It is very likely that having others present in the room can influence or invalidate the Visual Reaction Time™ data. In the fall of 1996, Abel Screening was evaluating 125 normal males. To accommodate this large number of normals, and because of space limitations, we ran these normals four at a time with the four units arranged in the same room, so no individual could see another individual’s images or the rating process. The resultant data was markedly different than any other data we had obtained with normal males, and we strongly suspected that the presence of others in the room invalidated the testing procedure. We searched the literature and found the article by Marvin Brown, et al, entitled “Factors Affecting Viewing Time of Pornography,” located in The Journal of Social Psychology, 1973, 90, 125-135. This is a study of forty male college students asked to make various ratings of slides that depicted increasingly graphic, erotic material while their viewing was measured. The experimenters anticipated that the presence of others in the room would contaminate viewing time. The experiment involved measuring viewing time; half of the subjects viewed the images alone in the room and rated them for their erotic-pornographic content, while the other half did a similar rating with three individuals in an audience. When subjects were alone, there was a clear positive relationship between the images’ reported erotic content and the subjects’ viewing the images longer. When the audience was present, this very clear effect was lost (see Figure 1 on page 132 in the reference). In every case of the fifteen images viewed, the presence of the audience dramatically reduced viewing time and destroyed the relationship between the increased erotic ratings and increasing looking time. Based upon these two experiences, we have made it clear in our manual that once a client is trained up on using the computer/image unit during the practice images, the client should be alone in a room by themselves when viewing the images. Having others in the room can influence or invalidate viewing time measurement. (Question originally submitted 7/8/99.)

Some clinicians evaluate incarcerated clients in settings where the client is not allowed to be in a room unattended. These clinicians were concerned whether having the administrator remain in the room would impact on the Visual Reaction Time™ (VRT™) and the self-reported sexual arousal to the images. To investigate this issue, Abel Screening completed a study. Thirty clients undergoing assessment or treatment at the Behavioral Medicine Institute of Atlanta were recruited to participate in the study. The study was designed to determine if any change occurred in VRT™ and self-reported arousal if the technician remained in the room but ignoring the client undergoing testing and focusing on clerical work. The setting was a windowless room 13’ 6” x 10’ 6”. Along one wall was an 8’ x 2’ counter where technicians normally do their clerical work. The Abel Assessment for sexual interest™ computer was located 5’ 6” from the end of the counter with the client facing towards the technician while doing the Visual Reaction Time™ portion of the test. After giving instructions to the client, the technician sat at the end of the counter and completed clerical tasks. The technician was not able to see the images the client was looking at, nor his responses. The sample of 30 adult males was divided into two groups. Group 1 took the test with the technician in the room for the first set of images. For the second set of images, Group 1 took the test with the technician outside the room. The 15 subjects in Group 2 completed the test in reverse order. Group 2 completed the first set of images with the technician outside the room, and the second set of images with the technician in the room. ASI’s greatest concern was whether the ratio of the average VRT™ of images of children divided by the average VRT™ of images of adults changed or remained the same with the technician in or out of the room. And, whether the ratio of self-reported sexual arousal to child images divided by the self-reported sexual arousal to adult images remained the same with the technician in or out of the room. The results were analyzed as a one-way repeated measures ANOVA. The difference between subjects in the two conditions was not statistically significant (P<=.42, t=-.82, DF=29) for the ratio of VRT of images of children divided by the VRT of images of adults (see Table 1 and Figure 1). The difference between subjects in the two conditions was also not statistically significant (P<=.48, t=-.78, DF=29) for the ratio of self-reported arousal to images of children divided by the self-reported arousal to images of adults (see Table 2 and Figure 2).

Table 1. Results of mixed model repeated measures ANOVA for VRT ratio Solution for Fixed Effects

Figure 1. The average ratio of VRT of children slides to VRT of Adult slides.

Table 2. Results of mixed model repeated measures ANOVA for self-report ratio Solution for Fixed Effects

Figure 2. The average ratio of self-reported attraction to child slides to adult slides

These results indicated that when a technician remains in the room (unable to see the computer images or the client’s answers and focused on clerical work), the relative interest in children versus adults as measured by VRT™, and the relative self-reported arousal to children versus adults is not significantly different when compared to results when the technician is out of the room. In a previous study by Brown, et al in 1973, three graduate students were asked to observe individuals doing a procedure similar to Visual Reaction Time™. Presumably, these graduate students looked at the images being presented to the client and to the client’s responses. It is expected that the graduate students would be next to or in back of the client and observing directly what the client was observing. This type of close observation of the client during VRT-like assessment nullifies the testing.

The study ASI conducted demonstrates that when a technician is not directly observant of the client, but instead, is attending to clerical duties, his or her presence does not impact on VRT™ measurement. For those settings in which it is required that the technician remain in the room with the client during VRT™ testing, we recommend that the assessment be conducted as described in our study for continued validity of the VRT™ assessment procedure.

We first recommend that you talk to the prison officials and explain that during the thirty-five minute Visual Reaction Time™ assessment, it is important that no one else be in the room. Explain that this is a test dealing with attention, and that is why it is so critical that during this phase of the Abel Assessment, the client be alone. Determine if the prison authorities will allow you to be outside of the room, given the requirements of the test. If in spite of your best efforts the institution requires that you remain in the room, then you must make your presence there as inconspicuous as possible. The equipment should be placed so that no one else can see the images that the client is looking at while the client is doing the VRT™ assessment. You must also position yourself so that you are not able to see the images. Furthermore, you should occupy yourself with work that demonstrates your apparent lack of concern for the testing the client is doing. It would be best if your back is to the client, and you are far in front of the laptop (so the back of the laptop screen is facing you) on which the images are shown. Make your activity consistent throughout the time that he is completing the VRT™ testing so that if your presence in the room is a potential contaminant, your behavior is constant throughout the VRT™ assessment and you don't appear to be scrutinizing the client's performance. (Question submitted 08/25/99.)

If there are questions regarding how to answer Question No. 1, specifically, “Client admits sexual behavior (sexual interaction, touching, or non-touching with an individual 17 years of age or younger),” this requires an answer of “yes” if the individual touches, carries out voyeuristic behavior or exposes themselves to a child. It does not include individuals viewing sexual images of children 17 years of age or younger. Under those conditions, if the client admits “yes” to “Using Internet sexual materials excessively”), then when the client gets to the Internet Behavior Section in the AASI-3 or AASI-2 Questionnaire, they have the opportunity to clarify who the individual is that they are looking at. In the questions related to the Internet, if the client denies looking at Internet child pornography, then we miss the images that they were accused of looking at. There is no further solution at this time. If they lie on the inner questions related to the Internet, the conflict between what they have said on page 2 of the Therapist Section Questions will show up and they can then be questioned further by the therapist. (Question originally submitted 2/8/07.)

Since the Abel-Blasingame Assessment System for individuals with intellectual disabilities™ (ABID) was developed specifically to be read out loud to clients, if you have the ABID it is recommended that you use it with all clients who are illiterate. The reason for using the ABID with illiterate clients, even if they have no intellectual disabilities, is that you are able to use the standardized instructions, which for the ABID include reading the test to the client. For clinicians who do not have access to the ABID, read the Adult AASI-3 or AASI-2 Questionnaire to adult clients who are illiterate, but are not intellectually disabled. Read the Adolescent AASI-2 Questionnaire to adolescent clients who are illiterate and adults who are illiterate and intellectually disabled. It is important to realize that reading the AASI-3 or AASI-2 to a client represents a deviation from the standardized administration instructions. AASI-3 and AASI-2 results from tests not administered in the standardized manner should be interpreted with a greater amount of caution. For all Hispanic/Latino clients who neither read Spanish nor understand spoken English, read the age-appropriate Spanish version of the AASI-3 for adults or AASI-2 (adult or adolescent). (Question originally submitted 2/7/07.)

The AASI Questionnaire for adults is primarily concerned about those behaviors where the client has sexually touched a child or sexually touched an adolescent since the client was an adult. However, if the client as an adolescent sexually touched a minor who was three or more years younger than the client, this would also be problematic and potentially constitute sexual abuse of the minor. If a client admits to sexually touching a child or adolescent in the Questionnaire, then the therapist should question the client further to establish the degree of inappropriate sexual touching that occurred, and what the age difference was between the client and the minor. (Question originally submitted 8/31/05.)

First of all, Abel Screening was happy that The New York Times chose to describe the AASI because they identified it as a standard test for evaluating individuals with sexual behavior problems. We feel this exposure in The New York Times confirms what we know to be true, that the AASI is a “strong diagnostic” test. If you read the article, you will see that specific details about the AASI are not given. They do mention that it involves looking at images, but as we have discussed in another Clinician FAQ the test is very difficult to fake. Let us tell you the history of this. In 1987, when Gene G. Abel, M.D. was testing the AASI regarding this issue, he would tell the clients involved in the testing that different people have different ideas as to how the test works. They were told there are three primary ways people believed it worked. They were then asked to select one of those numbers (1, 2 or 3). Once selected, he would tell the client what the premise was of that particular group (1, 2 or 3), and that he wanted the client to assume that premise was correct and to falsify the results. No matter whether they selected group 1, 2, or 3, Dr. Abel said that group believed Abel Screening was measuring how long the person looks at the slide. He told the client that if he looked at the slide longer it meant he had a greater sexual interest, and if he looked at it for a shorter time, it means that he had less sexual interest. Dr. Abel then asked the client to repeat the premise to ensure his understanding. Then Dr. Abel had the client retake the test; the test results didn’t change much. Let us assume the results of the AASI only measure attention to the images and let us assume a person had read the details of internal Abel Screening documents about how the measurement of sexual interest by viewing time works. Since there are multiple images per category (160 images total), the individual would have to first make a decision as to how many milliseconds they were going to look at any given category. As the images are displayed, the client would have to immediately identify which category an image belonged to. Therefore, the client would have to know how many milliseconds they were going to look at the images, and then be able to categorize these images immediately. Finally, they would have to distinguish between the images that were being used from the ones that weren’t being used in the data calculation. Among other things, The New York Times article does not distinguish which images are used and which ones are not. Other important aspects of the AASI that The New York Times article doesn’t address are the probability values and the logistic regression model. Perhaps they didn’t because they are difficult concepts to explain. For example, the logistic regression model is made up of a variety of variables which makes it problematic for a person to falsify. The client would have no way of knowing which variables (categories) are used or the coefficients assigned to those variables. As you can see, while The New York Times article identifies that the AASI measures Visual Reaction Time™, it did not invalidate results of individuals who take the test after reading the article. (Question originally submitted 3/3/05.)

The AASI has been used for a number of years to evaluate individuals with schizophrenia and other psychotic disorders once they were in remission. In many cases, the clients tested had been committed to an institution after they had been found not guilty of a sex crime by reason of insanity. Following treatment for their psychosis, they were tested on the AASI as part of an overall evaluation. The question to be answered: Was their inappropriate sexual behavior with children (a) a product of their primary psychosis with a resultant breakdown of their sexual impulsivity, or (b) secondary to a persistent chronic sexual interest in children? There are no absolute guidelines as to which psychiatric symptoms (or lack of) indicate that it is an appropriate time to evaluate the individual with a psychosis. However, we would suggest two criteria. One criterion would be when your agency has to make a decision regarding moving a client to a less restrictive environment and you have to determine the risk involved. A second criterion would be your patient's ability to understand the process of completing the Practice Images. Since there is no cost to running the Practice Images, we recommend that you give the client the instructions for the Practice Images and stay in the room while he completes the Practice Images. You should be able to determine whether he is following your instructions or not. If he can follow your instructions, then it is appropriate to go ahead with the test. Our experience of the AASI’s use with patients who have a serious and persistent mental illness indicates that a surprisingly high percentage of these patients have sustained chronic sexual interest in children once their psychotic illness is controlled with medication. However, there are a few individuals with psychoses, who once they have responded to anti-psychotics, do not have such persistent sexual interest in children. (Question originally submitted 3/22/2000.)

The Abel Assessment for sexual interest™ is an objective test. It measures the client's sexual interest to various stimuli. That is important to remember. A secondary measure that is not objective is the client’s self-report. We ask the client to rate each image from 1 to 7, with 1 being "highly sexually disgusting," 4 being "neutral," and 7 being "highly sexually arousing." We have this self-report measure because we want to know how aware the client is of his sexual interests and/or how willing he is to reveal his sexual interests. We know that sex offenders sometimes lie. That is why we need the Visual Reaction Time™ (VRT™) objective measure of their sexual interest in children. At the time you are evaluating both the objective and the self-report measures, it is the bars, the Z-scored VRTs, that are the most important. Often, while the client is answering all 1's or 4's, the test's primary function of <u>objectively</u> measuring his sexual interest is unaffected. However, when a client rates his sexual arousal to the slides as all 1’s or all 4's (on the 7-point scale), it strongly suggests that the individual is attempting to invalidate this self-reported ratings part of the test. He is reporting no differences in his sexual arousal irrespective of the age, gender, or ethnicity of the model in the image. Such an answering style indicates that the person does not discriminate between various categories of models in the images, which is extremely unlikely. The best way to avoid this kind of non-discriminatory answering is to train the individual, during the practice images, that such non-discriminatory answers are unacceptable because they are illogical. During the practice images, stand next to the client and observe his ratings of sexual arousal to the images. If you see this non-discriminatory responding of all 1's (sexually disgusting) or all 4's (neutral) or no numbers greater than 4, you should immediately confront the individual with how you interpret his responses and what it suggests to you. Possible comments could include: "How could it be that every one of your answers is the same?" "How can it be that none of the slides are arousing to you when you already told me that you are aroused to some age and gender categories?" "Are you really saying that as a human being you have no sexual arousal to any person of any age or any gender?" The client expects you to advise him during the practice images and your advice may stop the client from giving non-discriminatory answers. When you have finished training the client on the Practice Images, you should be able to say that the client understands the process and understands the inappropriateness of giving non-discriminatory answers. Of course, once the client begins rating the actual images, you should not be in the room. If the client, when he is alone, goes back to using non-discriminatory responses, you should interpret the meaning of such responding as probably an attempt to invalidate the test. This is a logical conclusion once you have made sure during the Practice Image training that the client knew the inappropriateness of such responding. If during the practice images training, the client changed his non-discriminatory responding to indicate some arousal to some categories of slides and less to other categories, but then went back to non-discriminatory responding on the Actual Images, there are a number of possible interpretations. The first might be that he is attempting to invalidate his self-report on the test, and therefore, further interpretation of that part of the test (beyond attempts to invalidate it) is not indicated. A second interpretation might be to explain exactly what the client’s answers were. For example, if the client indicates that every image category is highly sexually disgusting, simply write that the client finds every image category highly sexually disgusting. By indicating this fact, the person reading the report can appreciate the unlikely validity of the client's self-reported arousal to the various images. Some sex offender clients attempt to invalidate the clinical history they provide, the results of questionnaire they complete, and measures incorporated into the images portion of the Abel Assessment. The attempts on the client's part to invalidate such testing should be used to reflect on the client's cooperativeness with testing, his willingness to provide honest answers, the likelihood of his obstructing attempts to understand his problem and, of course, what all that means to his evaluation. Ultimately, the clinician providing the assessment must make interpretations as to the meaning of the client's attempts to invalidate the various elements of any assessment.

• • • Please note that two therapists who regularly use the Abel Assessment also gave excellent answers to your question. Their answers follow. • • •

Posted: December 4, 1999 Author: Gerry D. Blasingame, MA LMFT Site 1013 Redding, CA

I have run about 250 Abel Assessments, and have had numerous clients try to not give up any information by pressing only the 1 or 4 key. However, their self-report response is not all that is being measured, so I am able to compare their attempt to fake me out with the objective data. When their self-report rating is not consistent with the objective data, I am able to interpret this as either (a) they are trying to deceive me, (b) they lack insight as to their sexual interests, or (c) they did not understand the procedure. Since I have them explain to me what the numbers mean during the practice images, I omit option (c), and note that the self-report data could be interpreted the other two ways. I also explain this very thing to the clients before running the actual images, so it becomes even more meaningful when they persist to score everything with one number only. Also, since there are categories of interest might be very expected, to not rate any adult females or males (for example) as interesting would be a giveaway that they are not being cooperative. Regardless of the clients' attempts to falsify the self-report ratings, I confront them with what the computer measured. I have had very rare disagreement from the clients when I confront them with both sets of data. By the way, we polygraph after administering the Abel Assessment, so perhaps we get a different response set. I hope this is helpful.

Posted: December 14, 1999 Author: Dean Fazekas, LISW Site 1090 Cleveland, OH I

would like to thank Gerry for his posting. At our site, we have been successful in moving guys off 4. We often discover that the move was to 1. This often comes after they "accurately" rated the practice images and provided a varied range of responses. When I see all images rated in the disgusting range, I expect the social desirability scale to be high. Since one of the things I am looking for is the agreement between his mind and objective measures, I would not say the objective measures are invalid. I expect that he has tried to conceal his sexual interest, especially when he gave a wide range of responses on the practice images. In discussing the results with the individual, I often state that perhaps his mind does not appreciate what his objective measures are telling him. "That's OK for now. That is why you're here. Let's explore this together." I have not had many pedophiles rate children in the arousing range, yet their objective measures show high sexual interest in children. I would not say that the objective measures are invalid solely based on his unwillingness to reveal such information, especially with a sentencing pending. In our elderly population who are experiencing a lowered drive or erectile dysfunction, they will often give lowered ratings to the images. What I find guys objecting to the most is their sexual attraction to adolescent females; even after it is explained to them that it's "normal." When they persist in objecting, I ask them (taking away the Female Adult category) which would they like to pick as their 2nd category: Female 6-13, Female 5 or less, Male 5 or less, Male 6-13, Male 14-17, or Male Adult. They always ask for the Female 14-17 back. As with any assessment, one should use all tools at their disposal. The clinical interviews and a detailed sexual history can provide important information

We have conducted an internal review of the HIPAA requirements in an attempt to determine the applicability of the Act as it pertains to the transmission of client data related to the AASI. We have concluded that HIPAA does not apply in this situation provided the client ID numbers used by the customer sites are not unique identifying numbers such as social security numbers. It is clear that the data transmitted probably qualifies as “Protected Health Information” as defined under HIPAA, but it is not being transmitted in a fashion that is identifiable provided the client ID number is a number generated by the site, such as is the case when simple sequential numbers are used. In summary, as long as unique identifying numbers such as social security numbers are not used, there does not appear to be any danger of violating the HIPAA requirements.

Abel Screening has testing assumptions that are required to receive an accurate test result. For example, the Abel Assessment for sexual interest™ VRT testing requires that you only use the images provided by Abel Screening, Inc. (ASI), that you'll only use the computers recommended by ASI, that testing is done in a room that is both dimly lit and quiet, that there be no one in the room after the practice images while the client completes the testing, (for an exception to there being no one in the room, see Q: How should a clinician administer the Abel Assessment for sexual interest™ (AASI) when an observer must be in the room with the test taker?, that the individual can see well enough to identify the images before him or her, that the administrator has been trained on the proper administration of VRT™, that once the individual begins the practice images and the actual images, he does not take breaks in between image sets, etc. The administration of the test and subsequent results are based upon this and other test assumptions not being violated. Since there was greater than 15 minutes between the practice images and actual images, the test assumption was invalidated. We are unable to quantify how much test results will be invalidated when the test assumptions are broken. Instead, we focus on clarifying the test assumptions in our training so that everyone can administer the testing in the same fashion. Doing so ensures the validity of the testing.

The Abel Assessment for sexual interest-2™ for Boys and Girls cannot be used to diagnose anyone with pedophilia; indeed, there is no psychological test that can diagnose anyone. Diagnosis is only made by licensed clinicians trained regarding the diagnostic criteria for a disorder. Only a clinician can make a diagnosis, not psychological testing, including the Abel Assessment for sexual interest-2™ for Boys and Girls. (Question submitted 3/14/12.)

You were told by the client that the procedures used by the other site were not those that you were trained to follow. Your task is to evaluate the client using the methodology you have been trained to follow. If you become accusatory of the previous site’s evaluation methodology, you are stepping outside of your task of evaluating your client and getting into an investigative procedure that you are no doubt not trained in. We recommend that you complete the assessment you were asked to do, using the standard methodology and report those results. If an unusual methodology was used by the other site, that is between your client and the previous site. (Question submitted 07/13/09.)

score is 37, and his social desirability score is 35%. Attached is a copy of his AASI-3 Visual Reaction Time™ results. Do you see evidence that his Asperger’s Syndrome impacted on his understanding the AASI-3?

It was excellent that you watched him complete the practice images and since he did well, one should assume that the rest of the testing was valid. His reporting that he still has sexual fantasies of young girls suggests his need for cognitive-behavioral treatment which is further suggested by his high cognitive distortion score. It is not surprising that his social desirability score is low, since he was forthcoming about various inappropriate sexual behaviors. I ran a correlation between his VRT™ scores and his self-report scores from his bar graph, which showed a correlation of .718. This is exceedingly high and indicates a strong correlation between what he says he is aroused to and what the objective Visual Reaction Time™ measure indicates he is interested in. If Asperger’s Syndrome disrupted his understanding, one would not expect him to have such a high correlation between his VRT™ and self-report measures. There is no obvious reason why you should not accept his AASI-3 results as valid. (Question submitted 04/27/11.)

Your dilemma brings up a number of issues regarding the Abel Assessment for sexual interest™ administration and interpretation.

These issues include:

1. The most important point is that The Abel Assessment for sexual interest™ is a psychological test that adds to all the information the therapist collects on a client. Sexual interest is NOT a criterion for a diagnosis of any DSM-IV paraphilia; therefore, this assessment cannot make a diagnosis.

2. The AASI clinical guides clearly delineate that the assessments are not to be used to determine guilt or innocence, but instead to be used as a guide for the client's treatment needs and determination for risk.

3. The client's individual clinical history as collected by a licensed, objective therapist is a vital component of the interpretation of the Abel Assessment test results. This means that the only one qualified to interpret the graph is the therapist who has collected the clinical history and therefore is able to place the client's test results within that overall clinical context.

4. Test results produced by the Abel Assessment for sexual interest™ MUST be interpreted within the context of the therapist's total assessment of the client.

5. Graphs are identified by numbers only: the number of the customer site where the test is administered, and the test identification number assigned to the client.

6. Abel Assessment for sexual interest™ graphs are anonymous. Confidentiality is built into the Abel Assessment testing system. No one, including Dr. Abel nor or any of the Abel Screening staff, can connect a specific client to a specific test. The client's therapist is the only one who can match the client's test identification number to the client's name.

7. Dr. Abel does not give consultations on test results. His policy is that he only discusses Abel Assessment for sexual interest™ test results with the licensed, objective therapist who has completed a clinical interview. He does not discuss specific Abel Assessment test results with anyone in the judicial system, with any family member, or with any client who has been given the Abel Assessment by anyone other than his own staff. In answer to your question, neither Dr. Abel nor Abel Screening staff can help you for the reasons identified above. (Question originally submitted 10/10/99.)