A New Approach to Assessing Pedophilia and Preventing Child Sexual Abuse Keyton Sampson Pedophilia etiology & etiology & prevalence IMPLICATIONS Stigma that keeps those with pedophilia from seeking treatment increases their feelings of isolation and loneliness. Both are risk factors that contribute to committing a sexual offense (Imhoff & Jahnke, 2018). Although many advise that there should be no to limited contact with children, many pedophiles engage in social interaction with children on a daily basis without disclosing their sexual preference to them or their family (Geradt, Jahnke, Heinz, Hoyer & Hoyer, 2018). There is a concern that those with pedophilia, who never have experience with children may lack the opportunity to learn about children in a non-sexual way (Geradt, Jahnke, Heinz, Hoyer & Hoyer, 2018). It is recognized that some offenders are opportunistic and remorseless, but those who show distress for their actions, such as pedophiles, could undergo effective treatment (Glab, 2016). The etiology of sexual interest in children is unknown. Although environmental factors could play a role in pedophilia, research suggests there is biological and prenatal etiology (Cantor et al., 2015) There are altered hormone levels and hormonal responsivity in pedophilic sexual offenders(Alanko, Gunst, Mokros, & Santtila, 2016). Studies on sexual offenders regarding hormonal influence have focused on testosterone, luteinizing hormone-releasing hormone and prolactin, all of which are released by the hypothalamic-pituitary-gonadal axis (Alanko, Gunst, Mokros, & Santtila, 2016). It is presumed that 1% of the male population and an unknown percentage of the female population meet criteria for pedophilia. This makes it just as common as schizophrenia, autism spectrum disorder, and anorexia nervosa (Kaplan, 2015) Stigma in society & The criminal justice system Those who have pedophilia are not necessarily abusers and abusers do not always have pedophilic sexual preferences (Beier et al., 2009). There is a high stigma concerning pedophilia and most of the public wants to keep them out of their neighborhoods and away from their families (Geradt, Jahnke, Heinz, Hoyer & Hoyer, 2018). Our society finds sex crimes to be the most heinous, therefore, our criminal justice system works to punish rather than prevent (Glab, 2016). Two international studies show recidivism rates of 22-43% for child sex offenders who are left untreated after incarceration (Glab, 2016). Diagnostic criteria & characteristics The DSM-5 (Beier et al., 2009) criteria for pedophilia includes: “over a period of at least six months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger)” and “the person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty”. Pedophiles are often at least 16 years of age and at least 5 years older than the juvenile. In cases that include adolescent offenders, maturity levels are considered before a diagnosis is placed (Hall & Hall, 2007). The diagnosis for pedophilia may be made as early as the onset of puberty (Nobrega, 2016). Pedophiles sometimes engage in a wide variety of sexual acts with children, including exhibitionism, voyeurism, frotteurism, fondling, oral sex, and penetration. They often do not use force but rely on psychological manipulation (Hall & Hall, 2007). Pedophiles often have lower IQs, poorer visuospatial and verbal memory test scores, less education, shorter heights, are more likely to have suffered from a head injury before age 13, atypical body morphology, and a rate of non-right-handedness up to three times population rates (like those with autism and mental retardation) (Cantor et al, 2016). Most pedophiles are male and those who are women are often young (22-33 years old), have poor coping skills, may have another psychiatric disorder, and often fit the criteria for a personality disorder (Hall & Hall, 2007). Preventative measures Mental health professionals It is believed the most beneficial treatment for pedophilia and for child sexual exploitation is through advocacy techniques by creating awareness among society and social services (Nobrega, 2016). Treatment usually consists of stopping further offenses as opposed to altering the pedophiles sexual orientation (Hall and Hall, 2007). Cognitive-behavioral therapy in combination with medication that reduces sexual desire may be a good option (Kaplan, 2015). Popular treatment options include testosterone suppression by pharmacology means such as antiandrogenic therapy or chemical castration (more effective than physical castration because it requires follow up visits, continuous monitoring, psychiatric evaluation, and can be reversed (Hall & Hall, 2007). Many mental health professionals are reluctant to take pedophilic patients because of: lack of knowledge (20%), negative feelings towards pedophiles (13.3%), negative experiences (13.3%), and skepticism about the client’s motivation for seeking help (11.7%). Less than 5% said they would work with pedophiles or child sex offenders (Levenson, Willis, & Vicencio, 2017). References available upon request