Child Abuse & Neglect 36 (2012) 203–209

Contents lists available at SciVerse ScienceDirect

Child Abuse & Neglect

Assessment and treatment of adolescent sexual offenders: Implications

of recent research on generalist versus specialist explanations
Lesleigh Pullman a,∗ , Michael C. Seto b
a
University of Ottawa, Ottawa, ON, Canada
b
Royal Ottawa Health Care Group, Integrated Forensic Program, Brockville, ON, Canada

a r t i c l e i n f o a b s t r a c t

Article history: Objective: Adolescent sex offenders (ASOs) are commonly considered a special kind of
Received 18 November 2011 juvenile offender, with distinct risk and etiological factors from other adolescent offenders.
Accepted 22 November 2011 However, a growing body of research suggests that ASOs are more similar to other ado-
Available online 23 March 2012
lescent non-sex offenders than they are different (e.g., Awad, Saunders, & Levine, 1984;
Elliott, 1994; France & Hudson, 1993). The purpose of the present article is to review recent
Keywords:
literature pertaining to the distinction between generalist and specialist adolescent sex
Adolescent sex offender
Assessment
offenders (ASOs).
Treatment Method: This article summarizes the findings from Seto and Lalumière’s (2010) meta-
Generalist analysis on theoretically derived risk and etiological factors for adolescent sexual offending.
Specialist Based on these findings, recommendations for the assessment and treatment of this popu-
lation are made.
Results: The results of Seto and Lalumière’s (2010) meta-analysis suggests the majority of
ASOs are generalist offenders who are similar to other adolescent non-sex offenders, while
a minority of ASOs are specialist offenders, who have unique risk and etiological factors
including childhood sexual abuse/maltreatment and atypical sexual interests.
Conclusions: A clear distinction has been shown between generalist ASOs and special-
ist ASOs. Assessment measures and treatment targets geared toward one of these groups
may be less effective with the other group, which means that this distinction is clinically
important. It is expected that if treatment is matched to ASO type, sexual and nonsexual
recidivism will be reduced and positive changes in other clinically important areas will be
evident.
© 2012 Elsevier Ltd. All rights reserved.

Introduction

Sexual offending is considered one of the most heinous forms of criminal behavior and shocks the public conscience.
Even more disturbing is when these behaviors are committed by adolescents. Much of the research and clinical literature
on sexual offending has focused on adults. Yet, adolescent sexual offenders (ASOs) account for 12.5% of all arrests for rape
and 14% of all arrests for other sexual offenses (United States Department of Justice, 2009). Additionally, using data obtained
from the National Youth Survey, Weinrott (1996) found that 3% of youth in the general population have had or have tried
to have sexual relations with a non-consenting victim. Furthermore, up to half of adult sexual offenders admit that they
committed their first sexual offense as an adolescent (Abel, Osborn, & Twigg, 1993; Knight & Prentky, 1993; Rasmussen,
2004). These facts highlight the need to develop a greater understanding of ASOs in order to effectively assess, treat and
manage this population.

∗ Corresponding author address: University of Ottawa, Department of Psychology. 136 Jean Jacques Lussier (3001), Ottawa, ON, Canada K1N 6N5.

0145-2134/$ – see front matter © 2012 Elsevier Ltd. All rights reserved.
doi:10.1016/j.chiabu.2011.11.003
204 L. Pullman, M.C. Seto / Child Abuse & Neglect 36 (2012) 203–209

There are currently two main perspectives to explain adolescent sexual offending. First, the generalist perspective sug-
gests that the crimes committed by ASOs are a manifestation of general delinquent tendencies, in which sexual offenses
constitute only a part of their antisocial and criminal behavior (e.g., France & Hudson, 1993). This perspective suggests that
ASOs are more similar to other adolescent non-sex offenders than they are different, and thus they share risk factors, as well
as assessment and treatment needs. These risk factors include antisocial personality traits, antisocial attitudes and beliefs,
associations with delinquent peers, and substance use (see Quinsey, Skilling, Lalumière, & Craig, 2004). A central implication
of the generalist perspective is that the same assessment tools and treatment models that have been developed for juvenile
delinquents would be valid for ASOs.
Second, the specialist perspective suggests that ASOs differ from other adolescent offenders, and different factors explain
sexual offending compared to nonsexual offending. Therefore, ASOs require different assessment tools and treatment models.
Indeed, the National Adolescent Perpetrator Network, an organization of professionals involved with ASOs, concluded that,
“. . .sexually abusive youth require a specialized response from the justice system which is different from other delinquent
populations” (1993, p. 86). In the special issue, the task force outlined ways in which adolescent sexual offenders should be
treated differently in terms of legal and clinical responses.
Empirical research on this generalist versus specialist distinction is mixed. Some studies suggest that the specialist
explanation is more correct, citing evidence regarding sexual abuse history, sexual deviancy and atypical sexual development,
as well as early family and environmental factors. For example, Beauregard, Lussier, and Proulx (2004) found that proclivity
for rape was positively correlated with a sexually inappropriate family environment, which included witnessing incestuous
or promiscuous sexual behavior within the home during childhood or adolescence. Additionally, Robinson, Rouleau, and
Madrigano (1997) found that ASOs showed significantly more arousal to deviant stimuli involving coercive sex and children
compared to a non-offender control group. Lastly, Jespersen, Lalumière, and Seto (2009) found that adult sex offenders were
3.36 times more likely to experience sexual abuse as a child, than a comparative sample of non-sex offenders.
Conversely, other studies suggest that the generalist perspective is more correct, citing evidence regarding the many
similarities found between ASOs and other adolescent offenders, as well as evidence gathered from recidivism studies. For
example, Awad, Saunders, and Levine (1984) found that ASOs were more similar to other adolescent non-sex offenders
than they were different on variables such as psychiatric history, past delinquency/violence, inadequate parenting, school
misconduct and parent–child attachment. Furthermore, ASOs are significantly more likely to be re-arrested for a nonsexual
crime rather than a sexual offense; in fact, only 10–15% of ASOs continue sexual offending into adulthood (Caldwell, 2002).
Of course, these perspectives are not mutually exclusive. Both perspectives could be true, such that the ASO population
is a mixture of generalist and specialist offenders and, thus, individual study findings depend on the composition of the
ASOs in the sample. Butler and Seto (2002), for example, distinguished between 22 ASOs who had only committed sexual
offenses (sex-only) and 10 ASOs who had committed sexual as well as nonsexual offenses (sex-plus). Sex-plus ASOs were
more similar to other adolescent offenders than sex-only ASOs on measures of risk to reoffend and treatment needs.
The purpose of the present article is to summarize the results of a recent meta-analysis conducted by Seto and Lalumière
(2010) that will assist in bridging the gap between the generalist and specialist perspectives, as well as to highlight the
assessment and treatment implications of this generalist versus specialist distinction.

Seto and Lalumière (2010) meta-analysis

Seto and Lalumière examined 59 studies that directly compared ASOs and other adolescent offenders on theoretically
derived variables. These variables included offender age, conduct problems, criminal involvement, antisocial tendencies,
family problems, substance abuse, childhood maltreatment and exposure to violence, interpersonal problems, cognitive
abilities, sexuality, and psychopathology. The meta-analysis included a total sample of 3,855 male ASOs and 13,393 male
adolescent non-sex offenders. If the generalist perspective is correct, then ASOs and other adolescent offenders should not
differ on these theoretically derived variables. Whether an adolescent commits a sexual or nonsexual crime is a result of
chance, opportunity and situational factors. If the specialist perspective is correct, then the nature of the group differences
tells us which factors help explain why an adolescent commits a sexual rather than nonsexual crime.
The results of the meta-analysis indicated many variables where ASOs and other adolescent sex offenders did not differ,
including antisocial personality traits, antisocial attitudes and beliefs, early conduct problems, social problems, intelligence,
and general psychopathology. In terms of other general delinquency risk factors, ASOs did differ by having a less extensive
criminal history, fewer delinquent peers, and less substance abuse. In support of the specialist explanation, ASOs differed on
a set of variables having to do with maltreatment history and psychosexual development. ASOs were much more likely to
have been sexually abused than other adolescent offenders, and were also more likely to have been physically or emotionally
abused. ASOs were also more likely to have early exposure to sex or pornography, exposure to sexual violence in the family,
and atypical sexual interests (e.g., sexual fantasies about young children or coercive sex). The largest differences were found
for atypical sexual interests (d = .67, 95% CI 0.28–1.06) and sexual abuse history (d = .62, 95% CI 0.46–0.77), both of which
by convention are considered moderate to large effects. While sexual abuse history alone is significantly related to why a
youth commits a sexual rather than a non-sexual crime, other forms of maltreatment (physical and emotional abuse) are also
significantly related. It is possible that co-morbid maltreatment sequentially increases the likelihood of sexually aggressive
behavior in youth, although this was not explicitly tested.
 L. Pullman, M.C. Seto / Child Abuse & Neglect 36 (2012) 203–209 205

Seto and Lalumière (2010) concluded that ASOs and other adolescent non-sex offenders share many of the same delin-
quency risk factors. However, in order to explain why a particular adolescent commits a sexual rather than a nonsexual
crime, the special factors of sexual abuse history, exposure to sex or pornography, and atypical sexual interests also need to
be considered. Seto and Pullman (in press) discussed these results and their overlap with empirically or theoretically derived
ASO typologies that have been proposed (e.g., Butler & Seto, 2002; Chu & Thomas, 2010; Flitton, 1999; Lussier, Leblanc, &
Proulx, 2005; Worling, 2001) concluding that the generalist versus specialist typology does have preliminary support. They
also noted that there are likely different developmental trajectories for generalist versus specialist ASOs, integrating ideas
from models described by Moffitt (1993) and Seto and Barbaree (1997).

Risk/needs assessment of ASOs

Extensive research has identified a large set of risk factors associated with sexual recidivism among adult sexual offenders
(Hanson & Bussière, 1998; Hanson & Morton-Bourgon, 2005). Broadly, these risk factors can be organized into two primary
risk dimensions: (1) general antisocial orientation (criminal history, antisocial personality, antisocial attitudes and beliefs,
etc.), and (2) sexual deviance (atypical sexual interests, excessive sexual preoccupation, etc.). Adult sexual offenders who
are high in sexual deviance are more likely to sexually reoffend; those who are high in general antisocial orientation are at
greater risk of both sexually and non-sexually offending. Those who are high in both risk dimensions are the most likely to
sexually reoffend (Seto, Harris, Rice, & Barbaree, 2004). These findings have resulted in the production of multiple reliable
and valid risk assessment tools for use with adult sexual offenders (see Hanson & Morton-Bourgon, 2009).
Seto and Lalumière’s (2010) results suggest these two dimensions play a similar role among ASOs. ASOs and other adoles-
cent offenders are similar on some (but not all) variables reflecting general delinquency risk factors, but differ substantially
on sexuality-related variables, including atypical sexual interests and sexual abuse history. Both general delinquency risk
factors and atypical sexual interests are important in the prediction of recidivism among ASOs (McCann & Lussier, 2008).
It follows that ASOs need to be assessed on both dimensions to estimate the likelihood they will sexually reoffend. This
risk information can then drive intervention efforts, because the intensity of treatment and supervision should be related to
risk of reoffending for maximum efficacy, with more intense services for higher risk adolescents, and with services focusing
on those risk factors that are changeable (Andrews & Bonta, 2010). The ultimate goal is to reduce sexual offending, and
thereby reduce sexual victimization. Sexual victimization is associated with myriad negative outcomes, including physical
and mental health problems, substance abuse, sexual behavior problems, and later criminal behavior (Koenig, Doll, O’Leary, &
Pequegnat, 2004; Nelson et al., 2002; Rind & Tromovitch, 1997; Widom & Maxfield, 2001). Effective treatment of adolescent
sexual offenders can therefore prevent sexual abuse and other forms of maltreatment.

Risk scales

The 2 best known ASO risk assessment tools—the Juvenile Sex Offender Protocol II (JSOAP-II; Prentky & Righthand,
2003) and the Estimate of Risk of Adolescent Sexual Offense Recidivism (ERASOR; Worling & Curwen, 2001)—address
both risk dimensions. The JSOAP-II is a 28-item scale of theoretically derived static and dynamic risk factors for ASOs
(Prentky & Righthand, 2003). The items are organized into 4 subscales: Sexual Drive/Preoccupation (e.g., male child victim),
Impulsive/Antisocial Behavior (e.g., pervasive anger), Intervention (e.g., accepting responsibility), and Community Stabil-
ity/Adjustment (e.g., stability in school). This instrument has been found to predict sexual as well as nonsexual recidivism
by ASOs (Rajlic & Gretton, 2010). The Impulsive/Antisocial Behavior scale predicts general recidivism, while the Sexual
Drive/Preoccupation scale predicts sexual recidivism. The Intervention subscale and the Community Stability/Adjustment
subscales also predicted both sexual and non-sexual recidivism (Rajlic & Gretton, 2010).
The ERASOR is a 25-item scale reflecting the domains of Sexual Interests, Attitudes and Behaviors (e.g., atypical sexual
interests and sexual obsession), Historical Sexual Assaults (e.g., ever sexually assaulted 2 or more victims), Psychosocial
Functioning (e.g., negative peer associations), Family/Environmental Functioning (e.g., high stress family environment) and
Treatment (e.g., incomplete sexual offense specific treatment) (Worling & Curwen, 2001). Rajlic and Gretton (2010) found
that the ERASOR total score predicted sexual as well as nonsexual recidivism. All subscales except for Treatment predicted
sexual recidivism, and all subscales except for Historical Sexual Assaults predicted non-sexual recidivism. Rajlic and Gretton
(2010) also evaluated the JSOAP-II and ERASOR after distinguishing ASOs into generalist offenders and specialist offenders.
Generalist offenders typically had higher total scores on the JSOAP-II and ERASOR, indicating that generalist offenders are at
a higher risk to reoffend sexually and non-sexually. The majority of the specialist offenders did not commit a new sexual or
non-sexual offense. When they did reoffend sexually, the factors associated with this recidivism reflected sexual deviance.

Atypical sexual interests

The second step in the assessment of ASOs is the examination of atypical sexual interests, both to help in the assessment
of risk to sexually reoffend and to identify a potentially critical treatment need. Both the JSOAP-II and the ERASOR provide
information about atypical sexual interests by examining past sexual offending and sexual victim characteristics; the ERASOR
also includes an item that incorporates self-reported atypical sexual interests or observations of sexual arousal to young
children or sexual violence. The simplest way to assess atypical sexual interests is to ask, either through interview or
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questionnaire. Daleiden, Kaufman, Hilliker, and O’Neil (1998) describe the development and validation of the Sexual Fantasy
Questionnaire and Sexual History Form for adolescents, to assess acknowledged sexual fantasies and behavior, respectively.
Worling and Curwen (2000) found that self-reported atypical sexual interests predicted sexual recidivism among ASOs.
However, self-report has its limitations, particularly the understandable reluctance on the part of many ASOs to admit to
having atypical sexual interests, given the potential legal and social ramifications of this admission.
When an ASO denies having atypical sexual interests, objective measures are needed to corroborate this self-report.
Phallometric testing using penile plethysmography (PPG) involves the measurement of changes in penile circumference
in response to sexual and nonsexual stimuli (Association for the Treatment of Sexual Abusers, 2005). This technique is
commonly used with adult sex offenders because it is able to directly assess sexual arousal to children or sexual violence,
even among individuals who deny any such interests. Studies have consistently shown that adult sex offenders can be
distinguished from other men on the basis of their sexual arousal patterns (Lalumière, Harris, Quinsey, & Rice, 2005; Seto,
2008). Moreover, phallometrically assessed sexual arousal to children or to sexual violence predicts sexual recidivism among
adult sexual offenders (Hanson & Morton-Bourgon, 2005).
There is less PPG research on ASOs, but the available studies suggest that phallometric testing can distinguish ASOs,
particularly those with boy victims, from young adult comparison groups (Robinson et al., 1997; Seto, Lalumière, & Blanchard,
2000). Moreover, Clift, Rajlic, and Gretton (2009) reported that post-treatment assessments of sexual arousal predicted sexual
recidivism in a sample of 132 ASOs, consistent with the adult offender literature. However, ethical concerns have been raised
about the use of PPG with an adolescent population. It has been suggested that there may be negative effects to exposing
an adolescent to the deviant stimuli used in PPG during a critical developmental period. Many researchers have raised this
issue (e.g., Becker & Harris, 2004; Hunter & Lexier, 1998; Turpel-Lafond, 2011; Worling, 1998) however, it has never been
examined in detail.
Phallometric testing is not always available because of clinician qualms about using this technology or adolescent or
parent/guardian refusal to participate. In such cases, alternative objective measures are needed. First, the Screening Scale
for Pedophilic Interests (SSPI; Seto & Lalumière, 2001) is a brief scale composed of 4 sexual victim history items: any male
victim, more than 1 victim, any victim under age 12, and any unrelated victims. These items are weighted and scores can
range from 0 to 5. This scale was first developed and validated with a sample of adult sex offenders (Seto & Lalumière,
2001) and was subsequently cross-validated with a sample of ASOs (Seto, Murphy, Page, & Ennis, 2003). In both adult and
adolescent samples, SSPI total scores were significantly and positively correlated with phallometrically assessed sexual
arousal to children. Moreover, SSPI scores predict recidivism among adult sex offenders (Seto et al., 2004).
Another alternative to the PPG and the SSPI when assessing pedophilic and non-pedophilic atypical sexual interests is
a viewing time procedure. These procedures involve showing an individual a series of pictures depicting different sexual
content and measuring the length of time they spend viewing each picture. Individuals will tend to spend more time
viewing the pictures they find sexually interesting. Studies have shown that adult sex offenders can be distinguished from
other men on the basis of viewing time (Harris, Rice, & Quinsey, 1996). Worling (2006) found that viewing time measures
used with ASOs significantly differentiated youth who offended against male victims and those who offended against peers.
Additionally, Abel et al. (2004) found that the viewing time for images of children exhibited by ASOs was significantly and
positively correlated with the number of child victims they had. Viewing time procedures are also less intrusive than PPG.
However, both viewing time and the SSPI are limited because there is only peer-reviewed empirical support for their use in
the detection of sexual interest in children; neither measure has been shown to identify sexual interest in sexual violence.

Treatment of ASOs

Once a comprehensive assessment of risk to reoffend and clinical needs has been conducted, individualized intervention
options need to be considered. Consistent with Andrews and Bonta’s (2010) risk principle, more intensive services should be
reserved for higher-risk offenders. Those who pose a relatively low risk to reoffend may require only a period of supervision
in the community, whereas those at high risk may require long-term residential treatment.
For an ASO who has been identified as a generalist offender through high scores on the JSOAP-II and the ERASOR,
proven treatments for juvenile delinquency are warranted. It is noteworthy that the only treatment approach that has
been empirically demonstrated to reduce recidivism and other negative outcomes for ASOs, using the gold standard evalu-
ation design of randomized clinical trials, is multi-systemic therapy (Borduin, Schaeffer, & Heiblum, 2009; Letourneau et al.,
2009). Multi-systemic therapy (MST) is a family oriented treatment that simultaneously targets multiple domains includ-
ing family functioning, social skills and problem solving, peer interventions and academic achievement. Multiple studies
have shown that MST can reduce recidivism and out-of-home placements (e.g., incarceration and child protection custody)
among at-risk juvenile delinquents (see Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998). Borduin et al.
(2009) compared MST to usual community services provided for ASOs. Usual community services included individual coun-
seling targeting acceptance of responsibility, antisocial cognitions, victim awareness and empathy, and relapse prevention
(a cognitive-behavioral treatment originally designed to address addictive behavior by creating coping strategies to help
maintain change; Parks, Marlatt, & Anderson, 2001). The authors found that youth who received MST were significantly
less likely to be re-arrested for sexual or non-sexual offenses after an 8–9 year average follow-up, compared to youth who
received the usual community services (29.2% versus 58.3% re-arrest rate for non-sexual offenses and 8.3% versus 45.8% re-
arrest rate for sexual crimes). A similar family-oriented treatment model is Functional Family Therapy (Barton, Alexander,
 L. Pullman, M.C. Seto / Child Abuse & Neglect 36 (2012) 203–209 207

Waldron, Turner, & Warburton, 1985) or Multidimensional Family Therapy (Schmidt, Liddle, & Dakof, 1996). Unfortunately,
there is debate about the size and reliability of MST effects (Curtis, Ronan, & Borduin, 2004; Henggeler, Scott, Schoenwald,
Swenson, & Borduin, 2006; Littell, Popa, & Forsythe, 2005).
For ASOs who have been identified as specialist offenders through lower scores on the JSOAP-II and ERASOR, but high
scores on measures of atypical sexual interests, cognitive-behavioral therapy focusing on management of atypical sexual
arousal patterns and related concerns such as excessive sexual preoccupation (potentially caused by or associated with
early exposure to sex or pornography) could be beneficial (Aytes, Olsen, Zakrajsek, Murray, & Ireson, 2001). In a meta-
analysis examining treatment effectiveness with sex offenders, Hanson et al. (2002) found that CBT with adult sex offenders
significantly reduced sexual recidivism compared to no treatment (10% sexual recidivism versus 17%, respectively). Similar
results have been found by other researchers as well (e.g., Landenberger & Lipsey, 2005; McGrath, Hoke, & Vojtisek, 1998;
Scalora & Garbin, 2003). These studies should be interpreted with caution, however, as most treatment outcome studies
have used non-rigorous designs, precluding strong conclusions about treatment efficacy (Seto, 2008).

Treatment targets

An important element of treatment is the selection of treatment targets. Childhood sexual abuse and other forms of child-
hood victimization are significant antecedents of sexual offending by adolescents, and therefore may need to be addressed
in treatment. However, childhood victimization is a historical fact that cannot be changed. Instead, problems associated
with childhood victimization may be suitable treatment targets, including relationship functioning, atypical sexual arousal,
and self-regulation problems, all of which were identified in Seto and Lalumière’s (2010) review. Though there were no
differences between adolescent sexual and nonsexual offenders in depression, anxiety, and other forms of psychopathology,
treatment may also need to address these problems because they can interfere with change in other areas and because there
is research supporting a link between mood problems and problematic sexual behavior (Galli et al., 1999; Kafka & Hennen,
2002).

Prevention of adolescent sexual offending

The above risk assessment and treatment options detailed for ASOs assumes that an adolescent has already committed
at least one sexual offense. However, the results of the Seto and Lalumière (2010) meta-analysis highlight risk factors for
sexual offending that can be targeted before an offense has been committed. Within the context of child welfare work, a
youth who has been found to be sexually abused may be at greater risk of reactive sexual behavior in the short-term and
sexual offending later (Salter et al., 2003). Early intervention addressing sexual abuse effects could therefore have both
immediate (addressing the needs of the sexual abuse victim) and delayed (reducing later perpetration) effects. Fortunately,
there are effective treatments for sexual behavior problems. Carpentier, Silovsky, and Chaffin (2006) reported the results of
a randomized clinical trial showing that a relatively brief cognitive-behavioral treatment for children with sexual behavior
problems significantly reduced the likelihood of sexual offending compared to group play therapy after a 10-year follow-up.
Moreover, the recidivism rate was the same as a comparison group of children with nonsexual behavior problems.

Conclusions

The efficient and effective assessment and treatment of ASOs is vital to the administration of criminal justice, public
safety, and offender rehabilitation. Research suggests that many ASOs are generalist offenders who may be at risk for other
forms of delinquency as well, whereas a minority of ASOs are specialist offenders who are at risk primarily for further sexual
offending. Assessment measures and treatment approaches geared for one group are less efficient and effective for the other
group, so making this distinction is clinically important.
Assessment should begin with the use of a validated risk assessment tool such as the JSOAP-II or the ERASOR. Though
more empirical work is needed, early evidence indicates these measures can identify ASOs who are higher risk to reoffend,
and therefore are a higher priority for treatment and supervision services. Next, assessment of atypical sexual interests can
be conducted through clinical interview or questionnaires, scoring the relevant items on the JSOAP-II or ERASOR, and use of
PPG, the SSPI, or viewing time measures. Once these assessments have been completed, treatment options can be tailored
to a specific offender’s needs. Generalist offenders with many general delinquency risk factors will likely benefit most from
MST or similar treatment approaches that simultaneously target family, peer, personality and environmental risk factors.
The minority of ASOs who are specialist offenders may still benefit from general delinquency treatment, but may also require
cognitive-behavioral treatments focusing on managing atypical sexual interests and improving sexual self-regulation more
generally.
We would expect better treatment outcomes, in terms of reduced recidivism and positive changes on other outcomes
such as educational attainment, employment, and lifestyle stability, if treatment was matched to ASO type. Further research
is needed to evaluate this hypothesis. For example, we would predict that MST plus cognitive-behavioral therapy focusing
on sexual self-regulation (e.g., management of atypical sexual interests or sexual preoccupation), would result in less recidi-
vism among specialist ASOs compared to MST alone, whereas we would expect no differences between the two treatment
208 L. Pullman, M.C. Seto / Child Abuse & Neglect 36 (2012) 203–209

conditions for generalist ASOs. Understanding maltreatment history, as well as the consequences of that history is an essential
aspect of correct assessment and treatment of ASOs.

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