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Cantor, J. M. (2011, November). Brain research and pedophilia:

What it means for assessment, treatment, and policy.

Plenary address presented to the 30th Annual Meeting of the

Association for the Treatment of Sexual Abusers, Toronto,

Canada. Lecture slides retrieved from

http://individual.utoronto.ca/james_cantor/cantorplenary.ppt

Updates via twitter @JamesCantorPhD

http://twitter.com/jamescantorphd

Brain Research and Pedophilia:Brain Research and Pedophilia:

What it means for assessment, What it means for assessment, treatment, and policytreatment, and policy

James M. Cantor,James M. Cantor, PhD PhD

Head of Research, CAMH Sexual Behaviours ClinicHead of Research, CAMH Sexual Behaviours ClinicAssociate Professor of Psychiatry, University of TorontoAssociate Professor of Psychiatry, University of Toronto

Editor-in-Chief, Editor-in-Chief, Sexual Abuse: A Journal of Research and TreatmentSexual Abuse: A Journal of Research and Treatment

The Big QuestionsThe Big Questions

Is it in the brain? Is it in the brain? Can we treat it?Can we treat it?

Is it in the genes?Is it in the genes?

Were they born with it? Were they born with it?

Does it run in families?Does it run in families?

Can it change? Can it change? Are they responsible for it?Are they responsible for it?

Can we prevent it?Can we prevent it?

1886 Founding of modern sexology

1900–2000 Large scale studies of forensic samples

1980–1999 Neuropsych testing, early imaging (CT) studies

1999 First neuroimaging study of sexual arousal

2000– Large-scale studies of homogeneous samples

2007–2008 High-resolution studies of pedophilia published

2007 First fMRI studies of pedophilia published

Sexual Offending and the Brain: HistorySexual Offending and the Brain: History

Richard von Krafft-Ebing (1840Richard von Krafft-Ebing (1840–1902–1902))


Psychopathia Sexualis (1886)


Sexual anomalies are a“diseased condition of the

central nervous system” (p. 61).

Psychopathia Sexualis (1886)








Meta-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)

IQ FindingsIQ Findings

—Cantor, Blanchard, Robichaud, & Christensen (2005). Psychological Bulletin, 131, 555–568.

85

90

95

100

105

110

SexualOffenders

AgainstChildren

SexualOffenders

Against Adults

NonsexualOffenders

Nonoffenders SexualOffenders,

Victims' AgesMixed orUnknown

Adj

uste

d M

ean

IQ S

core

(s.

e.)

IQ of Adult Samples by Victims’ Age Group IQ of Adult Samples by Victims’ Age Group


85

90

95

100

105

110

SexualOffenders

AgainstChildren

SexualOffenders

Against Adults

NonsexualOffenders

Nonoffenders SexualOffenders,

Victims' AgesMixed orUnknown

Adj

uste

d M

ean

IQ S

core

(s.

e.)

IQ of Adult Samples by Victims’ Age Group IQ of Adult Samples by Victims’ Age Group


F (4, 158) = 7.74p < .0001

k=56 k=8 k=53 k=12 k=36

IQ by Definition of “Child” VictimIQ by Definition of “Child” Victim

85

90

95

100

105

110

115

12 13 14 15 16 17 18 19

Cutoff Defining "child"

Sam

ples

' Mea

n IQ

r (29) = .50p = .005









Frontal Lobe vs. Temporal Lobe TheoriesFrontal Lobe vs. Temporal Lobe Theories



Inhibition/self-control

The 4 F’s

Halstead-Reitan Battery

Yeudall (1977) RapistsYeudall et al. (1979) HeterogeneousLangevin et al. (1985) SadistsLangevin et al. (1988) Sexual killers, aggressivesLangevin et al. (1989) Exhibitionists

Luria-Nebraska Battery

Graber et al. (1982) HeterogeneousScott et al. (1984) Offenders vs. children, adultsHucker et al. (1986) PedophilesHucker et al. (1988) Sadists, sexual aggressivesLangevin et al. (1988) Sexual killers, aggressivesGalski et al. (1990) Heterogeneous

Neuropsychological BatteriesNeuropsychological Batteries

Halstead-Reitan Battery

Yeudall (1977) RapistsYeudall et al. (1979) HeterogeneousLangevin et al. (1985) SadistsLangevin et al. (1988) Sexual killers, aggressivesLangevin et al. (1989) Exhibitionists

Luria-Nebraska Battery

Graber et al. (1982) HeterogeneousScott et al. (1984) Offenders vs. children, adultsHucker et al. (1986) PedophilesHucker et al. (1988) Sadists, sexual aggressivesLangevin et al. (1988) Sexual killers, aggressivesGalski et al. (1990) Heterogeneous

Neuropsychological BatteriesNeuropsychological Batteries

Indications of general impairment.No reliable localization.

Trail-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)

StroopCohen et al. (2002)Dolan et al. (2002)Stone & Thompson (2001)Gillespie & Mckenzie (2000)

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)

Bender Gestalt TestLewis et al. (1979)Yeudall et al. (1986)

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)

Wechsler Memory ScaleDolan et al. (2002)Knox-Jones (1994)Langevin et al. (1989)Rubenstein (1992)Tarter et al. (1983)

Williams Verbal Learning TestAbracen et al. (1991)Baker (1985)O’Carroll (1989)Yeudall et al. (1986)

Finger-TappingKnox-Jones (1994)Langevin et al. (1989)Tarter et al. (1983)Yeudall et al. (1986)

Individual Neuropsychological TestsIndividual Neuropsychological Tests



















Indications of general impairment.(Methodological confound?)

No reliable localization.

CT studies

Graber et al. (1982) Offenders vs. women, children

Langevin et al. (1985) Sadists, nonsadistic offenders

Hucker et al. (1986) PedophilesHendricks et al. (1988) Offenders vs. childrenHucker et al. (1988) Sadists, nonsadistic vs.

womenLangevin et al. (1988) Incest offendersLangevin et al. (1989) PedophilesWright et al. (1990) Offenders vs. women,

pedophiles, incest offenders,

nonsex offenders

Early Brain ImagingEarly Brain Imaging


CT studies


CT studies

Indications of diffuse neuropathy.No reliable localization.

Contemporary Neuropsychology and BiometricsContemporary Neuropsychology and Biometrics

85

90

95

100

105

110

Pedophiles(n=47)

Hebephiles (n=158)

Teleiophiles(n=93)

Me

an

(S

E)

Fu

ll-S

cale

IQ

Covariates: F (2, 293) = 6.77 age, age@ESL p = .001

Intelligence Quotient (IQ)Intelligence Quotient (IQ)

—Cantor, Blanchard, Christensen, Dickey, et al. (2004). Neuropsychology, 18, 3–14.

Verbal Memory by Phallometric GroupVerbal Memory by Phallometric Group

20

21

22

23

24

25

Pedophiles(n=47)

Hebephiles (n=161)

Teleiophiles(n=94)

Me

an

(S

E)

HV

LT

-R T

ota

l R

ec

all Covariates: F (2, 297) = 5.08

age, age @ ESL p = .007


Visuospatial Memory by Phallometric GroupVisuospatial Memory by Phallometric Group

15

16

17

18

19

20

21

22

23

24

25

Pedophiles(n=43)

Hebephiles (n=138)

Teleiophiles(n=79)

Me

an

(S

E)

BV

MT

-R T

ota

l R

ec

all Covariates: F (2, 255) = 6.51

age, age @ ESL p = .002


Proportions Failing or in Special Ed. by GroupProportions Failing or in Special Ed. by Group

—Cantor, Kuban, Blak, Klassen, Dickey, & Blanchard. (2006). Archives of Sexual Behavior, 35, 743–751.

0%

10%

20%

30%

40%

50%

60%

70%

80%

TeleiophilicNonoffenders

TeleiophilicSexual

Offenders

Hebephilic Men Pedophilic Men

n=71 n=139 n=377 n=114

Wald = 16.72p = .001

Co-variates:IQ, parental edu.age, age @ ESL

0

5

10

15

20

25

30

35

% w

ith a

ny in

jurie

s

3+ Injuries

2 Injuries

1 Injury

Accidents Causing UnconsciousnessAccidents Causing Unconsciousness

Age < 13 Age ≥ 13p = .01 p = .66

—Blanchard, Kuban, Klassen, Dickey, Christensen, Cantor, & Blak. (2003). Archives of Sexual Behavior, 32, 573–581.

0

5

10

15

20

25

30

35

% w

ith a

ny in

jurie

s

3+ Injuries

2 Injuries

1 Injury

Accidents Causing UnconsciousnessAccidents Causing Unconsciousness

Age < 13 Age ≥ 13p = .01 p = .66

—Blanchard, Kuban, Klassen, Dickey, Christensen, Cantor, & Blak. (2003). Archives of Sexual Behavior, 32, 573–581.

175

176

177

178

179

180

Pedophiles Hebephiles TeleiophilicSexual

Offenders

Teleiophilic Non-offenders

Me

an

(s.

e.)

He

igh

t, in

cm

Covariate: F (4, 1220) = 4.11 age p = .003

—Cantor, Kuban, Blak, Klassen, Dickey, & Blanchard. (2007). Sexual Abuse, 19, 395–407.

n =n = n = n =237662 178 148

Physical HeightPhysical Height

Handedness in Pedophilia and HebephiliaHandedness in Pedophilia and Hebephilia

0

10

20

30

40

% n

on

-rig

ht-

ha

nd

ed

—Cantor, Klassen, Dickey, Christensen, Kuban, Blak, et al. (2005). Archives of Sexual Behavior, 34, 447–459.

age: Wald = 14.25, p = .0008sex: Wald = 0.64, p = .43

n= n= n= n= n= n= 325 242 41 38 40 41

Covariates:IQ, parental ed.,age, age @ ESL

Pedophilic men demonstrate:Pedophilic men demonstrate:

• Lower IQsLower IQs

• Lower scores on memory testsLower scores on memory tests

• More frequent grade failureMore frequent grade failure

• Less physical heightLess physical height

• Less right-handednessLess right-handedness

Consistent indications of general impairment in:Consistent indications of general impairment in:large large samples of samples of homogeneous homogeneous offenders (pedophiles) withoffenders (pedophiles) withphallometricphallometric data. data.

SummarySummary

Are Brain Differences Observable Are Brain Differences Observable Directly?Directly?

Study Theory Prediction Subjects VBM Analysis

Schiltzet al.

(2007)

Schifferet al.

(2007)

Cantoret al.

(2008)

Structural MRI Studies of PedophiliaStructural MRI Studies of Pedophilia



Schiltzet al. limbic “temporal”(2007)

Schiffer OCD/et al. impulsivity frontal(2007)

Cantoret al.

(2008)

Schiltz et al. (2007)Schiltz et al. (2007)


Schiltz 15 pedophileset al. limbic “temporal” 15 community(2007) controls


Cantoret al.

(2008)



Schiltz 15 pedophiles small volumeet al. limbic “temporal” 15 community corrected(2007) controls


Cantoret al.

(2008)



Schiltz 15 pedophiles small volumeet al. limbic “temporal” 15 community corrected(2007) controls


Cantoret al.

(2008)

Schiffer et al. (2007)Schiffer et al. (2007)


Schiltz 15 pedophiles small volumeet al. limbic “temporal” 15 community corrected

(2007) controls

Schiffer OCD/ 18 pedophiles small volumeet al. impulsivity frontal 24 community corrected

(2007) controls

Cantoret al.

(2008)

Schiffer et al. (2007)Schiffer et al. (2007)



(2007) controls


(2007) controls

Cantoret al.

(2008)

Junk Data or Blind Monks?Junk Data or Blind Monks?




(2007) controls


(2007) controls

Cantoret al.

(2008)

Cantor et al. (2008)Cantor et al. (2008)



(2007) controls


(2007) controls

Cantor 65 pedophiles whole brainet al. atheoretical none 62 nonsexual volume

(2008) offenders corrected

ProceduresProcedures

Sexological Measures MRI Measures

Phallometry Automated parcellation

Self-report, Voxel-based morphometry offense history (VBM)

ProceduresProcedures

Sexological Measures MRI Measures

Phallometry Automated parcellation

Self-report, Voxel-based morphometry offense history (VBM)

What’s a “voxel”?What’s a “voxel”?

SubjectsSubjects

PatientsPatientsnn = 65 sexology patients = 65 sexology patients Recruited from the Kurt Freund Laboratory (CAMH, Toronto)Recruited from the Kurt Freund Laboratory (CAMH, Toronto)

ControlsControlsnn = 62 nonsexual offenders = 62 nonsexual offendersRecruited from federal and provincial parole/probation officesRecruited from federal and provincial parole/probation offices

Exclusion criteriaExclusion criteria<18 years age<18 years age>300 lbs weight>300 lbs weightEver suffered traumatic brain injuryEver suffered traumatic brain injuryEver diagnosed with schizophreniaEver diagnosed with schizophreniaEver employed grinding metalEver employed grinding metalAny other metal object in body, counterindicating MRIAny other metal object in body, counterindicating MRI

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

SubjectsSubjects

CharacteristicCharacteristic PatientsPatients ControlsControls ComparisonComparison pp

AgeAge 36.436.4 ( (13.5)13.5) 36.936.9 ( (9.4)9.4) t t (125)(125) = = ––0.230.23 .82.82

Full-Scale IQFull-Scale IQ 96.296.2 ( (15.3)15.3) 96.396.3 (11.5) (11.5) t t (125)(125) = = ––0.030.03 .98.98

EducationEducation 12.212.2 ( (3.0)3.0) 12.112.1 (2.8) (2.8) t t (125)(125) = 0.20 = 0.20 .84.84

CAGE alcohol CAGE alcohol screenscreen

1.11.1 ( (1.4)1.4) 2.12.1 ( (1.6)1.6) t t (125)(125) = = ––3.83.8 .0003.0003

% non-right-% non-right-handedhanded

23.1%23.1% 14.5%14.5% 22 (1)(1) = 1.52 = 1.52 .22.22


VBM of Pedophilic vs. Nonsexual Offender MenVBM of Pedophilic vs. Nonsexual Offender Men





Superior Occipitofrontal FasciculusSuperior Occipitofrontal Fasciculus


(right) Arcuate Fasciculus(right) Arcuate Fasciculus


From Jellison et al. (2004). Amer J of Neurorad, 25, 356–369.

But, what does this But, what does this mean?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)


1.1. Humans have multiple social instincts.Humans have multiple social instincts.

2. In typical men, multiple grey matter regions are networked 2. In typical men, multiple grey matter regions are networked together to identify socially significant stimuli and evoke the together to identify socially significant stimuli and evoke the species-typical response:species-typical response:

●● Nurturance, parentingNurturance, parenting●● Obedience, imitationObedience, imitation●● Sexual arousal, courtshipSexual arousal, courtship●● Competition, combatCompetition, combat●● EscapeEscape……etc.etc.

3. In pedophiles, the white matter tissue is underdeveloped and 3. In pedophiles, the white matter tissue is underdeveloped and connects the wrong stimulus to the wrong response. connects the wrong stimulus to the wrong response.

??



Schiltzet al.

(2007)

Schifferet al.

(2007)

Cantoret al.

(2008)

Towards Understanding the ContradictionsTowards Understanding the Contradictions

Why didn’t Schiltz and Schiffer find white matter?

Why didn’t Cantor find grey matter?


Schiltzet al.

(2007)

Schifferet al.

(2007)

Cantoret al.

(2008)







(2007) controls


(2007) controls

Cantor 65 pedophiles whole brainet al. atheoretical unbiased 62 nonsexual volume





(2007) controls


(2007) controls




Schiltzet al.

(2007)

Schifferet al.

(2007)

Cantoret al.

(2008)







(2007) controls


(2007) controls




Striatum Hypothalamus AmygdalaOrbitofrontal cortex

Prefrontal cortex

Anti-Sociality

Pedophilia

Hippocampus

AdverseChildhood

Events

Cerebellar vermis

Corpus callo-sum

Fronto-occipital fasciculusArcuate fasciculus

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).

So, can an MRI detect pedophilia?So, can an MRI detect pedophilia?

functional functional MRI (MRI (ffMRI)MRI)Higher bloodflow = higher activity

Stuart Clare, FMRIB

Subject performs two+ tasks, including a control task.

Posner & Raichle, Images of Mind

Subject performs two+ tasks, including a control task.Use “subtractive” statistics to compare activity between tasks.

functional functional MRI (MRI (ffMRI)MRI)

Subject perform two+ tasks, including a control task.Use “subtractive” statistics to compare activity between tasks.

Study Anatomy Subjects Results

Walter et al.(2007)

Schiffer et al.(2008a)

Schiffer et al.(2008b)

Poeppl et al.(2011)

Sartorius et al.(2008)

Ponseti et al. (in press)




Walter et al. whole pedophiles, pedophiles respond(2007) brain healthy controls analogously to controls

Schiffer et al. whole homosexual pedophiles, pedophiles respond(2008a) brain healthy gay men analogously to controls

Schiffer et al. whole heterosexual pedophiles, no pedophilic responses(2008b) brain heterosexual controls

Poeppl et al. whole pedophiles, pedophiles respond(2011) brain nonsexual offenders analogously, but > controls

Sartorius et al.(2008)

Ponseti et al.(in press)








Sartorius et al. amygdala homosexual pedophiles, amygdala responded(2008) center heterosexual controls analogously

Ponseti et al.(in press)








Sartorius et al. amygdala homosexual pedophiles, amygdala responded(2008) center heterosexual controls analogously

Ponseti et al. empirical diverse pedophiles, 88% sensitivity and(in press) subset of diverse controls 100% specificity

brain


Research Clinical Screening Evidence

Phallometry of deniers (61% / 96%)

PSA for prostate c. (72% / 93%)

Digital exam of prostate (53% / 84%)

fMRI of admitters (95% / 95%)

Glucose tolerance (58% / 77%)

fMRI of amygdala (67% / 67%)

HIV antibody (99+% / 99+%)

“Rapid” H1N1 test (51% / 99%)

So, can So, can fMRIfMRI detect arousal to child stimuli? detect arousal to child stimuli?

Research Clinical Screening Evidence

Phallometry of deniers (61% / 96%)

PSA for prostate c. (72% / 93%)

Digital exam of prostate (53% / 84%)

fMRI of admitters (95% / 95%)

Glucose tolerance (58% / 77%)

fMRI of amygdala (67% / 67%)

HIV antibody (99+% / 99+%)

“Rapid” H1N1 test (51% / 99%)

So, can So, can fMRIfMRI detect arousal to child stimuli? detect arousal to child stimuli?

Getting close.

●● Overall features suggest early (Overall features suggest early (pre-natalpre-natal) origins) origins

●● Pedophilic Pedophilic brain structure slightly different brain structure slightly different from typicalfrom typical

●● Brain differences Brain differences not consistent with what changes not consistent with what changes withwith therapy, surgery, or current stem cell researchtherapy, surgery, or current stem cell research

●● Pedophilic brain Pedophilic brain “lights up” in same pattern “lights up” in same pattern as non-pedophilesas non-pedophiles

● ● Pedophiles respond to stimuli of children rather than adultsPedophiles respond to stimuli of children rather than adults

SummarySummary

The Big QuestionsThe Big Questions

Is it in the brain? Is it in the brain? Can we treat it?Can we treat it?

Is it in the genes?Is it in the genes?

Were they born with it? Were they born with it?

Does it run in families?Does it run in families?

Can it change? Can it change? Are they responsible for it?Are they responsible for it?

Can we prevent it?Can we prevent it?

The Public’s FearsThe Public’s Fears

MyMy Fears Fears

My HopesMy Hopes

What if…?

fMRI provides the next increment in accuracy of diagnosing pedophilia and is employed only within the bounds of contemporary professional ethics:

● Informed Consent● Confidentiality

My HopesMy Hopes

What if…?



With continued research, we pinpoint the prenatal process that goes awry.

Perhaps: A general prenatal health factor already known to interfere with normal growth of both body and brain...

My HopesMy Hopes

What if…?



With continued research, we pinpoint the prenatal process that goes awry.

Perhaps: A general prenatal health factor already known to interfere with normal growth of both body and brain...

Instead of preventing a second offense,

we can prevent the first offense.

Magnus Hirschfeld (1868Magnus Hirschfeld (1868–1935–1935))

““Justice through science”Justice through science”Wissenschaftlich-humanitäres KomiteeWissenschaftlich-humanitäres Komitee

(Scientific-Humanitarian Committee)(Scientific-Humanitarian Committee)

AcknowledgementsAcknowledgements

CAMH Law & Mental HealthCAMH Law & Mental HealthHoward BarbareeHoward BarbareeRobert DickeyRobert DickeyPhilip KlassenPhilip Klassen

CAMH Schizophrenia ProgramCAMH Schizophrenia ProgramBruce ChristensenBruce ChristensenRobert ZipurskyRobert Zipursky

TGH Dept. of Neuroimaging TGH Dept. of Neuroimaging David MikulisDavid MikulisHien TranHien Tran

Ontario Ministry of CorrectionsOntario Ministry of CorrectionsRobert BrownRobert Brown

CAMH Image Processing LabCAMH Image Processing LabNoor KabaniNoor KabaniKate Hanratty Kate Hanratty Blake RichardsBlake Richards

Kurt Freund LaboratoryKurt Freund LaboratoryRay BlanchardRay BlanchardThomas BlakThomas BlakMichael KubanMichael KubanSophie LafailleSophie LafailleNanci LipsteinNanci Lipstein

Correctional Service CanadaCorrectional Service CanadaElias ConstantatosElias ConstantatosRobert SmallRobert Small

Documents

To keep a copy of this PowerPoint file, use Save As… Cantor, J. M. (2011, November). Brain research and pedophilia: What it means for assessment, treatment,