Brain Research and Pedophilia - Association for the Treatment of ...
Brain Research and Pedophilia - Association for the Treatment of ...
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<strong>Brain</strong> <strong>Research</strong> <strong>and</strong> <strong>Pedophilia</strong>:What it means <strong>for</strong> assessment,treatment, <strong>and</strong> policyJames M. Cantor, PhDHead <strong>of</strong> <strong>Research</strong>, CAMH Sexual Behaviours ClinicAssociate Pr<strong>of</strong>essor <strong>of</strong> Psychiatry, University <strong>of</strong> TorontoEditor-in-Chief, Sexual Abuse: A Journal <strong>of</strong> <strong>Research</strong> <strong>and</strong> <strong>Treatment</strong>Presentation available at http://individual.utoronto.ca/james_cantor
The Big QuestionsIs it in <strong>the</strong> brain?Can we treat it?Is it in <strong>the</strong> genes?Does it run in families?Were <strong>the</strong>y born with it?Can it change?Are <strong>the</strong>y responsible <strong>for</strong> it?Can we prevent it?
Richard von Krafft-Ebing (1840–1902)Psychopathia Sexualis (1886)Sexual anomalies are a“diseased condition <strong>of</strong> <strong>the</strong>central nervous system” (p. 61).
IQ FindingsMeta-Analysis <strong>of</strong> all reports, 1931–2004• 75 reports with IQ data• 236 non-overlapping samples• 25,146 cases (7,045 sexual <strong>of</strong>fenders <strong>and</strong> 18,101 controls)—Cantor, Blanchard, Robichaud, & Christensen (2005). Psychological Bulletin, 131, 555–568.
Adjusted Mean IQ Score (s.e.)IQ <strong>of</strong> Adult Samples by Victims’ Age Group110F (4, 158) = 7.74p < .0001105100959085k=56 k=8 k=53 k=12 k=36SexualOffendersAgainstChildrenSexualOffendersAgainst AdultsNonsexualOffendersNon<strong>of</strong>fendersSexualOffenders,Victims' AgesMixed orUnknown—Cantor, Blanchard, Robichaud, & Christensen (2005). Psychological Bulletin, 131, 555–568.
Samples' Mean IQIQ by Definition <strong>of</strong> “Child” Victim115110r (29) = .50p = .00510510095908512 13 14 15 16 17 18 19Cut<strong>of</strong>f Defining "child"—Cantor, Blanchard, Robichaud, & Christensen (2005). Psychological Bulletin, 131, 555–568.
Frontal Lobe vs. Temporal Lobe Theories
Frontal Lobe vs. Temporal Lobe TheoriesInhibition/self-controlThe 4 F’s
Neuropsychological BatteriesHalstead-Reitan BatteryYeudall (1977)Yeudall et al. (1979)Langevin et al. (1985)Langevin et al. (1988)Langevin et al. (1989)RapistsHeterogeneousSadistsSexual killers, aggressivesExhibitionistsLuria-Nebraska BatteryGraber et al. (1982)Scott et al. (1984)Hucker et al. (1986)Hucker et al. (1988)Langevin et al. (1988)Galski et al. (1990)HeterogeneousOffenders vs. children, adultsPedophilesSadists, sexual aggressivesSexual killers, aggressivesHeterogeneous
Neuropsychological BatteriesIndications <strong>of</strong> general impairment.No reliable localization.
Individual Neuropsychological TestsTrail-MakingBowden (1987)Cohen et al. (2002)Dolan et al. (2002)Knox-Jones (1994)Langevin et al. (1989)Stone & Thompson (2001)Tarter et al. (1983)Yeudall et al. (1987)Controlled Oral Word Assoc.Cohen et al. (2002)Dolan et al. (2002)Gillespie & Mckenzie (2000)Knox-Jones (1994)Rubenstein (1992)Stone & Thompson (2001)Yeudall et al. (1987)Wisconsin Card SortCohen et al. (2002)Dolan et al. (2002)Kruger & Schiffer (2011)Miller (1997)Rubenstein (1992)Stone & Thompson (2001)Westergren (2002)Yeudall et al. (1987)Wechsler Memory ScaleDolan et al. (2002)Knox-Jones (1994)Langevin et al. (1989)Rubenstein (1992)Tarter et al. (1983)StroopCohen et al. (2002)Dolan et al. (2002)Stone & Thompson (2001)Gillespie & Mckenzie (2000)Williams Verbal Learning TestAbracen et al. (1991)Baker (1985)O’Carroll (1989)Yeudall et al. (1986)Bender Gestalt TestLewis et al. (1979)Yeudall et al. (1986)Finger-TappingKnox-Jones (1994)Langevin et al. (1989)Tarter et al. (1983)Yeudall et al. (1986)
Individual Neuropsychological TestsIndications <strong>of</strong> general impairment.(Methodological confound?)No reliable localization.
Early <strong>Brain</strong> ImagingCT studiesGraber et al. (1982)Langevin et al. (1985)Hucker et al. (1986)Hendricks et al. (1988)Hucker et al. (1988)Langevin et al. (1988)Langevin et al. (1989)Wright et al. (1990)Offenders vs. women, childrenSadists, nonsadistic <strong>of</strong>fendersPedophilesOffenders vs. childrenSadists, nonsadistic vs. womenIncest <strong>of</strong>fendersPedophilesOffenders vs. women, pedophiles,incest <strong>of</strong>fenders, nonsex <strong>of</strong>fenders
CT studiesEarly <strong>Brain</strong> Imaging
Early <strong>Brain</strong> ImagingIndications <strong>of</strong> diffuse neuropathy.No reliable localization.
Contemporary Neuropsychology <strong>and</strong> Biometrics
Mean (SE) Full-Scale IQIntelligence Quotient (IQ)110Covariates: F (2, 293) = 6.77age, age@ESL p = .001105100959085Pedophiles(n=47)Hebephiles(n=158)Teleiophiles(n=93)—Cantor, Blanchard, Christensen, Dickey, et al. (2004). Neuropsychology, 18, 3–14.
Mean (SE) HVLT-R Total RecallVerbal Memory by Phallometric Group25Covariates: F (2, 297) = 5.08age, age @ ESL p = .0072423222120Pedophiles(n=47)Hebephiles(n=161)Teleiophiles(n=94)—Cantor, Blanchard, Christensen, Dickey, et al. (2004). Neuropsychology, 18, 3–14.
Mean (SE) BVMT-R Total RecallVisuospatial Memory by Phallometric Group2524232221201918171615Covariates: F (2, 255) = 6.51age, age @ ESL p = .002Pedophiles(n=43)Hebephiles(n=138)Teleiophiles(n=79)—Cantor, Blanchard, Christensen, Dickey, et al. (2004). Neuropsychology, 18, 3–14.
Proportions Failing or in Special Ed. by Group80%70%60%50%40%30%20%10%Co-variates:IQ, parental edu.age, age @ ESLWald = 16.72p = .0010%TeleiophilicNon<strong>of</strong>fendersTeleiophilicSexualOffendersHebephilic Men Pedophilic Men(n=71) (n=139) (n=377) (n=114)—Cantor, Kuban, Blak, Klassen, Dickey, & Blanchard. (2006). Archives <strong>of</strong> Sexual Behavior, 35, 743–751.
% with any injuriesAccidents Causing Unconsciousness3530Age < 13 Age ≥ 13p = .01 p = .663+ Injuries2 Injuries1 Injury2520151050Hebe (n=225)Pedo (n=70)Teleio (n=133)Hebe (n=225)Pedo (n=70)Teleio (n=133)—Blanchard, Kuban, Klassen, Dickey, Christensen, Cantor, & Blak. (2003). Archives <strong>of</strong> Sexual Behavior, 32, 573–581.
Mean (s.e.) Height, in cmPhysical Height180Covariate: F (4, 1220) = 4.11age p = .003179178177176175Pedophiles Hebephiles TeleiophilicSexualOffendersTeleiophilic Non<strong>of</strong>fenders(n=237) (n=662) (n=178) (n=148)—Cantor, Kuban, Blak, Klassen, Dickey, & Blanchard. (2007). Sexual Abuse, 19, 395–407.
% non-right-h<strong>and</strong>edH<strong>and</strong>edness in <strong>Pedophilia</strong> <strong>and</strong> Hebephilia4030Covariates:IQ, parental ed.,age, age @ ESLage: Wald = 14.25, p = .0008sex: Wald = 0.64, p = .4320100n= n= n= n= n= n=325 242 41 38 40 41Het PedoHet HebeHet TeleioHomo PedoHomo HebeHomo Teleio—Cantor, Klassen, Dickey, Christensen, Kuban, Blak, et al. (2005). Archives <strong>of</strong> Sexual Behavior, 34, 447–459.
SummaryPedophilic men demonstrate:• Lower IQs• Lower scores on memory tests• More frequent grade failure• Less physical height• Less right-h<strong>and</strong>ednessConsistent indications <strong>of</strong> general impairment in:large samples <strong>of</strong>homogeneous <strong>of</strong>fenders (pedophiles) withphallometric data.
Are <strong>Brain</strong> Differences Observable Directly?
Schiltz et al. (2007)Study Theory Prediction Subjects VBM AnalysisSchiltz 15 pedophiles small volumeet al. limbic “temporal” 15 community corrected(2007) controls
Schiltz et al. (2007)Study Theory Prediction Subjects VBM AnalysisSchiltz 15 pedophiles small volumeet al. limbic “temporal” 15 community corrected(2007) controls
Schiffer et al. (2007)Study Theory Prediction Subjects VBM AnalysisSchiffer OCD/ 18 pedophiles small volumeet al. impulsivity frontal 24 community corrected(2007) controls
Schiffer et al. (2007)Study Theory Prediction Subjects VBM AnalysisSchiffer OCD/ 18 pedophiles small volumeet al. impulsivity frontal 24 community corrected(2007) controls
Junk Data or Blind Monks?
Cantor et al. (2008)Study Theory Prediction Subjects VBM AnalysisCantor 65 pedophiles whole brainet al. a<strong>the</strong>oretical none 62 nonsexual volume(2008) <strong>of</strong>fenders corrected
ProceduresSexological MeasuresPhallometryMRI MeasuresAutomated parcellationSelf-report,<strong>of</strong>fense historyVoxel-based morphometry(VBM)
What’s a “voxel”?
SubjectsPatientsn = 65 sexology patientsRecruited from <strong>the</strong> Kurt Freund Laboratory (CAMH, Toronto)Controlsn = 62 nonsexual <strong>of</strong>fendersRecruited from federal <strong>and</strong> provincial parole/probation <strong>of</strong>ficesExclusion criteria300 lbs weightEver suffered traumatic brain injuryEver diagnosed with schizophreniaEver employed grinding metalAny o<strong>the</strong>r metal object in body, counterindicating MRIFrom: Cantor, Kabani, Christensen, Zipursky, Barbaree, et al. (2008). Journal <strong>of</strong> Psychiatric <strong>Research</strong>, 42, 167–183.
SubjectsCharacteristic Patients Controls Comparison pAge 36.4 (13.5) 36.9 (9.4) t (125) = –0.23 .82Full-Scale IQ 96.2 (15.3) 96.3 (11.5) t (125) = –0.03 .98Education 12.2 (3.0) 12.1 (2.8) t (125) = 0.20 .84CAGE alcoholscreen% non-righth<strong>and</strong>ed1.1 (1.4) 2.1 (1.6) t (125) = –3.8 .000323.1% 14.5% 2 (1) = 1.52 .22From: Cantor, Kabani, Christensen, Zipursky, Barbaree, et al. (2008). Journal <strong>of</strong> Psychiatric <strong>Research</strong>, 42, 167–183.
VBM <strong>of</strong> Pedophilic vs. Nonsexual Offender MenFrom: Cantor, Kabani, Christensen, Zipursky, Barbaree, et al. (2008). Journal <strong>of</strong> Psychiatric <strong>Research</strong>, 42, 167–183.
VBM <strong>of</strong> Pedophilic vs. Nonsexual Offender MenFrom: Cantor, Kabani, Christensen, Zipursky, Barbaree, et al. (2008). Journal <strong>of</strong> Psychiatric <strong>Research</strong>, 42, 167–183.
Superior Occipit<strong>of</strong>rontal FasciculusFrom: Cantor, Kabani, Christensen, Zipursky, Barbaree, et al. (2008). Journal <strong>of</strong> Psychiatric <strong>Research</strong>, 42, 167–183.
(right) Arcuate FasciculusFrom: Cantor, Kabani, Christensen, Zipursky, Barbaree, et al. (2008). Journal <strong>of</strong> Psychiatric <strong>Research</strong>, 42, 167–183.
But, what does this mean?Middle Frontal Gyrus (Ferretti et al., 2005; Garavan et al., 2000; Gizewski et al., 2006;Karama et al., 2002; Montosori et al., 2003; Rauch et al., 2000)Insula <strong>and</strong> Opercula (Garavan et al., 2000; Gizewski et al., 2006; Karama et al., 2002;Park et al., 2001; Stoléru et al., 1999)Sup./Inf. Parietal Lobules (Beauregard et al., 2001; Bocher et al., 2001; Ferretti et al., 2005;Mouras et al., 2003; Stoléru et al., 2003)Occipital Cortex (Beauregard et al., 2001; Bocher et al., 2001; Ferreti et al., 2005;Garavan et al., 2000; Mouras et al., 2003; Park et al., 2001)
But, what does this mean?1. Humans have multiple social instincts.2. In typical men, multiple grey matter regions are networkedtoge<strong>the</strong>r to identify socially significant stimuli <strong>and</strong> evoke <strong>the</strong>species-typical response:Nurturance, parentingObedience, imitationSexual arousal, courtshipCompetition, combatEscape…etc.3. In pedophiles, <strong>the</strong> white matter tissue is underdeveloped <strong>and</strong>connects <strong>the</strong> wrong stimulus to <strong>the</strong> wrong response.?
Towards Underst<strong>and</strong>ing <strong>the</strong> ContradictionsStudy Theory Prediction Subjects VBM AnalysisWhy didn’t Schiltz <strong>and</strong> Schiffer find white matter?Why didn’t Cantor find grey matter?
Towards Underst<strong>and</strong>ing <strong>the</strong> ContradictionsStudy Theory Prediction Subjects VBM AnalysisSchiltz 15 pedophiles small volumeet al. limbic “temporal” 15 community corrected(2007) controlsSchiffer OCD/ 18 pedophiles small volumeet al. impulsivity frontal 24 community corrected(2007) controlsCantor 65 pedophiles whole brainet al. a<strong>the</strong>oretical unbiased 62 nonsexual volume(2008) <strong>of</strong>fenders corrected
Towards Underst<strong>and</strong>ing <strong>the</strong> ContradictionsStudy Theory Prediction Subjects VBM AnalysisSchiltz 15 pedophiles small volumeet al. limbic “temporal” 15 community corrected(2007) controlsSchiffer OCD/ 18 pedophiles small volumeet al. impulsivity frontal 24 community corrected(2007) controlsCantor 65 pedophiles whole brainet al. a<strong>the</strong>oretical unbiased 62 nonsexual volume(2008) <strong>of</strong>fenders corrected
Towards Underst<strong>and</strong>ing <strong>the</strong> ContradictionsStudy Theory Prediction Subjects VBM AnalysisSchiltz 15 pedophiles small volumeet al. limbic “temporal” 15 community corrected(2007) controlsSchiffer OCD/ 18 pedophiles small volumeet al. impulsivity frontal 24 community corrected(2007) controlsCantor 65 pedophiles whole brainet al. a<strong>the</strong>oretical unbiased 62 nonsexual volume(2008) <strong>of</strong>fenders corrected
Towards Underst<strong>and</strong>ing <strong>the</strong> Contradictions<strong>Pedophilia</strong>Fronto-occipital fasciculusArcuate fasciculusAnti-SocialityPrefrontal cortexStriatumHypothalamusAmygdalaOrbit<strong>of</strong>rontalcortexCerebellarvermisCorpus callosumHippocampusAdverseChildhoodEvents
So, can an MRI detect pedophilia?Yes, in groups.But…<strong>the</strong>re is still disagreement over which anatomy.No (or not yet), in individuals.But…<strong>the</strong>re is also functional brain scanning (fMRI).
functional MRI (fMRI)Subject per<strong>for</strong>ms two+ tasks, including a control task.Higher bloodflow = higher activityStuart Clare, FMRIB
functional MRI (fMRI)Subject per<strong>for</strong>ms two+ tasks, including a control task.Use “subtractive” statistics to compare activity between tasks.Posner & Raichle, Images <strong>of</strong> Mind
functional MRI (fMRI)Subject per<strong>for</strong>m two+ tasks, including a control task.Use “subtractive” statistics to compare activity between tasks.Study Anatomy Subjects ResultsWalter et al. whole pedophiles, pedophiles respond(2007) brain healthy controls analogously to controlsSchiffer et al. whole homosexual pedophiles, pedophiles respond(2008a) brain healthy gay men analogously to controlsSchiffer et al. whole heterosexual pedophiles, no pedophilic responses(2008b) brain heterosexual controlsPoeppl et al. whole pedophiles, pedophiles respond(2011) brain nonsexual <strong>of</strong>fenders analogously, but > controlsSartorius et al. amygdala homosexual pedophiles, amygdala responded(2008) center heterosexual controls analogouslyPonseti et al. empirical diverse pedophiles, 88% sensitivity <strong>and</strong>(in press) subset <strong>of</strong> diverse controls 100% specificitybrain
So, can fMRI detect arousal to child stimuli?<strong>Research</strong> Clinical Screening EvidencefMRI <strong>of</strong> amygdala (67 % / 67 % )Digital exam <strong>of</strong> prostate (53 % / 84 % )Glucose tolerance (58 % / 77 % )HIV antibody (99+ % / 99+ % )fMRI <strong>of</strong> admitters (95 % / 95 % )PSA <strong>for</strong> prostate c. (72 % / 93 % )Phallometry <strong>of</strong> deniers (61 % / 96 % )“Rapid” H1N1 test (51 % / 99 % )
SummaryOverall features suggest early (pre-natal) originsPedophilic brain structure slightly different from typical<strong>Brain</strong> differences not consistent with what changes with<strong>the</strong>rapy, surgery, or current stem cell researchPedophilic brain “lights up” in same pattern as non-pedophilesPedophiles respond to stimuli <strong>of</strong> children ra<strong>the</strong>r than adults
The Big QuestionsIs it in <strong>the</strong> brain?Can we treat it?Is it in <strong>the</strong> genes?Does it run in families?Were <strong>the</strong>y born with it?Can it change?Are <strong>the</strong>y responsible <strong>for</strong> it?Can we prevent it?
The Public’s Fears
My Fears
My HopesWhat if…?fMRI provides <strong>the</strong> next increment in accuracy <strong>of</strong> diagnosing pedophilia <strong>and</strong>is employed only within <strong>the</strong> bounds <strong>of</strong> contemporary pr<strong>of</strong>essional ethics:● In<strong>for</strong>med Consent● ConfidentialityWith continued research, we pinpoint <strong>the</strong> prenatal process that goes awry.Perhaps: A general prenatal health factor already known to interfere withnormal growth <strong>of</strong> both body <strong>and</strong> brain...Instead <strong>of</strong> preventing a second <strong>of</strong>fense,we can prevent <strong>the</strong> first <strong>of</strong>fense.
Magnus Hirschfeld (1868–1935)“Justice through science”Wissenschaftlich-humanitäres Komitee(Scientific-Humanitarian Committee)
AcknowledgementsCAMH Law & Mental HealthHoward BarbareeRobert DickeyPhilip KlassenCAMH Schizophrenia ProgramBruce ChristensenRobert ZipurskyTGH Dept. <strong>of</strong> NeuroimagingDavid MikulisHien TranOntario Ministry <strong>of</strong> CorrectionsRobert BrownCAMH Image Processing LabNoor KabaniKate HanrattyBlake RichardsKurt Freund LaboratoryRay BlanchardThomas BlakMichael KubanSophie LafailleNanci LipsteinCorrectional Service CanadaElias ConstantatosRobert Small
The full (color) version <strong>of</strong> thispresentation is downloadable from:http://individual.utoronto.ca/james_cantor