hemisphere leads to sexually deviant representations and
due to disturbed interhemispheric connections only these sexually de-
viant representations are able to induce an orgasm (Flor-Henry, 1987).
Some years later, Tost et al. (2004) described a pedophilic disorder
as a reward deficiency syndrome due to its phenomenological overlap
with compulsive-impulsive spectrum disorders. They further hypothe-
sized that—just like in other disorders from the compulsive-impulsive
spectrum (e.g., pathological gambling, binge eating disorder, or tri-
chotillomania)—there exists a specific rewarding content of interest,
i.e., sexual activity with children, which is the consequence of deficient
striato-thalamo-cortical processing loops (Tost et al., 2004). To test this
hypothesis Tost et al. (2004) assessed the neuropsychological func-
tioning of four pedophilic male subjects with a neuropsychological test
battery tapping into all cognitive domains relevant for their model and
found that the pedophilic men were severely impaired in most of the
proposed domains (up to five standard deviations below the mean of
the normative sample).
However, none of these early studies compared the performance of
pedophilic and non-pedophilic participants and thus it remains unclear
whether the impairments were due to a pedophilic disorder or rather
due to the fact that all included individuals were sexual offenders. This
is all the more important because deficits in neuropsychological func-
tioning have been found in different offender populations, including
sexual offenders against children, sexual offenders against adults, and
non-sexual violent offenders (Ogilvie et al., 2011). To find out whether
or not sexual offenders against children differ from other offenders
concerning their neuropsychological profile it is necessary to compare
the neuropsychological functioning of different offender subgroups,
which was the starting point of the current review.
1.3. Present study
The present systematic review aimed at improving our under-
standing of the neuropsychological functioning of sexual offenders
against children and tries to answer the following questions:
1.) Can sexual offenders against children be differentiated from non-
offending individuals or other offenders (e.g., non-sexual offenders,
sexual offenders against adults) according to their neuropsycholo-
gical profile?
2.) Are there any differences in the neuropsychological profiles be-
tween pedophilic and non-pedophilic sexual offenders against
children?
3.) Are there any differences in the neuropsychological profiles be-
tween intra- and extra-familial sexual offenders against children?
4.) Are there any differences in the neuropsychological profiles
D. Turner and M. Rettenberger
Fig. 1. PRISMA Flow Diagram for Systematic Reviews and Meta-Analyses.
between offending and non-offending pedophilic individuals?
2. Methods
2.1. Data search
The present systematic review was conducted according to the
PRISMA checklist for systematic reviews and meta-analyses (Moher,
Liberati, Tetzlaff, Altman, & The PRISMA Group, 2009). To identify
relevant publications, we performed a systematic search of the scientific
literature in PubMed, Google scholar, and PsycInfo using the following
combinations of keywords: pedophilia OR paraphilia OR sex offender
OR child molester AND neuropsychology OR neuropsychological OR
executive function OR brain function. Only journal articles that were
published between 1980 and 1st of May 2019 were considered for in-
clusion in the present review. Furthermore, the reference lists of all
pertinent papers as well as the reference lists of previous reviews and
meta-analyses (e.g., Adjorlolo & Egbenya, 2016; Blanchard, Cantor, &
Robichaud, 2006; Joyal et al., 2007; Joyal et al., 2014; Lang, 1993)
were checked for additional studies not identified through the search
engines (see Fig. 1). Relevant studies were selected based on the fol-
lowing inclusion criteria: 1.) published in a scientific journal, 2.) con-
tain a subgroup of sexual offenders against children whose results were
reported separately, 3.) contain a comparison group, 4.) report on at
least one neuropsychological outcome other than IQ, and 5.) English or
German language. Because the authors of the current systematic review
3
Aggression and Violent Behavior 54 (2020) 101405
have command of English and German language, only studies that were
conducted in these languages could be included in the systematic re-
view process; however, all of the identified studies were in English
language.
3. Results
Altogether we identified 25 relevant studies, which were included in
our systematic review. Eight of these studies (Habermeyer et al., 2013;
Kärgel et al., 2017; Langevin & Curnoe, 2008; Massau et al., 2017;
Perley-Robertson, Helmus, Derkzen, & Serin, 2016; Rosburg et al.,
2018; Suchy, Eastvold, Strassberg, & Franchow, 2014; Turner et al.,
2018) were neither included in the most recent systematic review by
Adjorlolo and Egbenya (2016) nor in the meta-analysis of Joyal et al.
(2014). All included studies were case control studies comparing neu-
ropsychological functioning in sexual offenders against children (child
sexual abusers; CSA) with either sexual offenders against adults, non-
sexual offenders (NSO), or healthy controls (HC). In the following we
will provide a detailed textual analysis of the included studies. Each
section begins with a short summary of the main results, followed by a
more detailed study description. Because most studies had multiple
control groups and in order to avoid redundancies detailed study de-
scriptions are only given once although one study might fall under
different subheadings. Furthermore, Table 1 provides a targeted
synthesis of the findings concerning the most researched neu-
ropsychological functions.
D. Turner and M. Rettenberger Aggression and Violent Behavior 54 (2020) 101405

Table 1
Overview about the findings concerning the most frequently studied neuropsychological functions.
Set-switching Abracen, O'Carroll, & Ladha, 1991; Becerra-García & Egan, 2014; Cohen et al., 2002;
Set-switching was evaluated in 12 studies. All except of one study used the Trail- Cohen, Nesci, Steinfeld, Haeri, & Galynker, 2010; Eastvold, Suchy, & Strassberg,
Making-Test B or the Wisconsin Card Sorting Test. In general, CSA showed more 2011; Joyal et al., 2007; Kruger & Schiffer, 2011; Langevin, Wortzman, Dickey,
deficits in set-switching than HC. However, it seems as if this difference is mainly Wright, & Handy, 1988; Langevin, Wortzman, Wright, & Handy, 1989; Massau et al.,
driven by non-pedophilic CSA. One study even found a superior set-switching 2017; Schiffer & Vonlaufen, 2011; Young, Justice, & Erdberg, 2012.
performance in pedophilic CSA compared to HC and non-offending pedophilic men.
Compared to NSO and sexual offenders against adults the findings were again less
clear. An equal number of studies could show performance deficits in CSA,
irrespective of whether or not they were diagnosed with a pedophilic disorder.
Inhibition Cohen et al., 2002; Cohen et al., 2010; Eastvold et al., 2011; Habermeyer et al., 2013;
Altogether, 10 studies evaluated inhibition performance in CSA. Most frequently the Joyal et al., 2007; Massau et al., 2017; Perley-Robertson et al., 2016; Schiffer &
Stroop Task, different versions of the Go/No-Go Task or of the Stop-Signal-Task were Vonlaufen, 2011; Suchy, Whittaker, Strassberg, & Eastvold, 2009; Turner et al.,
used to assess inhibition. While the Stroop Task measures interference inhibition, or 2018.
the ability to selectively attend goal-relevant stimuli and neglect distracting stimuli,
the Go/No-Go Task and the Stop-Signal-Task assess response inhibition, or the ability
to suppress an activated or already ongoing action (Stahl et al., 2014; Turner,
Sebastian, & Tüscher, 2017). CSA showed clearly more deficits in interference
inhibition compared to HC. Concerning response inhibition the findings of previous
studies are less clear, with some studies finding a worse performance in CSA
compared to HC, while others did not report any differences. Deficits in response
inhibition seem to be especially pronounced when sexual stimuli are used as Go- or
No-Go cues. More studies found deficits in inhibition in CSA compared to NSO,
however, a not negligible number of studies did not find any differences.
Attention Becerra-García & Egan, 2014; Cohen et al., 2002; Eastvold et al., 2011; Kruger &
Attention was assessed in eight studies altogether. Most frequently the Trail-Making- Schiffer, 2011; Langevin et al., 1988; Langevin et al., 1989; Schiffer & Vonlaufen,
Test A was applyed for the assessment of attention (six studies altogether). Only two 2011; Young et al., 2012
of the included studies found a weaker attention performance in CSA, in one study
compare to HC and in the other compared to NSO. Interestingly, in both studies this
accounted for intra-familial CSA only.
Planning Cantor et al., 2004; Cohen et al., 2002; Cohen et al., 2010; Eastvold et al., 2011;
Planning abilities were assessed in seven studies, always with the differing tests (the Massau et al., 2017; Schiffer & Vonlaufen, 2011; Valliant, Gauthier, Pottier, &
Tower of London Task was used in two studies). Two studies found a superior Kosmyna, 2000.
performance of pedophilic CSA compared to non-pedophilic CSA and opiate addicts.
No differences were found in comparison to HC, NSO and sexual offenders against
adults.
Verbal functioning Abracen et al., 1991; Cantor et al., 2004; Cohen et al., 2002; Cohen et al., 2010; Joyal
All in all, six studies assessed verbal functioning in terms of verbal memory or verbal et al., 2007; Schiffer & Vonlaufen, 2011.
fluency. While verbal fluency was in all cases evaluated using the Controlled Word
Association Task or comparable tests, verbal memory was always assessed with
different tasks. Again, compared to HC, CSA showed clear deficits in verbal fluency as
well as in verbal memory. No performance deficits were found compared to NSO.
While one study found impairments in CSA compared to sexual offenders against
adults, another study did not find any differences between the two groups.
Abstraction Eastvold et al., 2011; Langevin et al., 1988; Langevin et al., 1989; Young et al., 2012.
In total, four studies assessed abstraction performance. Three studies used the
Category Test of the RNTB. Two of the studies applying the Category Test found
performance deficits in CSA compared to NSO, while the third study reported about a
superior performance of CSA compared to sexual offenders against adults.
Working memory Becerra-García & Egan, 2014; Cantor et al., 2004; Eastvold et al., 2011; Massau et al.,
Four studies evaluated working memory. Of these three used the Digit Span Task. It 2017.
was found that CSA had poorer working memory capacity than HC. One study found
performance deficits in CSA compared to sexual offenders against adults, while one
study did not find any differences between CSA and NSO.

3.1. Differences between sexual offenders against children and healthy
controls
A total of 15 studies compared the neuropsychological functioning
between CSA and HC (Abracen et al., 1991; Becerra-García & Egan,
2014; Cohen et al., 2002; Cohen et al., 2010; Habermeyer et al., 2013;
Kärgel et al., 2017; Kruger & Schiffer, 2011; Massau et al., 2017; Plante,
Manuel, & Bryant, 1996; Rosburg et al., 2018; Schiffer & Vonlaufen,
2011; Scott, Cole, McKay, Golden, & Liggett, 1984; Suchy et al., 2009;
Turner et al., 2018; Valliant et al., 2000). Thereby, CSA showed more
impairments in inhibition (six out of ten studies), set-switching (four
out of seven studies), processing speed (four out of four studies), and
verbal functioning (three out of five studies). Furthermore, four studies
did not find any differences between CSA and HC on any of the included
neuropsychological measures.
The first study, which was conducted within the time period re-
levant for the present review was published by Scott et al. (1984). The
authors used the Luria-Nebraska Neuropsychological Test Battery
(LNNTB) for the assessment of neuropsychological functioning in 36
sexual offenders and 31 HC. The LNNTB is a standardized set of 14
different tests evaluating learning and cognitive skills. The submeasures
assess the following neuropsychological functions: motor performance,
rhythm, tactile and visual perception, receptive speech, expressive
speech, writing, reading, arithmetic, memory, intellectual processes,
pathognomonic, left hemisphere function, and right hemisphere func-
tion. The sexual offenders were further divided into sexual offenders
against adults and CSA; however, the authors did not report how many
individuals were assigned to each group. All sexual offenders were re-
cruited from a state psychiatric facility. The whole sexual offender
group performed significantly worse on most submeasures of the
LNNTB compared to the HC. Furthermore, CSA performed significantly
worse on all subtests compared to sexual offenders against adults.
As the first and only so far, Plante et al. (1996) compared 80 Roman
Catholic priests who had sexually abused children with 80 priests
without a history of sexually abusing minors. All participants were re-
cruited from a private psychiatric hospital specialized on the treatment

4
D. Turner and M. Rettenberger
of clergy. Participants from the non-abusive group were mainly treated
because of affective, adjustment, or eating disorders. Neuropsycholo-
gical functioning of all participants was assessed using the Halstead-
Reitan Neuropsychological Test Battery (RNTB). The RNTB is a com-
prehensive neuropsychological test battery measuring, for example, set-
switching, tactual performance, and motor speed but also provides a
composite measure for overall neuropsychological functioning. On that
composite score the two groups did not differ. Subtest performance was
not reported.
Cohen et al. (2002) compared the performance in verbal functioning
(Wechsler Adult Intelligence Scale-Revised [WAIS-R] vocabulary test),
set-switching (Wisconsin Card Sorting Test [WCST] and Trail-Making-
Test B [TMT-B]), visual attention (TMT-A), planning and impulse
control (Gambling Task), interference inhibition (Stroop Test), and
verbal fluency (Controlled Oral Word Association Test [COWAT]) be-
tween 22 CSA and 24 HC. All CSA were diagnosed with a non-exclusive
pedophilic disorder oriented towards female children based on the
DSM-IV diagnostic criteria. They were all either on parole or probation
following conviction for a contact sexual offence. No CSA was diag-
nosed with an axis I psychiatric disorder. No differences in demo-
graphic variables were found between the two groups. The CSA showed
a significantly worse performance in verbal functioning; however, when
controlling for education this difference disappeared. On all other tests
the groups did not differ significantly.
With the intention to replicate and extend their previous findings
Cohen et al. (2010) compared 51 CSA with 53 male and female opiate
addicts and 84 male and female HC. Again, all CSA were male, were
diagnosed with a pedophilic disorder based on DSM-IV, and were re-
cruited from an outpatient facility. The opiate addicts had at least a
two-year history of opiate dependence; however, they had been ab-
stinent from illicit substances for at least six months at the time the
study was conducted. HC were recruited from the general population.
CSA and opiate addicts were significantly older and significantly less
educated than HC. Neuropsychological functions included verbal flu-
ency (COWAT), reflection impulsivity and planning (Porteus Mazes),
interference inhibition (Stroop Test), and set-switching (TMT–B,
WCST). Because level of education was significantly correlated with
neuropsychological functioning, it was entered as a covariate in all
analyses. In sum, CSA showed a significantly worse performance in set-
switching and interference inhibition compared to HC and had a slower
processing speed compared to HC and opiate addicts. On the other side,
CSA had superior planning abilities at least compared to the opiate
addicts.
Habermeyer et al. (2013) assessed response inhibition abilities using
a Go/No-Go task in 11 outpatient CSA and compared their performance
with seven HC from the general population. All CSA were diagnosed
with a pedophilic disorder based on DSM-IV-TR. Five CSA were con-
victed because of a sexual offence against children involving direct
physical contact with the victim(s), while six CSA were convicted of
internet child pornography-related offences. CSA showed significantly
slower reaction times on No-Go trials and had significantly lower d’
scores (= hit rate minus false alarm rate), indicating a significantly
worse response inhibition performance than the HC.
3.2. Differences between sexual offenders against children and non-sexual
offenders
In total, 10 studies could be identified concerning studies comparing
CSA to non-sexual offenders (NSO) (Abracen et al., 1991; Eastvold
et al., 2011; Hucker et al., 1986; Langevin et al., 1988; Langevin et al.,
1989; Langevin & Curnoe, 2008; Perley-Robertson et al., 2016; Schiffer
& Vonlaufen, 2011; Suchy et al., 2014; Valliant et al., 2000). Impaired
neuropsychological functions found by most studies were inhibition
(three out of five studies) and processing speed (two out of three stu-
dies). Furthermore, CSA showed at least some impairments in attention,
set-switching, abstraction, verbal processing, and planning. Two studies
5
Aggression and Violent Behavior 54 (2020) 101405
did not find any differences between CSA and NSO and one study even
found some performance advantages—in abstraction and problem-sol-
ving—in CSA compared to NSO.
In this context, Abracen et al. (1991) compared the performance in
set-switching (TMT–B), abstract reasoning (Coloured Progressive Ma-
trices), and verbal memory (Williams' Verbal Learning Test) between
CSA (n = 12) and non-violent NSO (n = 12) from one penitentiary with
the performance of non-professional prison and hospital employees
(n = 13). Seven CSA had sexually abused male children only, while five
had sexually abused female children only. None of the CSA was diag-
nosed with a pedophilic disorder. CSA were significantly older than
participants from the other two groups. Age, education, and current or
previous alcohol dependence were significantly correlated with one of
the neuropsychological measures and were thus inserted as covariates
in all subsequent analyses. After controlling for these variables no dif-
ferences were found between the three groups on any of the neu-
ropsychological measures. Furthermore, no differences in neu-
ropsychological functioning were found when comparing CSA with one
victim with those who had multiple victims.
Langevin et al. (1988) compared the neuropsychological func-
tioning of 91 intra-familial CSA with 36 non-violent NSO on different
subtests from the RNTB. All participants were assessed at a local re-
search institution prior to their court trial. The intra-familial CSA were
significantly older, less educated, and had lower IQ scores than the
NSO. Although the two groups differed concerning these variables the
authors did not control for their influence in the subsequent analyses. It
was found that intra-familial CSA had a significantly poorer perfor-
mance in auditory attention and concentration, set-switching, psycho-
motor speed, and abstraction than NSO. Furthermore, higher levels of
violence during the index offence and a non-biological relationship
between offender and victim were associated with more neuropsycho-
logical deficits.
In another study using parts of the above sample Langevin and
Curnoe (2008) evaluated performance in the RNTB in 1180 sexual of-
fenders including 849 CSA in comparison to 113 NSO of whom some
were convicted for a violent offence. In contrast to the previous studies
of Langevin et al. (1988, 1989) only the global impairment score of the
RNTB was analyzed and reported. It was found that sexual offenders did
not differ from the NSO concerning their overall impairment score.
However, when comparing sexual offender subgroups, CSA were more
impaired than sexual offenders against adults. In order to identify the
influence of demographic and clinical variables on neuropsychological
performance, the authors calculated a stepwise logistic regression
analysis showing that age, IQ, learning disorders, and endocrine ab-
normalities had a significant influence on neuropsychological perfor-
mance across all participants.
3.3. Differences between sexual offenders against children and sexual
offenders against adults
Seven studies could be identified, which compared the neu-
ropsychological performance between CSA and sexual offenders against
adults (Cantor et al., 2004; Joyal et al., 2007; Langevin et al., 1989;
Langevin & Curnoe, 2008; Perley-Robertson et al., 2016; Valliant et al.,
2000; Young et al., 2012). While two studies found more neu-
ropsychological deficits in CSA compared to sexual offenders against
adults, including impairments in verbal functioning, working memory,
immediate and delayed recall, and visuospatial memory, one study
found a superior performance in attention, set-switching, memory for
shapes, and abstraction in CSA. All other studies did not find any dif-
ferences between CSA and sexual offenders against adults.
Cantor et al. (2004) compared 47 pedophilic CSA with 158 hebe-
philic CSA and 93 sexual offenders against adults using the WAIS-R.
CSA were identified as pedophilic (sexual preference for children below
the age of 13) or hebephilic (sexual preference for children aged 13 to
17 years) based on penile plethysmography (PPG) or self-report. All
D. Turner and M. Rettenberger
participants were outpatients at the time of data collection. CSA had
significantly lower full-scale IQ scores than HC. Pedophilic CSA showed
poorer verbal concept formation than sexual offenders against adults.
Furthermore, pedophilic and hebephilic CSA showed poorer func-
tioning in semantic knowledge, working memory, and in immediate
and delayed recall concerning verbal and visuospatial memory than
sexual offenders against adults.
Neuropsychological performance of 12 CSA and eight sexual of-
fenders against adults on interference inhibition (Stroop Test), verbal
fluency (COWAT), verbal memory (California Verbal Learning Test),
set-switching (WCST, TMT–B), and visuospatial integration (Rey-
Osterrieth Complex Figure Task) was assessed by Joyal et al. (2007). All
participants were from different forensic psychiatric hospitals and all
participants had an extensive history of sexual offending (i.e., at least
one sexual re-offence). The groups did not differ concerning IQ or any
of the included neuropsychological measures.
Like other researchers, Young et al. (2012) used different subtests of
the RNTB to compare neuropsychological functioning of 15 CSA and 45
sexual offenders against adults. The two comparison groups did not
differ concerning age or years of education and they were all placed in
one US prison at the time of study. CSA showed a superior performance
in auditory attention, set-switching, memory for shapes and abstraction
compared to sexual offenders against adults.
In a more recent study that was not included in previous systematic
reviews, Perley-Robertson et al. (2016) evaluated response inhibition
abilities of 37 CSA, nine sexual offenders against adults, and 75 NSO
using a Go/Stop impulsivity paradigm. All participants were from three
different federal prisons in Canada. Although descriptively CSA were on
average more than 14 years older than sexual offenders against adults
and more than 10 years older than NSO, it was not reported whether or
not these differences reached the commonly used level of significance.
Independently of this issue, the three groups did not differ in their re-
sponse inhibition performances.
3.4. Differences between CSA subgroups
3.4.1. Differences between pedophilic and non-pedophilic CSA
Six studies compared the neuropsychological functioning of CSA
with a pedophilic disorder with CSA without a pedophilic disorder
(Eastvold et al., 2011; Massau et al., 2017; Schiffer & Vonlaufen, 2011;
Suchy et al., 2009; Suchy et al., 2014; Turner et al., 2018). Suchy et al.
(2009) compared the neuropsychological functioning of 20 pedophilic
CSA, 20 non-pedophilic CSA, and 20 HC. While the CSA were from
three different residential treatment sites, the HC were recruited from
the general population. In order to be classified as pedophilic the in-
dividual CSA had to either acknowledge his sexual interest in pre-
pubescent children, had to show greater arousal to prepubescent chil-
dren than to adults using PPG, or had to have a score of four or five in
the Screening Scale for Pedophilic Interests (SSPI, Seto & Lalumiére,
2001). The three groups did not differ concerning age, level of educa-
tion, and IQ. The following neuropsychological functions were assessed:
semantic knowledge (WAIS), interference inhibition (Stroop Test), fig-
ural fluency (Ruff Figural Fluency Test), general executive functioning
(Behavioral Dyscontrol Scale), auditory and visual memory (Wechsler
Memory Scale [WMS]), motor speed (Simple Choice Reaction Time
Task), and processing speed (Complex Choice Reaction Time Task). The
pedophilic as well as the non-pedophilic CSA performed worse on
general executive functioning compared to the HC. Furthermore, the
pedophilic CSA had a slower processing speed than the non-pedophilic
CSA and the HC, while the non-pedophilic CSA performed more poorly
on semantic knowledge than the HC.
In a follow-up study, Suchy et al. (2014) compared 20 pedophilic
CSA with 20 non-pedophilic CSA and 20 NSO. All participants came
from different residential treatment facilities. Pedophilia was again
assessed based on self-report or PPG. The groups did not differ con-
cerning age, level of education, or IQ. Compared to non-pedophilic CSA
6
Aggression and Violent Behavior 54 (2020) 101405
as well as NSO, the pedophilic CSA showed a significantly worse per-
formance concerning visual-perceptual speed and speed of visual-motor
integration and made more errors in the Modified Visual Inspection
Time Task assessing visual-perceptual processing speed independent of
response speed. No differences were found in motor speed between the
three groups.
In a third study from the working group around Yana Suchy,
Eastvold et al. (2011) compared 30 pedophilic CSA, 30 non-pedophilic
CSA, and 29 NSO on different executive functioning tasks, including
set-switching, inhibition, abstraction, working memory, verbal fluency,
planning, and attention. All participants were in a residential treatment
program. Classification into pedophilic or non-pedophilic was based on
self-report or PPG. The NSO had significantly lower IQ scores than the
two CSA groups, while they did not differ concerning age or level of
education. Nevertheless, age and education were entered as covariates
in all analyses, while IQ was not. In sum, the authors found that both
CSA groups performed significantly worse on inhibition but had a sig-
nificantly superior performance in abstraction compared to NSO. Fur-
thermore, pedophilic CSA performed significantly better than non-
pedophilic CSA in planning.
Schiffer and Vonlaufen (2011) assessed attention and psychomotor
speed (TMT-A), set-switching (TMT–B, WCST), verbal fluency (Re-
gensburger Word Fluency Test), visuospatial and verbal memory
(Wechsler Memory Scale-Revised, WMS-R), response inhibition (Go/
No-Go Task), and planning and problem-solving (Tower of London) in
15 CSA diagnosed with a pedophilic disorder, 15 CSA without a ped-
ophilic disorder, 16 NSO, and 17 HC. The NSO were convicted for
homicide or grievous bodily harm and were recruited, just like the CSA,
from three different penitentiaries. The groups did not differ concerning
age and level of education. CSA with and without a pedophilic disorder
showed a significantly worse performance in set-switching, verbal flu-
ency, and verbal memory compared to HC. Furthermore, both CSA
groups were significantly impaired in response inhibition in comparison
to HC and NSO. No other comparisons reached the pre-determined level
of significance.
In a recent study 63 CSA were compared with 63 HC from the
general population on tasks assessing response inhibition (Go/No-Go
Task) and decision-making (Iowa Gambling Task, Game of Dice Task;
Turner et al., 2018). In contrast to previous studies applying the Go/No-
Go Task computer-generated images of nude children and adults as Go-
or No-Go cues were used. These sexual stimuli were also used within
the Iowa Gambling Task, while the Game of Dice Task was performed in
its original version. Because the two comparison groups differed in
terms of age and years of education, all subsequent analyses controlled
for these two variables. The CSA group had significantly more deficits
in response inhibition, irrespective whether child or adult images were
used as Go- or No-Go cues. In the Iowa Gambling Task, CSA with more
intense pedophilic sexual interests, measured with the SSPI, showed
more impairments in decision-making because they chose images of
children more regularly, irrespective whether child images were con-
sidered as advantageous or disadvantageous stimuli. No differences
were found in decision-making using the original version of the Game
of Dice Task.
3.4.2. Differences between pedophilic CSA and pedophilic men who have
not sexually offended against children
Also using a Go/No-Go task Kärgel et al. (2017) compared 40 CSA
diagnosed with a pedophilic disorder based on DSM-IV-TR, 37 in-
dividuals with a pedophilic disorder who have not yet been convicted
because of a sexual offence against children, and 40 male HC from the
general population. Pedophilic CSA were recruited from the commu-
nity, outpatient and inpatient settings. Pedophilic individuals without a
previous sexual offence were also recruited from the community or
from outpatient treatment facilities. The three groups did not differ on
any demographic characteristics. The authors found that pedophilic
CSA showed more deficits in response inhibition because they made
D. Turner and M. Rettenberger
more false responses in No-Go trials compared to pedophilic individuals
who were not yet convicted for a sexual offence against children.
Using participants from the same sample as Kärgel et al. (2017),
Massau et al. (2017) compared the neuropsychological performance
measured with the Cambridge Neuropsychological Test Automated
Battery (CANTAB) of 45 pedophilic CSA, 45 pedophilic individuals
without a previous sexual offence, 19 non-pedophilic CSA, and 49 HC
from the general population. The CANTAB is a computerized neu-
ropsychological test system measuring different domains of executive
functioning. For this study the following subtests were taken from the
CANTAB: response inhibition (Stop Signal Task [SST]), information
sampling (Information Sampling Task), planning (Stocking of Cam-
bridge Task), set-switching (Intra/Extradimensional Set Shift Task), and
working memory (Spatial Working Memory Task). While the compar-
ison groups did not differ concerning age, intelligence, handedness, and
sexual orientation, the HC were significantly better educated than both
the pedophilic and non-pedophilic CSA. Both CSA groups had a sig-
nificantly worse response inhibition performance than pedophilic in-
dividuals who had not been convicted for a sexual offence and HC.
Furthermore, CSA without a pedophilic disorder performed sig-
nificantly worse in the working memory task than HC. Finally, it was
found that pedophilic CSA had superior set-switching abilities com-
pared to the HC and the pedophilic individuals without a previous
sexual offence.
3.4.3. Differences between intra-familial and extra-familial CSA
In a Spanish study published by Becerra-García and Egan (2014), 21
intra-familial CSA, 11 extra-familial CSA, and 28 HC were compared on
set-switching (TMT–B), attention and psychomotor speed (TMT-A), as
well as on the short-term working memory performance (Digit Span
Task). All CSA were incarcerated and were convicted because of a
contact sexual offence including a child or adolescent below the age of
16 years. The groups did not differ concerning age or level of education.
Both CSA groups had significantly worse attention and psychomotor
speed and lower set-switching abilities than the HC. Furthermore, the
intra-familial CSA had a significantly lower working memory capacity
than extra-familial CSA and HC.
Langevin et al. (1989) assessed 160 extra-familial CSA, 123 intra-
familial CSA, 108 sexual offenders against adults, and 36 non-violent
NSO. The sexual offenders either faced charges of sexual assault, had
been convicted for a sexual offence, or were involved in a post-prison
treatment program for sexual offenders. Furthermore, some CSA were
also evaluated using PPG, in order to determine the presence of pedo-
philic sexual interests. Neuropsychological measures consisted of
subtests taken from the RNTB. Pedophilic CSA had significantly lower
IQ scores and lower overall neuropsychological impairment scores than
the NSO group. Furthermore, pedophilic CSA attracted towards female
children were more impaired on abstraction and language related dif-
ficulties compared to the homosexual and bisexual CSA as well as non-
sexual offenders.
Valliant et al. (2000) assessed planning abilities (Porteus Mazes) in
11 CSA with extra-familial victims, nine intra-familial CSA, 14 sexual
offenders against adults, 20 NSO as well as in 20 HC. At the time of
study all offenders were placed in one state prison. The HC had sig-
nificantly higher IQ scores than all four offender groups, while the latter
did not differ concerning their IQ scores. Despite these significant dif-
ferences, IQ was not entered as a covariate in further comparisons. The
data analyses showed that the three sexual offender groups had sig-
nificantly impaired planning abilities compared to NSO and HC.
3.4.4. Differences between CSA with male or female victims
Hucker et al. (1986) assessed 15 pedophilic CSA oriented towards
female children, 14 pedophilic CSA orientated towards male children,
10 pedophilic CSA oriented towards children of both genders, and 14
non-violent NSO with the RNTB and the LNNTB. Pedophilic sexual in-
terests were assessed using PPG and all participants were outpatients
7
Aggression and Violent Behavior 54 (2020) 101405
during the study period. NSO were significantly younger than CSA,
while no differences occurred concerning the level of education. Age
was controlled for in all subsequent analyses. The CSA as a whole group
had a significantly higher overall impairment score on both the RNTB
and LNNTB. No differences occurred between the CSA subgroups,
scores in RNTB and LNNTB submeasures were not reported.
Kruger and Schiffer (2011) compared nine pedophilic CSA attracted
towards female children and 11 pedophilic CSA attracted towards male
children with 14 heterosexual and 14 homosexual HC from the general
population. CSA were recruited from two high-security forensic treat-
ment facilities. CSA and HC were matched concerning age, sexual or-
ientation, handedness, socioeconomic status, and education. The fol-
lowing neuropsychological functions were assessed: set-switching
(WCST), visuospatial memory (Corsi-Block Tapping Test [CBT]), and
alertness and concentration (d2 Test of Attention). CSA showed a worse
alertness and concentration performance compared to HC. Further-
more, CSA made significantly more total errors in the WCST re-
presenting a worse set-switching ability. However, on the more difficile
outcome measures of the WCST the two groups did not differ, limiting
the generalizability of the results.
Rosburg et al. (2018) used a Go/No-Go task to assess response in-
hibition abilities in 21 contact CSA, 19 child pornography offenders,
and 21 HC. In this sample, the contact but not the child pornography
offenders were diagnosed with a pedophilic disorder. While the CSA
were significantly older compared to the HC, no differences were found
concerning the level of education. Across all outcome measures there
were no differences between CSA and HC, suggesting that CSA and HC
did not differ concerning their response inhibition abilities.
4. Discussion
The present systematic review is the first one summarizing relevant
research on the neuropsychological functioning of CSA and comparing
their performance to HC, NSO, and sexual offenders against adults.
Furthermore, the performance between different CSA subgroups was
compared. In general, the current state of research is quite hetero-
geneous making it difficult to find scientifically sound conclusions.
However, some noteworthy insights could be obtained and will be
discussed in the following sections.
Supported by a sufficient number of studies is the finding that CSA
show more neuropsychological impairments than HCs. In line with
previous reviews on the neuropsychological functioning of sexual of-
fenders in general, among the assessed executive functions impairments
in inhibition and set-shifting were found most frequently in CSA
(Adjorlolo & Egbenya, 2016; Joyal et al., 2014). CSA who are relatively
low in inhibition might be unable to control the impulse to sexually
abuse a child although the individual's long-term goal is the desistance
from sexual offending. The deficits in set-shifting could contribute to an
excessive fixation on a specific goal like, for example, the goal to abuse
children (Cohen et al., 2010). Furthermore, a CSA with deficient set-
switching abilities might not be able to shift between different pre-
vention strategies or cannot adopt his strategies to changing circum-
stances and environments.
There is growing recognition that successful self-regulation is based
on the effective interplay between an individual's executive functions
(Beaver, Wright, & Delisi, 2007; Hofmann et al., 2012; Ratchford &
Beaver, 2009; Wikström & Treiber, 2007). Previous research has shown
that impairments in executive functioning are associated with a wide
range of social problems including delinquent behavior (Denson,
Pedersen, Friese, Hahm, & Roberts, 2011; Ogilvie et al., 2011) and risky
sexual behaviors (Ariely & Loewenstein, 2006; Carrier Emond, Gagnon,
Nolet, Cyr, & Rouleau, 2018) which come along with impaired self-
regulation. Furthermore, a decreased self-regulation capacity is among
relevant risk factors for sexual but also for violent and general re-
cidivism in sexual offenders (Etzler, Eher, & Rettenberger, 2018;
Hanson & Morton-Bourgon, 2005; Mann, Hanson, & Thornton, 2010).
D. Turner and M. Rettenberger
Thus, it can be suggested that executive dysfunctions, on the one hand,
and sexual delinquency, on the other hand, might on a behavioral level
be linked through self-regulation failures. However, the question re-
mains whether these executive functioning impairments increase the
tendency to sexually offend against children in particular or to show
socially dysfunctional behavior in general (including all kinds of de-
linquent behaviors) or both.
Some studies found more neuropsychological deficits in CSA com-
pared to NSO which underscores the former suggestion, although there
were also single studies not finding any differences between these two
groups. Again, impairments in inhibition were found most frequently
(e.g., Eastvold et al., 2011; Schiffer & Vonlaufen, 2011). Because sexual
offences against children are among the most devastating offences it is
conceivable that the internal barriers that have to be overcome are
higher than for other offences, supporting the suggestion of a stronger
disinhibition in CSA compared to NSO (Finkelhor, 1984). However, this
also accounts for sexual offences against adults, explaining why most
studies did not find any differences between sexual offenders against
adults and CSA. Furthermore, sexual offences committed by non-ped-
ophilic CSA are usually seen as more impulsive and less planned than
those of pedophilic CSA (Eher, Neuwirth, Fruehwald, & Frottier, 2003).
Thus, in non-pedophilic CSA the deficits in inhibition could also be seen
as a result of a general behavioral disinhibition increasing all kinds of
delinquent behavior.
In pedophilic CSA the reported impairments in inhibition provide
some evidence that the pedophilic disorder shares some similarities
with disorders from the compulsive-impulsive spectrum which are also
characterized by concurrent behavioral disinhibition (Tost et al., 2004).
In this case, however, the neuropsychological deficits should be espe-
cially pronounced in sexual situations as these include the specific re-
warding content of interest. First evidence for this suggestion was
provided by a recent study showing that performance in a neu-
ropsychological test assessing impulsive decision-making and using
stimuli showing nude children was more impaired in those individuals
with more intense pedophilic sexual interests (Turner et al., 2018).
In the meantime, two studies have been published comparing of-
fending and non-offending pedophilic men (Kärgel et al., 2017; Massau
et al., 2017). In line with the above made suggestions that sexual of-
fending is the consequence of reduced self-regulation abilities caused by
dysfunctional executive functioning both studies found a worse in-
hibition performance in pedophilic CSA than in pedophilic non-of-
fending individuals.
This line of argument is only reasonable, however, if we assume that
it is a CSA's primary self-regulatory goal to desist from offending.
However, there are different pathways of sexual offending (Ward &
Hudson, 1998): While in some CSA the sexual offence is indeed the
consequence of self-regulatory failures, in others it is the result of a
careful and systematic planning process (Kingston, Yates, & Firestone,
2012; Marshall, 1996; Ward, Louden, Hudson, & Marshall, 1995; Yates
& Kingston, 2006). For example, men who explicitly take on a job that
puts them in close contact with children, in order to increase the pos-
sibility to abuse these children, show more sophisticated grooming
strategies and greater planning before executing the actual offence and
thus probably possess well-developed executive functions (Turner et al.,
2016; Turner, Rettenberger, Lohmann, Eher, & Briken, 2013; Turner &
Briken, 2015).
Ward and colleagues have proposed four different offence pathways
and it can be hypothesized that each pathway is accompanied by
neuropsychological—or more specifically—certain executive func-
tioning deficits (Ward & Gannon, 2006; Ward & Hudson, 1998). In-
dividuals following the avoidant-passive pathway have a desire to desist
from sexual offending but are not able to utilize the relevant self-reg-
ulation abilities. It can be assumed that these individuals show a gen-
eral impairment in executive functions. The avoidant-active pathway
describes individuals who actively try to desist from sexual offending;
however, they use ineffective or counterproductive strategies and are
8
Aggression and Violent Behavior 54 (2020) 101405
unable to change these strategies. These persons might possess well-
developed inhibition abilities but less-developed set-shifting skills and
thus are not able to adopt the appropriate strategies to desist from of-
fending. The approach-automatic pathway is characterized by the de-
sire to sexually offend but offending happens in an impulsive and
poorly planned way. Non-pedophilic CSA with low inhibition and low
planning skills could be prototypical for this pathway. Finally, the ap-
proach-explicit pathway describes sexual offenders whose offences are
not impulsive but carefully planned. These CSA are probably driven by
strong pedophilic sexual interests and most likely possess well-devel-
oped neuropsychological functions helping them to execute a highly
sophisticated offence. These hypotheses are not yet scientifically proven
but could provide the starting point for future research about the cur-
rently existing discrepancies in neuropsychological research in CSA.
The present systematic review has shown that distinct neu-
ropsychological deficits can be identified in CSA, some even over and
above the impairments found in general offenders. However, it has to
be concluded that the current state of research is far away from being
consistent. Methodological differences could be responsible for some of
these inconsistencies. While some studies assessed CSA who were cur-
rently incarcerated, others assessed CSA prior to their actual trial, from
outpatient settings, or from the general population. Furthermore, while
some studies assessed CSA with a pedophilic disorder, other studies
assessed CSA without a pedophilic disorder or mixed experimental
groups. Even the determination whether or not CSA were considered as
pedophilic differed between studies. Finally, not all studies controlled
for the influence of relevant demographic or clinical variables that
differed between the study populations like, for example, IQ, age, level
of education, or previous alcohol or drugs use. Despite all these in-
consistencies it seems obvious that deficits in neuropsychological
functioning are a relevant aspect regarding the explanation of sexual
offending against children.
Although large parts of the variance in neuropsychological func-
tioning is determined by the individual genetic make-up, it is possible
to improve neuropsychological functioning through psychotherapeutic
treatment (e.g., cognitive-behavioral therapy; Anastopoulos et al.,
2018; DeVito, Kiluk, Nich, Mouratidis, & Carroll, 2018), neurophysio-
logical treatments (e.g., neurofeedback, transcranial magnetic stimu-
lation, or transcranial direct current stimulation; Gill, Shah-Basak, &
Hamilton, 2015; Gruzelier, 2014; Hosseini, Oritchard-Berman, Sosa,
Ceja, & Kesler, 2016; Luber & Lisbany, 2014), or through environmental
enrichment (e.g., increased physical activity, education or occupation;
Colcombe & Kramer, 2003; Hillman, Erickson, & Kramer, 2008;
Petrosini et al., 2009). Effective treatment programs addressing the
enhancement of neuropsychological functioning will not only decrease
the risk of reoffending but also the risk of other maladaptive psycho-
social outcomes such as poor physical health, poor quality of life, and
poor school and job success (Bailey, 2007; Borella, Carretti, &
Pelegrina, 2010; Crescioni et al., 2011; Miller, Barnes, & Beaver, 2011).
This points towards the outstanding relevance of a precise under-
standing and assessment of the neuropsychological functioning in CSA
and other sexual offender subgroups.
Acknowledgments
None.
Funding
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
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