A considerable amount of research has investigated the relationship between potential neuropsychological dysfunction, pedophilia, and sexual offending against children. Until recently, these studies focused primarily on the relationship between executive functions and sexual offending against children, not accounting for underlying sexual preference disorders like pedophilia. Previous research generally supports a role of impaired neuropsychological function in individuals who have committed child sexual abuse offenses, but there are still unanswered questions of how this relates to pedophilia as a sexual preference disorder and whether these differences are also observed in non-offending individuals with pedophilia. This chapter will provide readers with a discussion of current findings as they relate to clinical practice, while using theoretical frameworks to guide future research.