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CHICAGO – Does clinical judgment improve or worsen an actuarial assessment of violence?

Forensic psychiatrist Brian A. Falls sought to answer the question in an inpatient study presented at the American Academy of Psychiatry and the Law’s annual meeting. His research, conducted while Dr. Falls was a fellow at the University of California Davis Medical Center in Sacramento, analyzed whether adding clinical judgment to the use of the Classification of Violence Risk (COVR) tool led to better prediction of future violence. COVR is a software program that considers up to 40 risk factors to estimate a patient’s violence risk. Dr. Fall’s study found that clinical judgment improves overall actuarial assessment of violence but does not have the same relationship with all types of violence.

In a video interview at the meeting, Dr. Falls spoke about how clinical conclusions can affect the use of COVR and why different violence categories might have yielded contrasting results. The first-of-its-kind research might help evaluators better identify individuals prone to committing violence and those at less risk.

[email protected]

On Twitter @legal_med

CHICAGO – Does clinical judgment improve or worsen an actuarial assessment of violence?

Forensic psychiatrist Brian A. Falls sought to answer the question in an inpatient study presented at the American Academy of Psychiatry and the Law’s annual meeting. His research, conducted while Dr. Falls was a fellow at the University of California Davis Medical Center in Sacramento, analyzed whether adding clinical judgment to the use of the Classification of Violence Risk (COVR) tool led to better prediction of future violence. COVR is a software program that considers up to 40 risk factors to estimate a patient’s violence risk. Dr. Fall’s study found that clinical judgment improves overall actuarial assessment of violence but does not have the same relationship with all types of violence.

In a video interview at the meeting, Dr. Falls spoke about how clinical conclusions can affect the use of COVR and why different violence categories might have yielded contrasting results. The first-of-its-kind research might help evaluators better identify individuals prone to committing violence and those at less risk.

[email protected]

On Twitter @legal_med

CHICAGO – Does clinical judgment improve or worsen an actuarial assessment of violence?

Forensic psychiatrist Brian A. Falls sought to answer the question in an inpatient study presented at the American Academy of Psychiatry and the Law’s annual meeting. His research, conducted while Dr. Falls was a fellow at the University of California Davis Medical Center in Sacramento, analyzed whether adding clinical judgment to the use of the Classification of Violence Risk (COVR) tool led to better prediction of future violence. COVR is a software program that considers up to 40 risk factors to estimate a patient’s violence risk. Dr. Fall’s study found that clinical judgment improves overall actuarial assessment of violence but does not have the same relationship with all types of violence.

In a video interview at the meeting, Dr. Falls spoke about how clinical conclusions can affect the use of COVR and why different violence categories might have yielded contrasting results. The first-of-its-kind research might help evaluators better identify individuals prone to committing violence and those at less risk.

[email protected]

On Twitter @legal_med

The inclusion of a new sleep disorder in the DSM-5 might raise awareness of the underreported diagnosis and help physicians better identify the condition.

Sexsomnia can present in different forms but is generally described as engaging in sexual activity while asleep.

“Classification of sexsomnia in DSM-5 adds legitimacy to the diagnosis as it takes it out of the proposed diagnosis or research diagnosis realm and places it into a formally accepted classification manual,” said Dr. Brandon G. Moore, a psychiatry resident at Western Michigan University School of Medicine in Kalamazoo. “The classification of the diagnosis helps patients in that it opens up the topic for further discussion and education of providers so that they may more readily recognize the disorder and offer appropriate treatment.”

Sexsomnia can involve varying degrees of sexual activity while unconscious, including masturbation, fondling, groping, and intercourse. Patients often are unaware they have the condition, and signs of the disorder frequently are reported by a partner, roommate, or spouse, Dr. Moore said in an interview. The condition is not well known to many doctors, which can lead to misdiagnoses and underdiagnoses, added Dr. Kannan Ramar, an internist who practices in the division of pulmonary and critical care medicine, and the Center for Sleep Medicine at the Mayo Clinic, Rochester, Minn.

“Awareness of this condition is not there among the medical community,” Dr. Ramar said in an interview. “More educational awareness needs to happen, and having this diagnosis listed in the DSM-5 is one right step in that direction.”

Dr. Moore recently treated a 44-year-old patient with sexsomnia referred by his neurologist. The patient originally presented for presumed restless legs syndrome but had a history of sleep-related sexual behavior. The neurologist instructed the patient and his wife to keep a sleep diary, which revealed sexual behavior by the patient during sleep, including intercourse, that had been occurring for the last 20 years, according to a case study poster by Dr. Moore presented at the American Academy of Psychiatry and the Law meeting.

Polysomnography indicated no significant sleep-disordered breathing or limb movements but did reveal episodes during non-REM sleep consistent with confusional arousal. After a diagnosis of parasomnia associated with sexual behavior, the patient was referred for psychiatric evaluation because his behavior, exacerbated by stress, was becoming increasingly aggressive and adversely affecting his marriage. The patient has since improved with the addition of paroxetine, an increase of his clonazepam dosage, as well as with psychotherapy, Dr. Moore reported.

Collecting collateral information about sleep habits from partners or roommates can help doctors pinpoint the possibility of sexsomnia, Dr. Moore said.

“Any sleepwalking disorder or history should at least raise some suspicion, but a bed partner who reports (any) physical or sexual contact that is unwanted should be explored,” he said.

Family physicians, internists, and other specialists also play a primary role in identifying sexsomnia in patients and conferring with sleep specialists.

“Knowing when to refer and/or when to call to get more information or help is needed to help manage patients with sleep disorders,” Dr. Ramar said. “Family physicians play a key role, as they are usually the first physician that a patient might see with a sleep disorder. If the treatment plan that is established for the patient does not work, then a referral to a sleep specialist is needed.”

Sexsomnia might be included as a diagnostic specifier when criteria for non-REM sleep arousal disorder, sleepwalking type, are met and accompanied by evidence of sleep-related sexual behavior.

[email protected]

On Twitter @legal_med

*This article was updated November 24, 2014.

The inclusion of a new sleep disorder in the DSM-5 might raise awareness of the underreported diagnosis and help physicians better identify the condition.

Sexsomnia can present in different forms but is generally described as engaging in sexual activity while asleep.

“Classification of sexsomnia in DSM-5 adds legitimacy to the diagnosis as it takes it out of the proposed diagnosis or research diagnosis realm and places it into a formally accepted classification manual,” said Dr. Brandon G. Moore, a psychiatry resident at Western Michigan University School of Medicine in Kalamazoo. “The classification of the diagnosis helps patients in that it opens up the topic for further discussion and education of providers so that they may more readily recognize the disorder and offer appropriate treatment.”

Sexsomnia can involve varying degrees of sexual activity while unconscious, including masturbation, fondling, groping, and intercourse. Patients often are unaware they have the condition, and signs of the disorder frequently are reported by a partner, roommate, or spouse, Dr. Moore said in an interview. The condition is not well known to many doctors, which can lead to misdiagnoses and underdiagnoses, added Dr. Kannan Ramar, an internist who practices in the division of pulmonary and critical care medicine, and the Center for Sleep Medicine at the Mayo Clinic, Rochester, Minn.

“Awareness of this condition is not there among the medical community,” Dr. Ramar said in an interview. “More educational awareness needs to happen, and having this diagnosis listed in the DSM-5 is one right step in that direction.”

Dr. Moore recently treated a 44-year-old patient with sexsomnia referred by his neurologist. The patient originally presented for presumed restless legs syndrome but had a history of sleep-related sexual behavior. The neurologist instructed the patient and his wife to keep a sleep diary, which revealed sexual behavior by the patient during sleep, including intercourse, that had been occurring for the last 20 years, according to a case study poster by Dr. Moore presented at the American Academy of Psychiatry and the Law meeting.

Polysomnography indicated no significant sleep-disordered breathing or limb movements but did reveal episodes during non-REM sleep consistent with confusional arousal. After a diagnosis of parasomnia associated with sexual behavior, the patient was referred for psychiatric evaluation because his behavior, exacerbated by stress, was becoming increasingly aggressive and adversely affecting his marriage. The patient has since improved with the addition of paroxetine, an increase of his clonazepam dosage, as well as with psychotherapy, Dr. Moore reported.

Collecting collateral information about sleep habits from partners or roommates can help doctors pinpoint the possibility of sexsomnia, Dr. Moore said.

“Any sleepwalking disorder or history should at least raise some suspicion, but a bed partner who reports (any) physical or sexual contact that is unwanted should be explored,” he said.

Family physicians, internists, and other specialists also play a primary role in identifying sexsomnia in patients and conferring with sleep specialists.

“Knowing when to refer and/or when to call to get more information or help is needed to help manage patients with sleep disorders,” Dr. Ramar said. “Family physicians play a key role, as they are usually the first physician that a patient might see with a sleep disorder. If the treatment plan that is established for the patient does not work, then a referral to a sleep specialist is needed.”

Sexsomnia might be included as a diagnostic specifier when criteria for non-REM sleep arousal disorder, sleepwalking type, are met and accompanied by evidence of sleep-related sexual behavior.

[email protected]

On Twitter @legal_med

*This article was updated November 24, 2014.

The inclusion of a new sleep disorder in the DSM-5 might raise awareness of the underreported diagnosis and help physicians better identify the condition.

Sexsomnia can present in different forms but is generally described as engaging in sexual activity while asleep.

“Classification of sexsomnia in DSM-5 adds legitimacy to the diagnosis as it takes it out of the proposed diagnosis or research diagnosis realm and places it into a formally accepted classification manual,” said Dr. Brandon G. Moore, a psychiatry resident at Western Michigan University School of Medicine in Kalamazoo. “The classification of the diagnosis helps patients in that it opens up the topic for further discussion and education of providers so that they may more readily recognize the disorder and offer appropriate treatment.”

Sexsomnia can involve varying degrees of sexual activity while unconscious, including masturbation, fondling, groping, and intercourse. Patients often are unaware they have the condition, and signs of the disorder frequently are reported by a partner, roommate, or spouse, Dr. Moore said in an interview. The condition is not well known to many doctors, which can lead to misdiagnoses and underdiagnoses, added Dr. Kannan Ramar, an internist who practices in the division of pulmonary and critical care medicine, and the Center for Sleep Medicine at the Mayo Clinic, Rochester, Minn.

“Awareness of this condition is not there among the medical community,” Dr. Ramar said in an interview. “More educational awareness needs to happen, and having this diagnosis listed in the DSM-5 is one right step in that direction.”

Dr. Moore recently treated a 44-year-old patient with sexsomnia referred by his neurologist. The patient originally presented for presumed restless legs syndrome but had a history of sleep-related sexual behavior. The neurologist instructed the patient and his wife to keep a sleep diary, which revealed sexual behavior by the patient during sleep, including intercourse, that had been occurring for the last 20 years, according to a case study poster by Dr. Moore presented at the American Academy of Psychiatry and the Law meeting.

Polysomnography indicated no significant sleep-disordered breathing or limb movements but did reveal episodes during non-REM sleep consistent with confusional arousal. After a diagnosis of parasomnia associated with sexual behavior, the patient was referred for psychiatric evaluation because his behavior, exacerbated by stress, was becoming increasingly aggressive and adversely affecting his marriage. The patient has since improved with the addition of paroxetine, an increase of his clonazepam dosage, as well as with psychotherapy, Dr. Moore reported.

Collecting collateral information about sleep habits from partners or roommates can help doctors pinpoint the possibility of sexsomnia, Dr. Moore said.

“Any sleepwalking disorder or history should at least raise some suspicion, but a bed partner who reports (any) physical or sexual contact that is unwanted should be explored,” he said.

Family physicians, internists, and other specialists also play a primary role in identifying sexsomnia in patients and conferring with sleep specialists.

“Knowing when to refer and/or when to call to get more information or help is needed to help manage patients with sleep disorders,” Dr. Ramar said. “Family physicians play a key role, as they are usually the first physician that a patient might see with a sleep disorder. If the treatment plan that is established for the patient does not work, then a referral to a sleep specialist is needed.”

Sexsomnia might be included as a diagnostic specifier when criteria for non-REM sleep arousal disorder, sleepwalking type, are met and accompanied by evidence of sleep-related sexual behavior.

[email protected]

On Twitter @legal_med

*This article was updated November 24, 2014.

CHICAGO – Younger children and those in foster care have a higher likelihood of aggressive behavior, reported Kacey Appel at the annual meeting of the American Academy of Psychiatry and the Law.

Ms. Appel,who is affiliated with Cincinnati Children’s Hospital Medical Center (CCHMC), and her coinvestigators evaluated 4,148 children aged 4-18 years who were admitted through the medical center’s emergency department to the College Hill Campus, a pediatric residential treatment facility. The admissions, made between May 1, 2010 and April 31, 2014, lasted 30 days or less. The children were administered the Brief Rating of Aggression by Children and Adolescents (BRACHA) in the emergency department and later were scored twice a day using the Overt Aggression Scale (OAS), which records instances of aggression.

Investigators assessed the OAS scores, focusing on four demographic elements: age, gender, living arrangement, and history of previous hospitalizations. An OAS score of above 0 is generally considered aggressive, but Ms. Appel and her associates compared severity levels of aggression and their interplay with the four demographics.

Findings showed “no matter how you define aggression, the demographic variables remain significant,” said Ms. Appel, an epidemiology PhD candidate at the University of Cincinnati.

Continue for additional results >>

Results showed also that children living in foster care had a 10%-20% higher probability of being aggressive than another child with the same demographics but a different living arrangement. Only 5% of patients in the study sample were considered to live in a foster arrangement, Ms. Appel noted in an interview.

Additionally, the probability of aggression in children spiked when they were younger and decreased as they grew older, findings showed. For example, a nonfoster, female child with no previous hospitalizations had about a 60% probability of being aggressive at age 4. That probability of aggression for the same child at age 16 was about 15%. Investigators did not look at variables individually, but instead studied the four demographics together. Boys had a higher probability of being aggressive than girls.

The foster care finding is consistent with other data showing that children within such living arrangements often have a history of abuse and/or neglect, said Dr. Drew H. Barzman, director of the child and adolescent forensic psychiatry service at CCHMC and a coauthor of the study.

“Foster care kids may develop reactive attachment disorder or posttraumatic stress disorder, and these diagnoses can be associated with aggression on the inpatient unit, Dr. Barzman said in an interview.

The findings about age likely relate to younger children’s cognitive development, hormones, and mental processing, Ms. Appel added. “When kids are young, they often act out because they don’t know how to communicate what they’re frustrated about, and they can’t process what they’re frustrated about,” she said in an interview. “As they grow older, cognitively, they can more aptly process why they’re upset.”

The original intent of the research was to identify which BRACHA factors are most significant in predicting aggression. They will next study the significance of BRACHA factors based on frequency of aggression and time to aggressive incident. A primary goal of the research is to develop a web application tool for clinicians aimed at predicting more accurately which children within an inpatient population will be aggressive. The application will allow health providers to enter demographic data and BRACHA responses to determine predicted probability of aggression.

“If we can accurately predict the probability of a child being aggressive in the unit, we hope to improve safety on these inpatient units,” Ms. Appel said.

No conflicts of interest were reported.

CHICAGO – Younger children and those in foster care have a higher likelihood of aggressive behavior, reported Kacey Appel at the annual meeting of the American Academy of Psychiatry and the Law.

Ms. Appel,who is affiliated with Cincinnati Children’s Hospital Medical Center (CCHMC), and her coinvestigators evaluated 4,148 children aged 4-18 years who were admitted through the medical center’s emergency department to the College Hill Campus, a pediatric residential treatment facility. The admissions, made between May 1, 2010 and April 31, 2014, lasted 30 days or less. The children were administered the Brief Rating of Aggression by Children and Adolescents (BRACHA) in the emergency department and later were scored twice a day using the Overt Aggression Scale (OAS), which records instances of aggression.

Investigators assessed the OAS scores, focusing on four demographic elements: age, gender, living arrangement, and history of previous hospitalizations. An OAS score of above 0 is generally considered aggressive, but Ms. Appel and her associates compared severity levels of aggression and their interplay with the four demographics.

Findings showed “no matter how you define aggression, the demographic variables remain significant,” said Ms. Appel, an epidemiology PhD candidate at the University of Cincinnati.

Continue for additional results >>

Results showed also that children living in foster care had a 10%-20% higher probability of being aggressive than another child with the same demographics but a different living arrangement. Only 5% of patients in the study sample were considered to live in a foster arrangement, Ms. Appel noted in an interview.

Additionally, the probability of aggression in children spiked when they were younger and decreased as they grew older, findings showed. For example, a nonfoster, female child with no previous hospitalizations had about a 60% probability of being aggressive at age 4. That probability of aggression for the same child at age 16 was about 15%. Investigators did not look at variables individually, but instead studied the four demographics together. Boys had a higher probability of being aggressive than girls.

The foster care finding is consistent with other data showing that children within such living arrangements often have a history of abuse and/or neglect, said Dr. Drew H. Barzman, director of the child and adolescent forensic psychiatry service at CCHMC and a coauthor of the study.

“Foster care kids may develop reactive attachment disorder or posttraumatic stress disorder, and these diagnoses can be associated with aggression on the inpatient unit, Dr. Barzman said in an interview.

The findings about age likely relate to younger children’s cognitive development, hormones, and mental processing, Ms. Appel added. “When kids are young, they often act out because they don’t know how to communicate what they’re frustrated about, and they can’t process what they’re frustrated about,” she said in an interview. “As they grow older, cognitively, they can more aptly process why they’re upset.”

The original intent of the research was to identify which BRACHA factors are most significant in predicting aggression. They will next study the significance of BRACHA factors based on frequency of aggression and time to aggressive incident. A primary goal of the research is to develop a web application tool for clinicians aimed at predicting more accurately which children within an inpatient population will be aggressive. The application will allow health providers to enter demographic data and BRACHA responses to determine predicted probability of aggression.

“If we can accurately predict the probability of a child being aggressive in the unit, we hope to improve safety on these inpatient units,” Ms. Appel said.

No conflicts of interest were reported.

CHICAGO – Younger children and those in foster care have a higher likelihood of aggressive behavior, reported Kacey Appel at the annual meeting of the American Academy of Psychiatry and the Law.

Ms. Appel,who is affiliated with Cincinnati Children’s Hospital Medical Center (CCHMC), and her coinvestigators evaluated 4,148 children aged 4-18 years who were admitted through the medical center’s emergency department to the College Hill Campus, a pediatric residential treatment facility. The admissions, made between May 1, 2010 and April 31, 2014, lasted 30 days or less. The children were administered the Brief Rating of Aggression by Children and Adolescents (BRACHA) in the emergency department and later were scored twice a day using the Overt Aggression Scale (OAS), which records instances of aggression.

Investigators assessed the OAS scores, focusing on four demographic elements: age, gender, living arrangement, and history of previous hospitalizations. An OAS score of above 0 is generally considered aggressive, but Ms. Appel and her associates compared severity levels of aggression and their interplay with the four demographics.

Findings showed “no matter how you define aggression, the demographic variables remain significant,” said Ms. Appel, an epidemiology PhD candidate at the University of Cincinnati.

Continue for additional results >>

Results showed also that children living in foster care had a 10%-20% higher probability of being aggressive than another child with the same demographics but a different living arrangement. Only 5% of patients in the study sample were considered to live in a foster arrangement, Ms. Appel noted in an interview.

Additionally, the probability of aggression in children spiked when they were younger and decreased as they grew older, findings showed. For example, a nonfoster, female child with no previous hospitalizations had about a 60% probability of being aggressive at age 4. That probability of aggression for the same child at age 16 was about 15%. Investigators did not look at variables individually, but instead studied the four demographics together. Boys had a higher probability of being aggressive than girls.

The foster care finding is consistent with other data showing that children within such living arrangements often have a history of abuse and/or neglect, said Dr. Drew H. Barzman, director of the child and adolescent forensic psychiatry service at CCHMC and a coauthor of the study.

“Foster care kids may develop reactive attachment disorder or posttraumatic stress disorder, and these diagnoses can be associated with aggression on the inpatient unit, Dr. Barzman said in an interview.

The findings about age likely relate to younger children’s cognitive development, hormones, and mental processing, Ms. Appel added. “When kids are young, they often act out because they don’t know how to communicate what they’re frustrated about, and they can’t process what they’re frustrated about,” she said in an interview. “As they grow older, cognitively, they can more aptly process why they’re upset.”

The original intent of the research was to identify which BRACHA factors are most significant in predicting aggression. They will next study the significance of BRACHA factors based on frequency of aggression and time to aggressive incident. A primary goal of the research is to develop a web application tool for clinicians aimed at predicting more accurately which children within an inpatient population will be aggressive. The application will allow health providers to enter demographic data and BRACHA responses to determine predicted probability of aggression.

“If we can accurately predict the probability of a child being aggressive in the unit, we hope to improve safety on these inpatient units,” Ms. Appel said.

No conflicts of interest were reported.

CHICAGO – Younger children and those in foster care have a higher likelihood of aggressive behavior, reported Kacey Appel at the annual meeting of the American Academy of Psychiatry and the Law.

Ms. Appel,who is affiliated with Cincinnati Children’s Hospital Medical Center (CCHMC), and her coinvestigators evaluated 4,148 children aged 4-18 years who were admitted through the medical center’s emergency department to the College Hill Campus, a pediatric residential treatment facility. The admissions, made between May 1, 2010 and April 31, 2014, lasted 30 days or less. The children were administered the Brief Rating of Aggression by Children and Adolescents (BRACHA) in the emergency department and later were scored twice a day using the Overt Aggression Scale (OAS), which records instances of aggression.

Investigators assessed the OAS scores, focusing on four demographic elements: age, gender, living arrangement, and history of previous hospitalizations. An OAS score of above 0 is generally considered aggressive, but Ms. Appel and her associates compared severity levels of aggression and their interplay with the four demographics.

Findings showed “no matter how you define aggression, the demographic variables remain significant,” said Ms. Appel, an epidemiology PhD candidate at the University of Cincinnati.

Results showed also that children living in foster care had a 10%-20% higher probability of being aggressive than another child with the same demographics but a different living arrangement. Only 5% of patients in the study sample were considered to live in a foster arrangement, Ms. Appel noted in an interview.

Additionally, the probability of aggression in children spiked when they were younger and decreased as they grew older, findings showed. For example, a nonfoster, female child with no previous hospitalizations had about a 60% probability of being aggressive at age 4. That probability of aggression for the same child at age 16 was about 15%. Investigators did not look at variables individually, but instead studied the four demographics together. Boys had a higher probability of being aggressive than girls.

The foster care finding is consistent with other data showing that children within such living arrangements often have a history of abuse and/or neglect, said Dr. Drew H. Barzman, director of the child and adolescent forensic psychiatry service at CCHMC and a coauthor of the study.

“Foster care kids may develop reactive attachment disorder or posttraumatic stress disorder, and these diagnoses can be associated with aggression on the inpatient unit, Dr. Barzman said in an interview.

The findings about age likely relate to younger children’s cognitive development, hormones, and mental processing, Ms. Appel added. “When kids are young, they often act out because they don’t know how to communicate what they’re frustrated about, and they can’t process what they’re frustrated about,” she said in an interview. “As they grow older, cognitively, they can more aptly process why they’re upset.”

The original intent of the research was to identify which BRACHA factors are most significant in predicting aggression. They will next study the significance of BRACHA factors based on frequency of aggression and time to aggressive incident. A primary goal of the research is to develop a web application tool for clinicians aimed at predicting more accurately which children within an inpatient population will be aggressive. The application will allow health providers to enter demographic data and BRACHA responses to determine predicted probability of aggression.

“If we can accurately predict the probability of a child being aggressive in the unit, we hope to improve safety on these inpatient units,” Ms. Appel said.

No conflicts of interest were reported.

[email protected]

On Twitter @legal_med

CHICAGO – Younger children and those in foster care have a higher likelihood of aggressive behavior, reported Kacey Appel at the annual meeting of the American Academy of Psychiatry and the Law.

Ms. Appel,who is affiliated with Cincinnati Children’s Hospital Medical Center (CCHMC), and her coinvestigators evaluated 4,148 children aged 4-18 years who were admitted through the medical center’s emergency department to the College Hill Campus, a pediatric residential treatment facility. The admissions, made between May 1, 2010 and April 31, 2014, lasted 30 days or less. The children were administered the Brief Rating of Aggression by Children and Adolescents (BRACHA) in the emergency department and later were scored twice a day using the Overt Aggression Scale (OAS), which records instances of aggression.

Investigators assessed the OAS scores, focusing on four demographic elements: age, gender, living arrangement, and history of previous hospitalizations. An OAS score of above 0 is generally considered aggressive, but Ms. Appel and her associates compared severity levels of aggression and their interplay with the four demographics.

Findings showed “no matter how you define aggression, the demographic variables remain significant,” said Ms. Appel, an epidemiology PhD candidate at the University of Cincinnati.

Results showed also that children living in foster care had a 10%-20% higher probability of being aggressive than another child with the same demographics but a different living arrangement. Only 5% of patients in the study sample were considered to live in a foster arrangement, Ms. Appel noted in an interview.

Additionally, the probability of aggression in children spiked when they were younger and decreased as they grew older, findings showed. For example, a nonfoster, female child with no previous hospitalizations had about a 60% probability of being aggressive at age 4. That probability of aggression for the same child at age 16 was about 15%. Investigators did not look at variables individually, but instead studied the four demographics together. Boys had a higher probability of being aggressive than girls.

The foster care finding is consistent with other data showing that children within such living arrangements often have a history of abuse and/or neglect, said Dr. Drew H. Barzman, director of the child and adolescent forensic psychiatry service at CCHMC and a coauthor of the study.

“Foster care kids may develop reactive attachment disorder or posttraumatic stress disorder, and these diagnoses can be associated with aggression on the inpatient unit, Dr. Barzman said in an interview.

The findings about age likely relate to younger children’s cognitive development, hormones, and mental processing, Ms. Appel added. “When kids are young, they often act out because they don’t know how to communicate what they’re frustrated about, and they can’t process what they’re frustrated about,” she said in an interview. “As they grow older, cognitively, they can more aptly process why they’re upset.”

The original intent of the research was to identify which BRACHA factors are most significant in predicting aggression. They will next study the significance of BRACHA factors based on frequency of aggression and time to aggressive incident. A primary goal of the research is to develop a web application tool for clinicians aimed at predicting more accurately which children within an inpatient population will be aggressive. The application will allow health providers to enter demographic data and BRACHA responses to determine predicted probability of aggression.

“If we can accurately predict the probability of a child being aggressive in the unit, we hope to improve safety on these inpatient units,” Ms. Appel said.

No conflicts of interest were reported.

[email protected]

On Twitter @legal_med

CHICAGO – Younger children and those in foster care have a higher likelihood of aggressive behavior, reported Kacey Appel at the annual meeting of the American Academy of Psychiatry and the Law.

Ms. Appel,who is affiliated with Cincinnati Children’s Hospital Medical Center (CCHMC), and her coinvestigators evaluated 4,148 children aged 4-18 years who were admitted through the medical center’s emergency department to the College Hill Campus, a pediatric residential treatment facility. The admissions, made between May 1, 2010 and April 31, 2014, lasted 30 days or less. The children were administered the Brief Rating of Aggression by Children and Adolescents (BRACHA) in the emergency department and later were scored twice a day using the Overt Aggression Scale (OAS), which records instances of aggression.

Investigators assessed the OAS scores, focusing on four demographic elements: age, gender, living arrangement, and history of previous hospitalizations. An OAS score of above 0 is generally considered aggressive, but Ms. Appel and her associates compared severity levels of aggression and their interplay with the four demographics.

Findings showed “no matter how you define aggression, the demographic variables remain significant,” said Ms. Appel, an epidemiology PhD candidate at the University of Cincinnati.

Results showed also that children living in foster care had a 10%-20% higher probability of being aggressive than another child with the same demographics but a different living arrangement. Only 5% of patients in the study sample were considered to live in a foster arrangement, Ms. Appel noted in an interview.

Additionally, the probability of aggression in children spiked when they were younger and decreased as they grew older, findings showed. For example, a nonfoster, female child with no previous hospitalizations had about a 60% probability of being aggressive at age 4. That probability of aggression for the same child at age 16 was about 15%. Investigators did not look at variables individually, but instead studied the four demographics together. Boys had a higher probability of being aggressive than girls.

The foster care finding is consistent with other data showing that children within such living arrangements often have a history of abuse and/or neglect, said Dr. Drew H. Barzman, director of the child and adolescent forensic psychiatry service at CCHMC and a coauthor of the study.

“Foster care kids may develop reactive attachment disorder or posttraumatic stress disorder, and these diagnoses can be associated with aggression on the inpatient unit, Dr. Barzman said in an interview.

The findings about age likely relate to younger children’s cognitive development, hormones, and mental processing, Ms. Appel added. “When kids are young, they often act out because they don’t know how to communicate what they’re frustrated about, and they can’t process what they’re frustrated about,” she said in an interview. “As they grow older, cognitively, they can more aptly process why they’re upset.”

The original intent of the research was to identify which BRACHA factors are most significant in predicting aggression. They will next study the significance of BRACHA factors based on frequency of aggression and time to aggressive incident. A primary goal of the research is to develop a web application tool for clinicians aimed at predicting more accurately which children within an inpatient population will be aggressive. The application will allow health providers to enter demographic data and BRACHA responses to determine predicted probability of aggression.

“If we can accurately predict the probability of a child being aggressive in the unit, we hope to improve safety on these inpatient units,” Ms. Appel said.

No conflicts of interest were reported.

[email protected]

On Twitter @legal_med

CHICAGO – Many factors motivate the actions of child molesters, including feelings of inadequacy, repressed sexuality, and childhood experiences, a small study showed.

In the study, the motivations of 18 child molesters receiving treatment were assessed. All subjects were adult men who had admitted to and been convicted of a hands-on sexual offense against a child. The offenders ranged in age from 24 to 73, with a mean age of 50. All molesters knew their victims, Natasha Knack reported at the American Academy of Psychiatry and the Law annual meeting.

The goal of the qualitative research was to better identify the motivations behind offenders who sexually abuse children in order to more effectively treat them, said Ms. Knack, forensic research assistant at the Royal Ottawa Mental Health Centre.*

Alicia Gallegos/Frontline Medical News

“One of the things that makes treating sex offenders more complicated is that they are a very diverse group,” she said. “Even child molesters specifically are very heterogeneous, and they have different motivations for offending. It seems the general public assumes there’s basically one motivation for committing these offenses, and that’s sexual gratification. While that’s something that came out in the research, that is definitely not the only motivation that we found.”

Ms. Knack conducted in-depth interviews with each offender and asked questions pertaining to what factors led to their crimes. Factors that contributed to the abuse fell into categories of explicit or implicit motivations. Explicit motivations included sexual gratification with such underlying themes as opportunity and feelings of inadequacy among adults. Seeking intimacy and self-identifying as a teacher were some explicit, nonsexual gratification motivations that were found.

Implicit motivations included childhood experiences such as personal abuse, repressed sexuality, and a lack of sexual information. Other implicit motivations found were life experiences such as poor romantic relationships with adults and problems with substance abuse.

Ms. Knack noted that the absence of sexual information among victims and offenders when they were children played a part in the abuse. For example, some offenders admitted choosing victims who were naive about sex, had parents who did not openly discuss sex, and would be unlikely to tell their parents of the abuse. At the same time, some offenders noted they had developed misconceived ideas about sex as children, had parents who did not discuss the subject, or had learned about sexual topics from friends.

“Parents really need to talk about sex with their children more,” Ms. Knack said at the meeting. “It needs to come from parents. Children need to know they can talk to their parents if they need to. That makes them more likely to disclose abuse that happens and more likely to know what’s appropriate behavior with an adult and what’s not.”

Investigators hope the research into the motivations of child molesters will assist in more targeted and effective approaches to treatment and prevention.

The University of Ottawa Medical Research Fund funded the study.

[email protected]

On Twitter @legal_med

*Correction, 10/30/2014: An earlier version of this story misstated the title of Natasha Knack.

CHICAGO – Many factors motivate the actions of child molesters, including feelings of inadequacy, repressed sexuality, and childhood experiences, a small study showed.

In the study, the motivations of 18 child molesters receiving treatment were assessed. All subjects were adult men who had admitted to and been convicted of a hands-on sexual offense against a child. The offenders ranged in age from 24 to 73, with a mean age of 50. All molesters knew their victims, Natasha Knack reported at the American Academy of Psychiatry and the Law annual meeting.

The goal of the qualitative research was to better identify the motivations behind offenders who sexually abuse children in order to more effectively treat them, said Ms. Knack, forensic research assistant at the Royal Ottawa Mental Health Centre.*

Alicia Gallegos/Frontline Medical News

“One of the things that makes treating sex offenders more complicated is that they are a very diverse group,” she said. “Even child molesters specifically are very heterogeneous, and they have different motivations for offending. It seems the general public assumes there’s basically one motivation for committing these offenses, and that’s sexual gratification. While that’s something that came out in the research, that is definitely not the only motivation that we found.”

Ms. Knack conducted in-depth interviews with each offender and asked questions pertaining to what factors led to their crimes. Factors that contributed to the abuse fell into categories of explicit or implicit motivations. Explicit motivations included sexual gratification with such underlying themes as opportunity and feelings of inadequacy among adults. Seeking intimacy and self-identifying as a teacher were some explicit, nonsexual gratification motivations that were found.

Implicit motivations included childhood experiences such as personal abuse, repressed sexuality, and a lack of sexual information. Other implicit motivations found were life experiences such as poor romantic relationships with adults and problems with substance abuse.

Ms. Knack noted that the absence of sexual information among victims and offenders when they were children played a part in the abuse. For example, some offenders admitted choosing victims who were naive about sex, had parents who did not openly discuss sex, and would be unlikely to tell their parents of the abuse. At the same time, some offenders noted they had developed misconceived ideas about sex as children, had parents who did not discuss the subject, or had learned about sexual topics from friends.

“Parents really need to talk about sex with their children more,” Ms. Knack said at the meeting. “It needs to come from parents. Children need to know they can talk to their parents if they need to. That makes them more likely to disclose abuse that happens and more likely to know what’s appropriate behavior with an adult and what’s not.”

Investigators hope the research into the motivations of child molesters will assist in more targeted and effective approaches to treatment and prevention.

The University of Ottawa Medical Research Fund funded the study.

[email protected]

On Twitter @legal_med

*Correction, 10/30/2014: An earlier version of this story misstated the title of Natasha Knack.

CHICAGO – Many factors motivate the actions of child molesters, including feelings of inadequacy, repressed sexuality, and childhood experiences, a small study showed.

In the study, the motivations of 18 child molesters receiving treatment were assessed. All subjects were adult men who had admitted to and been convicted of a hands-on sexual offense against a child. The offenders ranged in age from 24 to 73, with a mean age of 50. All molesters knew their victims, Natasha Knack reported at the American Academy of Psychiatry and the Law annual meeting.

The goal of the qualitative research was to better identify the motivations behind offenders who sexually abuse children in order to more effectively treat them, said Ms. Knack, forensic research assistant at the Royal Ottawa Mental Health Centre.*

Alicia Gallegos/Frontline Medical News

“One of the things that makes treating sex offenders more complicated is that they are a very diverse group,” she said. “Even child molesters specifically are very heterogeneous, and they have different motivations for offending. It seems the general public assumes there’s basically one motivation for committing these offenses, and that’s sexual gratification. While that’s something that came out in the research, that is definitely not the only motivation that we found.”

Ms. Knack conducted in-depth interviews with each offender and asked questions pertaining to what factors led to their crimes. Factors that contributed to the abuse fell into categories of explicit or implicit motivations. Explicit motivations included sexual gratification with such underlying themes as opportunity and feelings of inadequacy among adults. Seeking intimacy and self-identifying as a teacher were some explicit, nonsexual gratification motivations that were found.

Implicit motivations included childhood experiences such as personal abuse, repressed sexuality, and a lack of sexual information. Other implicit motivations found were life experiences such as poor romantic relationships with adults and problems with substance abuse.

Ms. Knack noted that the absence of sexual information among victims and offenders when they were children played a part in the abuse. For example, some offenders admitted choosing victims who were naive about sex, had parents who did not openly discuss sex, and would be unlikely to tell their parents of the abuse. At the same time, some offenders noted they had developed misconceived ideas about sex as children, had parents who did not discuss the subject, or had learned about sexual topics from friends.

“Parents really need to talk about sex with their children more,” Ms. Knack said at the meeting. “It needs to come from parents. Children need to know they can talk to their parents if they need to. That makes them more likely to disclose abuse that happens and more likely to know what’s appropriate behavior with an adult and what’s not.”

Investigators hope the research into the motivations of child molesters will assist in more targeted and effective approaches to treatment and prevention.

The University of Ottawa Medical Research Fund funded the study.

[email protected]

On Twitter @legal_med

*Correction, 10/30/2014: An earlier version of this story misstated the title of Natasha Knack.

CHICAGO – New flexibility should help make maintenance of certification efforts a bit more palatable for psychiatrists, according to Dr. Larry Faulkner, president and CEO fo the American Board of Psychiatry and Neurology.

Key changes include a more-relaxed approach to how psychiatrists and neurologists can complete the feedback module and the waiving of some continuing medical education credit hours upon completion of certain peer review activities, Dr. Faulkner said at the annual meeting of the American Academy of Psychiatry and the Law. The modifications come in response to new maintenance of certification (MOC) standards by the American Board of Medical Specialties (ABMS) that go into effect in 2015.

Alicia Gallegos/Frontline Medical News

“We are trying to make sure our program is credible, but at the same time, we don’t want the program to be so exhausting that it brings people to their knees in order to accomplish our program,” Dr. Faulkner said. “We’re trying to strike this balance.”

The ABPN’s MOC program consists of four components: professional standing; self-assessment and continuing medication education (CME); cognitive expertise; and performance in practice (PIP). PIP units require two modules – clinical and feedback. The feedback module now can be fulfilled by completing a patient survey, a peer survey, an institutional peer review of general competencies, supervisor evaluations of general competencies, resident evaluations of general competencies, or a 360-degree evaluation of general competencies.

Additionally, some required CME credits to be waived for completing a non-CME self-assessment activity, Dr. Faulkner said. Diplomates are required to complete an average of 30 specialty and/or subspecialty CME credits averaged over 3 years. At least eight credits per year, averaged over 3 years, must involve self-assessment. In summer 2014, ABPN decided it would waive eight CME credits for such activities as passing an ABPN cognitive certification or recertification examination; receiving documented feedback on an approved scientific grant application. or by receiveing documented feedback on an academic/scientific journal article accepted for publication. The ABPN will waive a maximum of 16 self-assessment CME credits for two different non-CME self-assessment activities in a 3-year MOC block. Other options for receiving waived credits are listed on the ABPN’s website.

Dr. Faulkner acknowledged that many physicians have expressed dissatisfaction over MOC and its validity. In June, physicians at the American Medical Association House of Delegates meeting spoke out about MOC being too expensive, too lengthy, and having too little value. The AMA delegates defeated a resolution that asked the organization to put a moratorium on MOC until it was proven to improve the quality of care and patient outcomes. However, delegates agreed to directing the AMA to explore the feasibility of a study to evaluate the effect MOC requirements and maintenance of licensure principles have on workforce, practice costs, patient outcomes, patient safety, and patient access.

Despite some negative sentiments, Dr. Faulkner stressed that MOC is not going away, and that physicians should view the process as a way to demonstrate efforts of their ongoing professional learning.

“I’ve never heard somebody deny that life-long learning is important,” he said. “Maintenance of certification is a little more than a formal way for you to document your life-long learning efforts, and I would encourage you to think of maintenance of certification in that vein.”

[email protected]

On Twitter @legal_med

CHICAGO – New flexibility should help make maintenance of certification efforts a bit more palatable for psychiatrists, according to Dr. Larry Faulkner, president and CEO fo the American Board of Psychiatry and Neurology.

Key changes include a more-relaxed approach to how psychiatrists and neurologists can complete the feedback module and the waiving of some continuing medical education credit hours upon completion of certain peer review activities, Dr. Faulkner said at the annual meeting of the American Academy of Psychiatry and the Law. The modifications come in response to new maintenance of certification (MOC) standards by the American Board of Medical Specialties (ABMS) that go into effect in 2015.

Alicia Gallegos/Frontline Medical News

“We are trying to make sure our program is credible, but at the same time, we don’t want the program to be so exhausting that it brings people to their knees in order to accomplish our program,” Dr. Faulkner said. “We’re trying to strike this balance.”

The ABPN’s MOC program consists of four components: professional standing; self-assessment and continuing medication education (CME); cognitive expertise; and performance in practice (PIP). PIP units require two modules – clinical and feedback. The feedback module now can be fulfilled by completing a patient survey, a peer survey, an institutional peer review of general competencies, supervisor evaluations of general competencies, resident evaluations of general competencies, or a 360-degree evaluation of general competencies.

Additionally, some required CME credits to be waived for completing a non-CME self-assessment activity, Dr. Faulkner said. Diplomates are required to complete an average of 30 specialty and/or subspecialty CME credits averaged over 3 years. At least eight credits per year, averaged over 3 years, must involve self-assessment. In summer 2014, ABPN decided it would waive eight CME credits for such activities as passing an ABPN cognitive certification or recertification examination; receiving documented feedback on an approved scientific grant application. or by receiveing documented feedback on an academic/scientific journal article accepted for publication. The ABPN will waive a maximum of 16 self-assessment CME credits for two different non-CME self-assessment activities in a 3-year MOC block. Other options for receiving waived credits are listed on the ABPN’s website.

Dr. Faulkner acknowledged that many physicians have expressed dissatisfaction over MOC and its validity. In June, physicians at the American Medical Association House of Delegates meeting spoke out about MOC being too expensive, too lengthy, and having too little value. The AMA delegates defeated a resolution that asked the organization to put a moratorium on MOC until it was proven to improve the quality of care and patient outcomes. However, delegates agreed to directing the AMA to explore the feasibility of a study to evaluate the effect MOC requirements and maintenance of licensure principles have on workforce, practice costs, patient outcomes, patient safety, and patient access.

Despite some negative sentiments, Dr. Faulkner stressed that MOC is not going away, and that physicians should view the process as a way to demonstrate efforts of their ongoing professional learning.

“I’ve never heard somebody deny that life-long learning is important,” he said. “Maintenance of certification is a little more than a formal way for you to document your life-long learning efforts, and I would encourage you to think of maintenance of certification in that vein.”

[email protected]

On Twitter @legal_med

CHICAGO – New flexibility should help make maintenance of certification efforts a bit more palatable for psychiatrists, according to Dr. Larry Faulkner, president and CEO fo the American Board of Psychiatry and Neurology.

Key changes include a more-relaxed approach to how psychiatrists and neurologists can complete the feedback module and the waiving of some continuing medical education credit hours upon completion of certain peer review activities, Dr. Faulkner said at the annual meeting of the American Academy of Psychiatry and the Law. The modifications come in response to new maintenance of certification (MOC) standards by the American Board of Medical Specialties (ABMS) that go into effect in 2015.

Alicia Gallegos/Frontline Medical News

“We are trying to make sure our program is credible, but at the same time, we don’t want the program to be so exhausting that it brings people to their knees in order to accomplish our program,” Dr. Faulkner said. “We’re trying to strike this balance.”

The ABPN’s MOC program consists of four components: professional standing; self-assessment and continuing medication education (CME); cognitive expertise; and performance in practice (PIP). PIP units require two modules – clinical and feedback. The feedback module now can be fulfilled by completing a patient survey, a peer survey, an institutional peer review of general competencies, supervisor evaluations of general competencies, resident evaluations of general competencies, or a 360-degree evaluation of general competencies.

Additionally, some required CME credits to be waived for completing a non-CME self-assessment activity, Dr. Faulkner said. Diplomates are required to complete an average of 30 specialty and/or subspecialty CME credits averaged over 3 years. At least eight credits per year, averaged over 3 years, must involve self-assessment. In summer 2014, ABPN decided it would waive eight CME credits for such activities as passing an ABPN cognitive certification or recertification examination; receiving documented feedback on an approved scientific grant application. or by receiveing documented feedback on an academic/scientific journal article accepted for publication. The ABPN will waive a maximum of 16 self-assessment CME credits for two different non-CME self-assessment activities in a 3-year MOC block. Other options for receiving waived credits are listed on the ABPN’s website.

Dr. Faulkner acknowledged that many physicians have expressed dissatisfaction over MOC and its validity. In June, physicians at the American Medical Association House of Delegates meeting spoke out about MOC being too expensive, too lengthy, and having too little value. The AMA delegates defeated a resolution that asked the organization to put a moratorium on MOC until it was proven to improve the quality of care and patient outcomes. However, delegates agreed to directing the AMA to explore the feasibility of a study to evaluate the effect MOC requirements and maintenance of licensure principles have on workforce, practice costs, patient outcomes, patient safety, and patient access.

Despite some negative sentiments, Dr. Faulkner stressed that MOC is not going away, and that physicians should view the process as a way to demonstrate efforts of their ongoing professional learning.

“I’ve never heard somebody deny that life-long learning is important,” he said. “Maintenance of certification is a little more than a formal way for you to document your life-long learning efforts, and I would encourage you to think of maintenance of certification in that vein.”

[email protected]

On Twitter @legal_med

CHICAGO– The Stalking Risk Profile, a tool designed to access recidivism risk, is effective in predicting the potential for future stalking in offenders. In an analysis of 230 stalkers, more than 1 in 3 with a high SRP score went on to stalk the same victim again, while fewer than 1 in 10 with a low SRP score stalked again, research presented at the American Academy of Psychiatry and the Law annual meeting showed.

“For us, this is really positive because it shows that the tool does work,” said Troy McEwan, D.Psych., a Melbourne-based forensic psychologist and lecturer for the Centre for Forensic Behavioural Science at Swinburne University of Technology. “It doesn’t mean if you are high risk that you are going to reoffend,” Dr. McEwan added at the AAPL meeting, “it means you reoffend at a higher base rate.”

Alicia Gallegos/Frontline Medical News

The SRP is a structured, professional judgment tool developed by Dr. McEwan and several colleagues that accesses and manages risk in stalking cases. The tool measures whether a stalker will continue stalking, start stalking again once having stopped, and/or become violent in the context of stalking. SRP scores range from low to moderate to high.

The tool is structured differently from most risk assessment tools, said Dr. McEwan, who also practices at the Problem Behaviour Program at the Victorian Institute of Forensic Mental Health, Fairfield, Australia, known as Forensicare. Rather than approaching all offenders similarly and applying the same risk factors to all stalkers, the test identifies risk factors relevant to different stalker types. For instance, when accessing a rejected ex-partner for future violence, key risk factors include prior violence and threats. Additionally, having shared children is a unique risk factor for stalking recidivism among rejected ex-partners. However, for intimacy-seeking stalkers who pursue strangers, prior violence and paranoid ideation are specific risk factors to future violence, while erotomania is a factor in this group’s recidivism risk.

For the study, investigators administered the SRP to patients referred to Forensicare’s Problem Behaviour Program for stalking between 2010 and 2013 and also applied the tool retrospectively to clients assessed for stalking during 2004-2007. Of the 230 subjects, 51% had stalked an ex-partner, 33% had stalked an acquaintance, and 16% had stalked a stranger. Researchers followed up with police for subsequent charging data in July 2014. Of the subjects, 26.5% stalked again. About 14% stalked the same victim, 13.5% stalked a different victim, and 3% stalked the same and a different victim, according to research data.

Of a 16% base rate prevalence of reoffending against the same victim, fewer than 1 in 10 subjects with a low SRP went on to reoffend against the same victim, results found; more than 1 in 3 of those with a high SRP score went on to reoffend against the same victim. Of a 14% base rate prevalence of reoffending against a different victim, fewer than 1 in 10 of subjects went on to reoffend against a new victim, while about 1 in 3 of high SRP scorers pursued a new victim.

In addition, the reliability that individual evaluators would reach the same or similar SRP scores was high, the study found. The study found also a 72% probability that stalkers who reoffend against the same victim will score higher on the SRP than do stalkers who do not reoffend against the same victim. A 69% probability exists that a stalker who reoffends against a different victim will get a higher SRP score than would a subject who does not reoffend against a different victim.

The findings show the SRP is a strong and depending tool for measuring future stalking, Dr. McEwan said. The measurement enables clinicians to better target stalking interventions compared with general tools such as the The Historical Clinical Risk Management–20 (HCR-20), she noted.

“Essentially, it means we can use (the SRP) reliably, which is really positive,” she said at the meeting. “It means it does discriminate against offenders and non-offenders, and it does predict who is going to reoffend fairly well.”

Dr. McEwan reported no financial conflicts of interest.

[email protected]

On Twitter @legal_med

CHICAGO– The Stalking Risk Profile, a tool designed to access recidivism risk, is effective in predicting the potential for future stalking in offenders. In an analysis of 230 stalkers, more than 1 in 3 with a high SRP score went on to stalk the same victim again, while fewer than 1 in 10 with a low SRP score stalked again, research presented at the American Academy of Psychiatry and the Law annual meeting showed.

“For us, this is really positive because it shows that the tool does work,” said Troy McEwan, D.Psych., a Melbourne-based forensic psychologist and lecturer for the Centre for Forensic Behavioural Science at Swinburne University of Technology. “It doesn’t mean if you are high risk that you are going to reoffend,” Dr. McEwan added at the AAPL meeting, “it means you reoffend at a higher base rate.”

Alicia Gallegos/Frontline Medical News

The SRP is a structured, professional judgment tool developed by Dr. McEwan and several colleagues that accesses and manages risk in stalking cases. The tool measures whether a stalker will continue stalking, start stalking again once having stopped, and/or become violent in the context of stalking. SRP scores range from low to moderate to high.

The tool is structured differently from most risk assessment tools, said Dr. McEwan, who also practices at the Problem Behaviour Program at the Victorian Institute of Forensic Mental Health, Fairfield, Australia, known as Forensicare. Rather than approaching all offenders similarly and applying the same risk factors to all stalkers, the test identifies risk factors relevant to different stalker types. For instance, when accessing a rejected ex-partner for future violence, key risk factors include prior violence and threats. Additionally, having shared children is a unique risk factor for stalking recidivism among rejected ex-partners. However, for intimacy-seeking stalkers who pursue strangers, prior violence and paranoid ideation are specific risk factors to future violence, while erotomania is a factor in this group’s recidivism risk.

For the study, investigators administered the SRP to patients referred to Forensicare’s Problem Behaviour Program for stalking between 2010 and 2013 and also applied the tool retrospectively to clients assessed for stalking during 2004-2007. Of the 230 subjects, 51% had stalked an ex-partner, 33% had stalked an acquaintance, and 16% had stalked a stranger. Researchers followed up with police for subsequent charging data in July 2014. Of the subjects, 26.5% stalked again. About 14% stalked the same victim, 13.5% stalked a different victim, and 3% stalked the same and a different victim, according to research data.

Of a 16% base rate prevalence of reoffending against the same victim, fewer than 1 in 10 subjects with a low SRP went on to reoffend against the same victim, results found; more than 1 in 3 of those with a high SRP score went on to reoffend against the same victim. Of a 14% base rate prevalence of reoffending against a different victim, fewer than 1 in 10 of subjects went on to reoffend against a new victim, while about 1 in 3 of high SRP scorers pursued a new victim.

In addition, the reliability that individual evaluators would reach the same or similar SRP scores was high, the study found. The study found also a 72% probability that stalkers who reoffend against the same victim will score higher on the SRP than do stalkers who do not reoffend against the same victim. A 69% probability exists that a stalker who reoffends against a different victim will get a higher SRP score than would a subject who does not reoffend against a different victim.

The findings show the SRP is a strong and depending tool for measuring future stalking, Dr. McEwan said. The measurement enables clinicians to better target stalking interventions compared with general tools such as the The Historical Clinical Risk Management–20 (HCR-20), she noted.

“Essentially, it means we can use (the SRP) reliably, which is really positive,” she said at the meeting. “It means it does discriminate against offenders and non-offenders, and it does predict who is going to reoffend fairly well.”

Dr. McEwan reported no financial conflicts of interest.

[email protected]

On Twitter @legal_med

CHICAGO– The Stalking Risk Profile, a tool designed to access recidivism risk, is effective in predicting the potential for future stalking in offenders. In an analysis of 230 stalkers, more than 1 in 3 with a high SRP score went on to stalk the same victim again, while fewer than 1 in 10 with a low SRP score stalked again, research presented at the American Academy of Psychiatry and the Law annual meeting showed.

“For us, this is really positive because it shows that the tool does work,” said Troy McEwan, D.Psych., a Melbourne-based forensic psychologist and lecturer for the Centre for Forensic Behavioural Science at Swinburne University of Technology. “It doesn’t mean if you are high risk that you are going to reoffend,” Dr. McEwan added at the AAPL meeting, “it means you reoffend at a higher base rate.”

Alicia Gallegos/Frontline Medical News

The SRP is a structured, professional judgment tool developed by Dr. McEwan and several colleagues that accesses and manages risk in stalking cases. The tool measures whether a stalker will continue stalking, start stalking again once having stopped, and/or become violent in the context of stalking. SRP scores range from low to moderate to high.

The tool is structured differently from most risk assessment tools, said Dr. McEwan, who also practices at the Problem Behaviour Program at the Victorian Institute of Forensic Mental Health, Fairfield, Australia, known as Forensicare. Rather than approaching all offenders similarly and applying the same risk factors to all stalkers, the test identifies risk factors relevant to different stalker types. For instance, when accessing a rejected ex-partner for future violence, key risk factors include prior violence and threats. Additionally, having shared children is a unique risk factor for stalking recidivism among rejected ex-partners. However, for intimacy-seeking stalkers who pursue strangers, prior violence and paranoid ideation are specific risk factors to future violence, while erotomania is a factor in this group’s recidivism risk.

For the study, investigators administered the SRP to patients referred to Forensicare’s Problem Behaviour Program for stalking between 2010 and 2013 and also applied the tool retrospectively to clients assessed for stalking during 2004-2007. Of the 230 subjects, 51% had stalked an ex-partner, 33% had stalked an acquaintance, and 16% had stalked a stranger. Researchers followed up with police for subsequent charging data in July 2014. Of the subjects, 26.5% stalked again. About 14% stalked the same victim, 13.5% stalked a different victim, and 3% stalked the same and a different victim, according to research data.

Of a 16% base rate prevalence of reoffending against the same victim, fewer than 1 in 10 subjects with a low SRP went on to reoffend against the same victim, results found; more than 1 in 3 of those with a high SRP score went on to reoffend against the same victim. Of a 14% base rate prevalence of reoffending against a different victim, fewer than 1 in 10 of subjects went on to reoffend against a new victim, while about 1 in 3 of high SRP scorers pursued a new victim.

In addition, the reliability that individual evaluators would reach the same or similar SRP scores was high, the study found. The study found also a 72% probability that stalkers who reoffend against the same victim will score higher on the SRP than do stalkers who do not reoffend against the same victim. A 69% probability exists that a stalker who reoffends against a different victim will get a higher SRP score than would a subject who does not reoffend against a different victim.

The findings show the SRP is a strong and depending tool for measuring future stalking, Dr. McEwan said. The measurement enables clinicians to better target stalking interventions compared with general tools such as the The Historical Clinical Risk Management–20 (HCR-20), she noted.

“Essentially, it means we can use (the SRP) reliably, which is really positive,” she said at the meeting. “It means it does discriminate against offenders and non-offenders, and it does predict who is going to reoffend fairly well.”

Dr. McEwan reported no financial conflicts of interest.

[email protected]

On Twitter @legal_med