Brain Research and Pedophilia - Association for the Treatment of ...

Brain Research and Pedophilia:What it means for assessment,treatment, and policyJames M. Cantor, PhDHead of Research, CAMH Sexual Behaviours ClinicAssociate Professor of Psychiatry, University of TorontoEditor-in-Chief, Sexual Abuse: A Journal of Research and TreatmentPresentation available at http://individual.utoronto.ca/james_cantor

The Big QuestionsIs it in the brain?Can we treat it?Is it in the genes?Does it run in families?Were they born with it?Can it change?Are they responsible for it?Can we prevent it?

Richard von Krafft-Ebing (1840–1902)Psychopathia Sexualis (1886)Sexual anomalies are a“diseased condition of thecentral nervous system” (p. 61).

IQ FindingsMeta-Analysis of all reports, 1931–2004• 75 reports with IQ data• 236 non-overlapping samples• 25,146 cases (7,045 sexual offenders and 18,101 controls)—Cantor, Blanchard, Robichaud, & Christensen (2005). Psychological Bulletin, 131, 555–568.

Adjusted Mean IQ Score (s.e.)IQ of Adult Samples by Victims’ Age Group110F (4, 158) = 7.74p < .0001105100959085k=56 k=8 k=53 k=12 k=36SexualOffendersAgainstChildrenSexualOffendersAgainst AdultsNonsexualOffendersNonoffendersSexualOffenders,Victims' AgesMixed orUnknown—Cantor, Blanchard, Robichaud, & Christensen (2005). Psychological Bulletin, 131, 555–568.

Samples' Mean IQIQ by Definition of “Child” Victim115110r (29) = .50p = .00510510095908512 13 14 15 16 17 18 19Cutoff 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 of 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 of general impairment.(Methodological confound?)No reliable localization.

Early Brain 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 offendersPedophilesOffenders vs. childrenSadists, nonsadistic vs. womenIncest offendersPedophilesOffenders vs. women, pedophiles,incest offenders, nonsex offenders

CT studiesEarly Brain Imaging

Early Brain ImagingIndications of diffuse neuropathy.No reliable localization.

Contemporary Neuropsychology and 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%TeleiophilicNonoffendersTeleiophilicSexualOffendersHebephilic Men Pedophilic Men(n=71) (n=139) (n=377) (n=114)—Cantor, Kuban, Blak, Klassen, Dickey, & Blanchard. (2006). Archives of 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 of Sexual Behavior, 32, 573–581.

Mean (s.e.) Height, in cmPhysical Height180Covariate: F (4, 1220) = 4.11age p = .003179178177176175Pedophiles Hebephiles TeleiophilicSexualOffendersTeleiophilic Nonoffenders(n=237) (n=662) (n=178) (n=148)—Cantor, Kuban, Blak, Klassen, Dickey, & Blanchard. (2007). Sexual Abuse, 19, 395–407.

% non-right-handedHandedness in Pedophilia and 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 of Sexual Behavior, 34, 447–459.

SummaryPedophilic men demonstrate:• Lower IQs• Lower scores on memory tests• More frequent grade failure• Less physical height• Less right-handednessConsistent indications of general impairment in:large samples ofhomogeneous offenders (pedophiles) withphallometric data.

Are Brain 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. atheoretical none 62 nonsexual volume(2008) offenders corrected

ProceduresSexological MeasuresPhallometryMRI MeasuresAutomated parcellationSelf-report,offense historyVoxel-based morphometry(VBM)

What’s a “voxel”?

SubjectsPatientsn = 65 sexology patientsRecruited from the Kurt Freund Laboratory (CAMH, Toronto)Controlsn = 62 nonsexual offendersRecruited from federal and provincial parole/probation officesExclusion criteria300 lbs weightEver suffered traumatic brain injuryEver diagnosed with schizophreniaEver employed grinding metalAny other metal object in body, counterindicating MRIFrom: Cantor, Kabani, Christensen, Zipursky, Barbaree, et al. (2008). Journal of Psychiatric Research, 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-righthanded1.1 (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 of Psychiatric Research, 42, 167–183.

VBM of Pedophilic vs. Nonsexual Offender MenFrom: Cantor, Kabani, Christensen, Zipursky, Barbaree, et al. (2008). Journal of Psychiatric Research, 42, 167–183.

VBM of Pedophilic vs. Nonsexual Offender MenFrom: Cantor, Kabani, Christensen, Zipursky, Barbaree, et al. (2008). Journal of Psychiatric Research, 42, 167–183.

Superior Occipitofrontal FasciculusFrom: Cantor, Kabani, Christensen, Zipursky, Barbaree, et al. (2008). Journal of Psychiatric Research, 42, 167–183.

(right) Arcuate FasciculusFrom: Cantor, Kabani, Christensen, Zipursky, Barbaree, et al. (2008). Journal of Psychiatric Research, 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 and 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 networkedtogether to identify socially significant stimuli and evoke thespecies-typical response:Nurturance, parentingObedience, imitationSexual arousal, courtshipCompetition, combatEscape…etc.3. In pedophiles, the white matter tissue is underdeveloped andconnects the wrong stimulus to the wrong response.?

Towards Understanding the ContradictionsStudy Theory Prediction Subjects VBM AnalysisWhy didn’t Schiltz and Schiffer find white matter?Why didn’t Cantor find grey matter?

Towards Understanding the 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. atheoretical unbiased 62 nonsexual volume(2008) offenders corrected

Towards Understanding the 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. atheoretical unbiased 62 nonsexual volume(2008) offenders corrected

Towards Understanding the 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. atheoretical unbiased 62 nonsexual volume(2008) offenders corrected

Towards Understanding the ContradictionsPedophiliaFronto-occipital fasciculusArcuate fasciculusAnti-SocialityPrefrontal cortexStriatumHypothalamusAmygdalaOrbitofrontalcortexCerebellarvermisCorpus callosumHippocampusAdverseChildhoodEvents

So, can an MRI detect pedophilia?Yes, in groups.But…there is still disagreement over which anatomy.No (or not yet), in individuals.But…there is also functional brain scanning (fMRI).

functional MRI (fMRI)Subject performs two+ tasks, including a control task.Higher bloodflow = higher activityStuart Clare, FMRIB

functional MRI (fMRI)Subject performs two+ tasks, including a control task.Use “subtractive” statistics to compare activity between tasks.Posner & Raichle, Images of Mind

functional MRI (fMRI)Subject perform 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 offenders analogously, but > controlsSartorius et al. amygdala homosexual pedophiles, amygdala responded(2008) center heterosexual controls analogouslyPonseti et al. empirical diverse pedophiles, 88% sensitivity and(in press) subset of diverse controls 100% specificitybrain

So, can fMRI detect arousal to child stimuli?Research Clinical Screening EvidencefMRI of amygdala (67 % / 67 % )Digital exam of prostate (53 % / 84 % )Glucose tolerance (58 % / 77 % )HIV antibody (99+ % / 99+ % )fMRI of admitters (95 % / 95 % )PSA for prostate c. (72 % / 93 % )Phallometry of deniers (61 % / 96 % )“Rapid” H1N1 test (51 % / 99 % )

SummaryOverall features suggest early (pre-natal) originsPedophilic brain structure slightly different from typicalBrain differences not consistent with what changes withtherapy, surgery, or current stem cell researchPedophilic brain “lights up” in same pattern as non-pedophilesPedophiles respond to stimuli of children rather than adults

The Big QuestionsIs it in the brain?Can we treat it?Is it in the genes?Does it run in families?Were they born with it?Can it change?Are they responsible for it?Can we prevent it?

The Public’s Fears

My Fears

My HopesWhat if…?fMRI provides the next increment in accuracy of diagnosing pedophilia andis employed only within the bounds of contemporary professional ethics:● Informed Consent● ConfidentialityWith continued research, we pinpoint the prenatal process that goes awry.Perhaps: A general prenatal health factor already known to interfere withnormal growth of both body and brain...Instead of preventing a second offense,we can prevent the first offense.

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. of NeuroimagingDavid MikulisHien TranOntario Ministry of CorrectionsRobert BrownCAMH Image Processing LabNoor KabaniKate HanrattyBlake RichardsKurt Freund LaboratoryRay BlanchardThomas BlakMichael KubanSophie LafailleNanci LipsteinCorrectional Service CanadaElias ConstantatosRobert Small

The full (color) version of thispresentation is downloadable from:http://individual.utoronto.ca/james_cantor