1

Established in June 1997, CSOM’s goal is to enhance public safety by preventing further victimization through improving the 

management of adult and juvenile sex offenders who are in the community. A collaborative effort of the Office of Justice 

Programs, the National Institute of Corrections, the State Justice Institute, and the American Probation and Parole Association, 

CSOM is administered by the Center for Effective Public Policy. 

 

C enter for S ex O ffender M anagement 

A Project of the Office of Justice Programs, U.S. Department of Justice 

Understanding Juvenile Sexual Offending Behavior: Emerging 

Research, Treatment Approaches and Management Practices 

December 1999 

Introduction 

Juveniles commit a significant number of the 

sexual assaults against children and women in 

this country. The onset of sexual offending 

behavior in these youth can be linked to 

numerous factors reflected in their experiences, 

exposure, and/or developmental deficits. 

Emerging research suggests that, as in the case 

of adult sex offenders, a meaningful distinction 

can be made between youth who target peers or 

adults and those who offend against children. 

However, juveniles who sexually offend are 

distinct from their adult counterparts. Youth who 

commit sexual offenses are not necessarily “little 

adults;” many will not continue to offend sexually. 

This is a formative area of research; while there is 

an ever-increasing body of knowledge regarding 

the etiologies of dysfunction and aggression, there 

remains a tremendous need for additional data to 

understand the etiology of juveniles sexual 

offending. 

The purpose of this brief is to discuss the current 

state of research on sexually abusive youth, 

legislative trends, and promising approaches to 

the treatment and supervision of these youth. 

Research Developments 

Characteristics of Juvenile Sexual Abuse 

Sexual aggression perpetrated by young people 

has been a growing concern in the United States 

over the past decade. Currently, it is estimated 

that juveniles account for up to one-fifth of all 

rapes1

 and almost one-half of all cases of child 

 

1

 In 1995, youth were involved in 15 percent of all forcible 

rapes that resulted in arrest; approximately 18 adolescents per 

100,000 (ages 10 to 17) were arrested for forcible rape in 1995 

(Sickmund et al, 1997). 

molestation2 committed each year (Barbaree et al, 

1993, Becker et al, 1993, Sickmund et al, 1997). 

Adolescents age 13 to 17 account for the vast 

majority of cases of rape and child molestation 

perpetrated by minors (Davis and Leitenberg, 

1987). The majority of incidents of juvenile sexual 

aggression involve male perpetrators (Sickmund 

et al, 1997). However, a number of clinical 

studies also point to prepubescent youths and 

females engaging in sexually abusive behaviors. 

Although racial and socioeconomic differences 

may be over represented in certain settings (e.g., 

juvenile justice), juveniles referred for treatment in 

a variety of environments reflect the same racial, 

religious, and socioeconomic distribution as the 

general population of the United States (Ryan et 

al, 1996). 

A number of etiological factors (risk factors) have 

been identified to help explain the developmental 

origin of sexual offending. Factors receiving the 

most attention are abusive experiences and 

exposure to aggressive role models. Other 

factors in focus are substance abuse and 

exposure to pornography; however, these are 

seen more as disinhibitors than as causal 

influences. 

The Effects of Physical and Sexual Abuse 

Recent studies show that rates of abusive 

histories vary widely for sexually abusive youth. A 

history of physical abuse has been found in 20 to 

50 percent of these youth; a history of sexual 

abuse has been found in 40 to 80 percent of 

2

 Approximately 16,100 adolescents were arrested for sexual 

offenses in 1995 (excluding rape and prostitution). This is 

approximately 3 times the number of youths arrested for 

forcible rape (Sickmund et al, 1997). 
sexually abusive youth (Hunter and Becker, 1998, 

Kahn and Chambers, 1991). Rates of physical 

abuse and sexual victimization are even higher in 

samples of prepubescent and young female 

sexual abusers (Gray et al, 1997, Mathews et al, 

1997). Research suggests that age of onset, 

number of incidents of abuse, the period of time 

elapsing between the abuse and its first report, as 

well as perceptions of familial responses to 

awareness of the abuse are all relevant in 

understanding why some sexually abused youths 

go on to commit sexual assaults while others do

not (Hunter and Figueredo, in press). 

The influence of abusive experiences is 

considered multi-faceted and includes effects 

related to both Post-Traumatic Stress Disorder

and modeling (Freeman-Longo, 1986, Gil and 

Johnson, 1992). Symptoms of Post-Traumatic 

Stress Disorder have been observed in a number 

of youths with sexual behavior disorders, 

especially children ages 13 and younger and 

females. These symptoms include recurrent and 

intrusive recollections of past traumatic events 

and increased levels of irritability and anger. 

Youths who have directly experienced or 

witnessed sexual abuse may imitate the behavior 

of the aggressive role model(s) in their 

interactions with others.

The presence of child maltreatment—whether 

neglect, physical abuse, sexual abuse, or other 

forms of victimization—may eventually prove to be 

a significant predictor of sexual offending

behavior. 

Exposure to Aggressive Role Models 

Studies show that male child witnesses to

domestic violence tend to engage in externalizing 

behaviors (the acting-out of psychological conflict 

or tension), including acts of interpersonal 

aggression, more than their female counterparts 

(Stagg et al, 1989). Exposure to family violence is

linked to the likelihood of sexually offending as an 

adolescent, as well as the severity of 

psychosexual disturbance (Fagan and Wexler, 

1988, Smith 1988). The effects of exposure may 

be cumulative, as well as interactive with other 

developmental experiences, such as child abuse 

and neglect (O’Keefe, 1994). Recent studies

suggest that exposure to severe community 

violence (e.g., murders) may also increase the 

likelihood of engaging in violent and antisocial 

behavior (Johnson-Reid, 1998). 

Substance Abuse and Exposure to Pornography 

While there is strong research to support the 

association between violent crime and alcohol 

use, the association between sexual offending

and substance abuse is not fully established. 

Estimates of the extent of substance abuse vary 

widely for the population of youth who sexually 

offend (Lightfoot and Barbaree, 1993). The 

influence of pornography on the developing 

male’s potential for sexual offending is an issue of 

similar controversy. One recent study found that 

sexually abusive youth were exposed to 

pornographic material at younger ages on the 

average, and to “harder core” pornography, than 

either status offenders or violent non-sex

offending youths (Ford and Linney, 1995). 

Research in these areas is lacking and clearly, 

juvenile sexual offending is far more complex than 

simple exposure to pornography or substance 

abuse. 

Developmental Progression 

While sexual aggression may emerge early in the 

developmental process, there is no evidence to 

suggest that the majority of sexually abusive 

youth become adult sex offenders. Recidivism 

rates for these youth may have been exaggerated 

by a reliance on retrospective research studies 

(studies that examine historical data), which can 

overstate the strength of correlations. 

Longitudinal studies (studies that examine current 

data), which tend to be more reliable, suggest that 

aggressive behavior in youths often does not 

continue into adulthood, although some portion of 

those who commit rape may continue to abuse 

(Elliott, 1994, Loeber and Stouthamer-Loeber, 

1998). 

Other Characteristics Common to Sexually 

Abusive Youth 

Sexually abusive youth share other common 

characteristics, including: 

• high rates of learning disabilities and 

academic dysfunction (30 to 60 percent) 

(Awad and Saunders, 1991, Hunter and

Goodwin, 1992, Epps, 1991); 

• the presence of other behavioral health 

problems, including substance abuse and 

conduct disorders (up to 80 percent have the 

same diagnosable psychiatric disorder) 

(Kavoussi et al, 1988); and 

2
In general, the sexual arousal patterns of sexually 

abusive youth appear more changeable than 

those of adult sex offenders, and relate less 

directly to their patterns of offending behavior 

(Hunter and Becker, 1994, Hunter et al, 1994). 

• observed difficulties with impulse control and 

judgment (Smith et al, 1987, Epps, 1991, 

Vizard et al, 1995). 

The following table outlines some of the common 

characteristics found in youth who sexually offend. 

Treatment Research 

Table 1

Characteristics of Sexually Abusive Youth

• Typically adolescents, age 

13 to 17. 

• Mostly male perpetrators. 

• Difficulties with impulse 

control and judgment. 

• Up to 80 percent have a 

diagnosable psychiatric 

disorder. 

• 30 to 60 percent exhibit 

learning disabilities and 

academic dysfunction. 

• 20 to 50 percent have 

histories of physical 

abuse. 

• 40 to 80 percent have 

histories of sexual abuse. 

While funding and ethical issues have made it 

difficult to conduct carefully controlled treatment 

outcome studies, a number of encouraging clinical 

reports on the treatment of sexually abusive youth 

have been published (Becker and Hunter, 1997). 

While these studies are not definitive, they provide 

support for the belief that the majority of sexually 

abusive youth are amenable to, and can benefit 

from, treatment. 

Typology 

The clinical and criminal dimensions of juvenile 

male sexual abusers often vary. As with their adult 

counterparts, juvenile sexual abusers fall primarily 

into two major types: those who target children 

and those who offend against peers or adults. 

The distinction between these two groups is 

based on the age difference between the victim 

and the perpetrator (child perpetrators are those 

who target children five3

 or more years younger 

than themselves). 

Table 2 (see page 4) examines distinctions in 

characteristics between these two groups of 

sexually abusive youth. 

Deviant Sexual Interests 

A minority of sexually abusive youth manifest 

established paraphilic (deviant) sexual arousal 

and interest patterns. These arousal and interest 

patterns are recurrent and intense, and relate 

directly to the nature of the sexual behavior 

problem (e.g., sexual arousal to young children). 

Deviant sexual arousal is more clearly established 

as a motivator of adult sexual offending, 

particularly as it relates to pedophilia. A small 

subset of juveniles who sexually offend against 

children may represent cases of early onset 

pedophilia. Research has demonstrated that the 

highest levels of deviant sexual arousal are found 

in juveniles who exclusively target young male 

children, specifically when penetration is involved 

(Hunter and Becker, 1994, Marshall et al, 1991). 

 3

 Some state laws refer to a three or four year age difference 

between the perpetrator and child victim. 

3
Table 2 

Comparing Two Sub-Groups of Sexually Abusive Youth 

Characteristics: Offend Against Peers or Adults Offend Against Children 

Victims • Predominantly assault females. 

• Assault mostly strangers or

acquaintances (Hunter et al, in press). 

• Females victimized at slightly higher rates. 

• Nearly half assault at least one male. 

• Up to 40 percent of victims are either siblings or 

relatives (Hunter et al, in press). 

Offense Patterns • More likely to commit in conjunction with 

other criminal activity. 

• More likely to commit offenses in public 

areas (Hunter et al, in press). 

• Reliance on opportunity and guile, particularly when

victim is a relative. 

• Trick child by using bribes or threatening loss of 

relationship (Hunter et al, in press, Kaufman et al, 

1996). 

Social and Criminal 

History 

• More likely to have histories of non-sexual 

criminal offenses. 

• Generally delinquent and conductdisordered (Hunter et al, in press, 

Kaufman et al, 1996, Richardson, et al, 

1997). 

• Deficits in self-esteem and social competency are 

common. 

• Often lack skills and attributes necessary for forming 

and maintaining healthy interpersonal relationships 

(Awad and Saunders, 1989, Monto et al, 1998). 

Behavior Patterns • Display higher levels of aggression and 

violence (Awad and Saunders, 1989, 

Monto et al, 1998). 

• More likely to use weapons and cause 

injuries to their victims (Awad and 

Saunders, 1989, Monto et al, 1998). 

• Frequently display signs of depression (Becker et al, 

1991). 

• Youths with severe personality and/or psychosexual 

disturbance may display high levels of aggression 

and violence (Becker and Hunter, 1993). 

Multisystemic Therapy 

In what is perhaps the best controlled study to 

date, Borduin, Henggeler, Blaske, and Stein 

compared “Multisystemic Therapy” (MST) with 

individual therapy in the outpatient treatment of 16 

juvenile sex abusers (Borduin et al, 1990). 

MST is an intensive family- and community-based

treatment that addresses the multiple factors of 

serious antisocial behavior in juvenile abusers. 

Treatment can involve any combination of the 

individual, family, and extrafamilial (e.g., peer, 

school, or neighborhood) factors. MST promotes 

behavior change in the youth’s natural 

environment, using the strengths of the youth’s 

family, peers, school, and neighborhood to 

facilitate change. 

In this study, rearrest records were used as a 

measure of sexual and non-sexual recidivism; the 

groups were compared at a three-year follow-up 

interval. Results revealed that youths receiving 

multisystemic therapy had recidivism rates of 12.5 

percent for sex offenses and 25 percent for nonsex offenses, while those receiving individual 

therapy had recidivism rates of 75 percent for sex 

offenses and 50 percent for non-sex offenses. 

Other Treatment Research 

Program evaluation data suggests that the sexual 

recidivism rate for juveniles treated in specialized 

programs ranges from approximately 7 to 13 

percent over follow-up periods of two to five years 

(Becker, 1990). Furthermore, juveniles appear to 

respond well to cognitive/behavioral and/or 

relapse prevention treatment, with recidivism rates 

of approximately 7 percent through follow-up

periods of more than five years (Alexander, 1999). 

Studies suggest that rates of non-sexual

recidivism are generally higher (25 to 50 percent) 

(Becker, 1990, Kahn and Chambers, 1991, 

Schram et al, 1991). Findings from outcome 

studies on adult offenders show higher sexual 

recidivism rates for individuals who fail to 

successfully complete treatment programs 

(Marques et al, 1994). 

"Mulitsystemic" Therapy Recidivism

In a recently conducted study, Hunter and 

Figueredo found that as many as 50 percent of 

13%

75%

25%

50%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Multisystemic Therapy Individual Therapy

Rearrests

Sexual Offense Recidivism

Non-Sexual Offense

Recidivism

Borduin et al, 1990

“Multisystemic” Therapy Recidivism

Borduin et al, 1990 

4
youths entering a community-based treatment 

program were expelled during the first year of 

their participation (Hunter and Figueredo, 1999). 

Those who failed the program had higher overall 

levels of sexual maladjustment, as measured on 

assessment instruments, and were judged to be 

at greater long-term risk for sexual recidivism. 

Policy Development Issues 

Trends in Juvenile Justice 

The rise in juvenile perpetrated violence over the 

past decade has resulted in legislation designed 

to enhance public safety and raise the level of 

accountability of juveniles in the criminal justice 

system (Hunter and Lexier, 1998). Substantive 

changes have been made in legal statutes or 

regulatory policy in over 90 percent of the states. 

These reforms include changes related to: 

• juvenile court waivers; 

• sentencing guidelines; 

• record confidentiality; 

• community notification; 

• registration requirements for sex offenders; 

and 

• correctional programming. 

The number of delinquency cases waived to adult 

criminal courts increased by 71 percent between 

1985 and 1994 (Szymanski, 1998). The age at 

which a juvenile may be tried as an adult has 

been lowered in over half of the states. Twenty 

jurisdictions4

 have no minimum age restriction for 

trying a juvenile as an adult for certain serious 

crimes (Szymanski, 1998). Legislative changes 

have also made it more likely that once a juvenile 

is convicted of a crime in the adult courts, he or 

she will serve at least some minimum sentence 

(Sickmund et al, 1997). Presently, more than half 

of the states permit public access to juvenile court 

records with some age and offense restrictions, 

while eleven states5

 permit public juvenile

hearings with no age or crime restrictions

(Szymanski, 1998). 

 4

 Alaska, Arizona, Delaware, the District of Columbia, Florida, 

Georgia, Maine, Maryland, Nebraska, Nevada, Ohio, 

Oklahoma, Oregon, Pennsylvania, Rhode Island, South 

Carolina, Tennessee, Washington, West Virginia, and 

Wisconsin. 

5

 Arizona, Arkansas, Colorado, Florida, Iowa, Michigan, 

Montana, Nevada, New Mexico, Texas, and Washington. 

Registration and Community Notification Laws 

The registration and tracking of individuals 

convicted of violent sex crimes or crimes against 

minors began with the passing of the 1994 Jacob 

Wetterling Act. The Wetterling Act was amended 

in 1996, with the passage of “Megan’s Law,” 

which requires (as opposed to authorizing) state 

and local law enforcement agencies to release 

information that is necessary to protect the public

concerning a specific person required to register. 

The Pam Lychner Sexual Offender Tracking and 

Identification Act of 1996 created criteria for 

mandatory lifetime registration of highlydangerous sex offenders, penalties for failure to 

register, and a requirement that the FBI create a 

national sex offender registry to assist law 

enforcement in tracking sex offenders when they 

move. 

Under federal guidelines, states are not required 

to register juveniles who are adjudicated

delinquent for a sex crime. However, states may 

require registration for these youth if they wish to 

do so. Juveniles convicted as adults are required 

to register under provisions of these guidelines

(U.S. Department of Justice, Office of the Attorney 

General, 1998). At least 27 states have enacted 

registration laws for juveniles convicted (or 

adjudicated) of sex crimes.6

 In some states, 

juveniles are subjected to the same registration 

Idaho’s Juvenile Registry

Idaho maintains a registry of juveniles adjudicated of sexual 

offenses, separate from the adult registry. This registry is 

open to public inspection, and is shared with the 

superintendent of public instruction who then notifies public 

and private schools regarding the enrollment of any 

registered juveniles. In Idaho, juveniles are required to 

register annually until they reach the age of 21, at which 

time a prosecutor can file a petition to have the youth 

transferred to the adult registry. If no petition is filed, the 

juvenile is deleted from the registry. 

requirements as adult sex offenders. In others, 

juveniles register until they reach a certain age 

(e.g., 18 or 21); in some instances, the court may 

require continued registration as an adult sex 

offender once a juvenile reaches that age. 

 6

 Arizona, California, Colorado, Delaware, Florida, Idaho, 

Indiana, Iowa, Kansas, Kentucky, Louisiana, Massachusetts, 

Michigan, Minnesota, Mississippi, Montana, New Jersey, North 

Carolina, Oregon, Rhode Island, South Carolina, South 

Dakota, Texas, Utah, Virginia, Washington, and Wisconsin. 

5
Promising Approaches to 

Intervention 

The number of programs providing treatment 

services to juvenile sex abusers more than 

doubled between 1986 and 1992, and continues 

Alternative Disposition in Washington State 

In Washington State, the court has the option to order a 

treatment sentence for most sexually abusive youth. Under 

the Special Sex Offender Disposition Alternative (SSODA), 

the judge can suspend the offender’s sentence, place the 

offender on community supervision for up to two years, and 

require the juvenile to participate in treatment with a statecertified therapist. The state pays the cost of treatment. If 

an offender does not comply with sentence conditions, or if 

the judge determines that the juvenile is not making

adequate progress in treatment, the disposition may be 

revoked and a determinate sentence imposed. The law

allows courts to remove the registration requirement for any 

juvenile after he or she has fulfilled sentence requirements 

(Lieb, R., 1998).

to climb. This growth reflects both increased 

societal concern about rising rates of juvenile sex 

offenses and the professional belief that early 

intervention helps to stem the emergence of 

chronic patterns of sexual offending. The 

following is a review of issues essential to the 

development of successful community-based

treatment programming for sexually abusive 

youth. 

Coordination Between the Criminal 

Justice System and Treatment Providers 

Most treatment specialists believe that successful 

programming for sexually abusive youth requires 

a coordinated effort between criminal justice 

system actors and treatment providers (National 

Task Force on Juvenile Sexual Offending, 1993). 

For juveniles to productively participate in

treatment programming, they must be willing to 

address their problems and comply with 

therapeutic directives. Adjudication and

supervision typically prove useful in ensuring 

client accountability and compliance with

treatment, as well as a means to prevent future 

victimization. 

Clinical experience has demonstrated that the 

suspension of the youth’s sentence contingent 

upon his or her successful completion of a 

treatment program is a particularly effective 

motivator. Under collaborative arrangements, the 

treatment specialist provides ongoing progress 

reports to the courts. Those youth who fail to 

comply with program expectations can be brought 

back before the court for review. 

Supervision 

To date, no studies have been conducted that 

clearly identify which supervision strategies are 

most effective with these youth. However, 

research on adult sex offender supervision 

suggests that model management strategies 

involve: intensive supervision and sex offense 

specific treatment; interagency collaboration, 

multidisciplinary teams, and the specialization of 

supervision and treatment staff; the use of the 

polygraph to monitor therapy and compliance with 

supervision conditions; and program monitoring

and evaluation, to ensure prescribed policies and 

practices are delivered as planned (English et al, 

1996). However, there has been little research on 

the application of adult conditions to juveniles. 

Too little is yet known about young perpetrators to 

apply adult standards to them. 

The Role of Supervision Officers 

In many programs, parole and probation officers 

play an integral role in assisting treatment 

providers by addressing critical issues and 

supervising youths’ activities in the home and 

community. Parole and probation officers help 

evaluate the extent to which clients are 

productively participating in the treatment program 

and complying with court and therapeutic

directives. They provide an additional link 

between the provider and youths’ families, and 

often assist therapists in impressing upon families 

the importance of their involvement in the youths’ 

rehabilitative programming. In some instances, 

parole and probation officers participate directly in 

the delivery of therapeutic services as cotherapists in treatment groups.7

 While there is 

little consensus among the treatment community 

about the proper role of supervision officers in the 

treatment of young sexual abusers, supervision 

officers should, at a minimum, communicate and 

collaborate with treatment providers. 

Typically, parole and probation officers provide an 

essential case management function. This 

includes analysis (sometimes with the help of 

social services) of the appropriateness of youth 

receiving in-home treatment and of the need for 

supplemental community programming, such as

 7

 This typically occurs in cases where the probation officer has 

received additional training in the treatment of sex offenders. 

For further information, contact the Association for the 

Treatment of Sexual Abusers (ATSA). 

6
community service projects. As case managers, 

parole/probation officers also facilitate appropriate 

communications between treatment providers and 

other community agencies, such as school 

officials involved in the youths’ overall care. 

Assessment 

Careful screening is critical to the success of 

community-based programming. Ideally, this 

assessment reflects the careful consideration of 

the danger that the perpetrator presents to the 

community, the severity of psychiatric and 

psychosexual problems, and the juvenile’s

amenability to treatment. The latter issues involve 

an assessment of the youth’s level of 

accountability for his or her sex offenses, 

motivation for change, and receptivity to 

professional help. Professionals who are 

experienced working with sexually abusive youth 

should conduct these evaluations. Programs 

should not compromise community safety by 

admitting youths who are more aggressive and 

violent, those who have psychiatric problems that 

are beyond the scope of the community-based 

program, or those who demonstrate little regard 

for their actions or interest in receiving help. 

Clinical Assessment 

Professional evaluation of youth and their 

appropriateness for placement should be 

conducted post-adjudication and prior to court 

sentencing. Clinical assessments should be 

comprehensive and may include careful record 

review, clinical interviewing, screening for cooccurring psychiatric disorders, and the 

administration of both specialized psychometric 

instruments designed to assess sexual attitudes 

and interests, as well as those related to more 

global personality adjustment and functioning. 

Assessment of the Youth’s Home 

Assessments of the juvenile’s appropriateness for 

community-based programming should include a 

thorough review of his or her living arrangements, 

as well as a determination as to whether his or her 

parents are capable of supervising the youth. 

Proper assessment requires evaluation of whether 

the living environment affords the level of

structure and supervision necessary for the youth 

while providing for the safety of others in the 

home and the community. Special consideration 

must be given to the needs and concerns of 

individuals living in the home who may have been 

victimized by the youth (e.g., younger siblings). It 

is essential that other children are protected from 

potential harm, both physical and psychological. 

It is often necessary to place a juvenile who 

sexually offends against family members 

temporarily outside of the home. These youth 

should not be returned home until sufficient 

clinical progress is attained, and issues of safety 

and psychological comfort of family members are 

resolved. For an adjudicated youth, this decision 

is typically made by the presiding judge with input 

from the parole/probation officer and social 

services worker, the youth’s treatment provider, 

the provider of services to family victim(s), and the 

youth’s family. 

Table 3

Types of Assessments used with Youth

Offend Against Peers or Adults 

Specialized Assessment Instruments 

• Multiphasic Sex Inventory (Nichols and Molinder, 1984) 

• Adolescent Cognitions Scale (Hunter et al, 1991) 

• Adolescent Sexual Interest Card Sort (Hunter et al, 

1991) 

Inventories Appropriate for Children with Sexual Behavior 

Problems 

• Child Sexual Behavior Inventory (Friedrich et al, 1991) 

General Assessment Instruments 

• MMPI-A (Archer, 1997) 

• Child Behavior Checklist (Achenbach et al, 1987) 

• Family Environment Scale (Moos and Moos, 1986) 

• Child and Adolescent Functional Assessment Scale 

(Hodges et al, 1982) 

Adjunctive Assessment Tools* 

• Plethysmograph 

• Polygraph 

(*There is little research on these tools to determine whtether 

they are effective on juvenile populations.) 

Clinical Programming 

Clinical programming for sexually abusive youth 

typically includes a combination of individual, 

group, and family therapies. In addition, many 

programs offer supportive educational groups to 

families of these youth. Juveniles who display 

more extensive psychiatric or behavioral

problems, such as substance abuse, may require 

additional treatment, including drug and alcohol 

rehabilitation and psychiatric care. All therapies 

provided to sexually abusive youth should be 

carefully coordinated within the treatment agency 

and with external agencies providing case 

management and oversight. Treatment programs

need to be individually tailored through a 

7
thorough assessment of the youth, family, and 

environment. 

Providers have established the following as 

essential components of the treatment process: 

• Gaining control of behavior. 

• Teaching the impulse control and coping

skills needed to successfully manage sexual 

and aggressive impulses. 

• Teaching assertiveness skills and conflict 

resolution skills to manage anger and resolve 

interpersonal disputes. 

• Enhancing social skills to promote greater 

self-confidence and social competency. 

• Programming designed to enhance empathy 

and promote a greater appreciation for the 

negative impact of sexual abuse on victims 

and their families. 

• Provisions for relapse prevention. This 

includes teaching youths to understand the 

cycle of thoughts, feelings, and events that 

are antecedent to the sexual acting-out, 

identify environmental circumstances and 

thinking patterns that should be avoided 

because of increased risk of reoffending, and 

identify and practice coping and self-control 

skills necessary for successful behavior 

management. 

• Establishing positive self-esteem and pride in 

one’s cultural heritage. 

• Teaching and clarifying values related to

respect for self and others, and a 

commitment to stop interpersonal violence. 

The most effective programs promote a 

sense of healthy identity, mutual respect in 

male-female relationships, and a respect for 

cultural diversity. 

• Providing sex education to give an 

understanding of healthy sexual behavior 

and to correct distorted or erroneous beliefs 

about sexual behavior. 

The planning and implementation of treatment 

services ideally reflect the collaborative 

involvement of the youth, family, and all agencies

involved in the youth’s care as well as those 

agencies serving victims of these youth. Often, 

this is accomplished by forming an advisory board 

to oversee the operation of the program and serve 

as a mediator between the program and the 

community. These boards typically consist of 

representatives from public institutions serving 

youths and families, including the local juvenile 

court, the department of social services, the 

prosecutor’s office, the public defender’s office, 

victim advocacy services, and parents of youthful 

perpetrators. The advisory board helps to ensure 

that the treatment program is serving the needs of 

its clients while meeting community safety 

standards. 

Controversial Areas of Practice 

The following areas of practice have generated 

controversy, and therefore pose special ethical 

and legal risks for practitioners assessing and 

treating sexually abusive youth (Hunter and 

Lexier, 1998). 

Involuntary Treatment 

Treatment of juveniles who sexually offend is 

usually court ordered or mandatorily provided in 

correctional settings. Historically, juvenile courts 

have prescribed mental health care for youths 

with an emphasis on rehabilitation. In contrast, 

adult courts have typically ordered involuntary 

treatment on the grounds that the youth 

represents an imminent danger to public safety. 

Given the shift of juvenile courts to a more adultlike criminal justice model, and the increasing

frequency with which juveniles are being

adjudicated and tried as adults, the issue of 

involuntary treatment may need to be reexamined. 

Judicial decisions are no longer made with a 

consistent emphasis on rehabilitation rather than 

punishment as a means of ensuring public safety. 

However, many sexually abusive youth may not 

meet the legal criteria for involuntary treatment 

based upon imminence of danger criteria. 

Pre-Adjudication Evaluations 

A number of sexually abusive youth are referred 

for evaluation prior to the initiation or completion 

of the adjudication process. Often, these referrals 

are made by the court, or another public agency, 

in an attempt to determine the most appropriate 

disposition for alleged sexual abusers. 

Pre-adjudication assessments raise a number of 

ethical and legal issues. Youths facing 

prosecution are placed in the position of being 

asked to reveal information that may be used

against them in court. Evaluations present 

another set of problems associated with the 

8
validity of available assessment instrumentation to 

determine innocence or guilt. There is no

scientific basis for assuming that any currently 

available psychometric or psycho-physiological 

measure of personality or sexual interest is valid 

for that purpose (Murphy and Peters, 1992). 

Risk Assessment 

The courts frequently give clinicians the

responsibility of determining the youth’s risk of 

recidivism. These assessments are used to make 

dispositional decisions and, as a result of

legislative mandates, have potential relevance in 

determining which juveniles should be placed on 

state registries, as well as whether information 

about certain sexually abusive youth should be 

released to the public. 

Unfortunately, risk assessment, especially risk of 

violence, remains an inexact science (Borum, 

1996, Monahan and Steadman, 1996). Although 

a number of risk assessment instruments are 

emerging as promising in the assessment of risk 

of adult sex offenders, to date none of these have 

been validated on a juvenile population. At this 

time, clinicians working with sexually abusive 

youth rely on experience, existing research on 

delinquency and pro-social functioning of youth, 

and retrospective and actuarial information on 

adults who reoffend in making their evaluations of 

the risk posed by a youth. 

A recent study has presented encouraging 

findings on an actuarial scale for assessing risk 

among adolescent sexual abusers (Prentky et al, 

in press). In this study, the Juvenile Sex Offender 

Assessment Protocol (J-SOAP) was used to 

assess risk on 96 youth receiving treatment in an 

institutional setting. Results from a 12-month 

follow-up period suggest that the instrument is 

reliable, internally consistent and appears to 

possess concurrent and predictive validity. The JSOAP is currently being used in a variety of 

locations and continues to be the subject of 

empirical scrutiny. 

Phallometric Assessment 

Phallometry is a diagnostic method to assess 

sexual arousal by measuring blood flow 

(tumescence) to the penis during the presentation 

of potentially erotic stimuli in the laboratory. The 

plethysmograph is a tool commonly used in 

phallometric assessment. Use of the 

plethysmograph with juveniles is an issue of some 

controversy (National Task Force on Juvenile 

Sexual Offending, 1993). Research suggests that 

issues of client age and denial compromise the 

validity of plethysmographic assessment of 

juveniles. Younger clients appear to produce less 

reliable patterns of responding, and those who 

deny their offenses tend to produce suppressed, 

and therefore non-interpretable, patterns of 

arousal (Becker et al, 1992, Kaemingk et al, 

1995). Most practitioners agree that phallometric

assessment should not be used on youth under 

the age of 14. Phallometric assessments of 

sexual arousal patterns are most appropriate for 

older adolescent males who report deviant sexual 

interest, and/or those juveniles with more 

extensive histories of sexual offending. Under 

these circumstances, such assessments may be 

useful for identifying youths with emergent 

Polygraph Legislation in Texas

In Texas, law requires use of the polygraph on certain 

sexually abusive youth. In 1997, legislation was enacted that 

prescribed release conditions, including counseling and 

treatment for adolescents convicted of certain sex offenses. 

Under this law, youth can be required, as a condition of 

release from the Texas Youth Commission, to attend 

psychological counseling sessions and to submit to 

polygraph examinations in order to evaluate treatment 

progress (Texas Human Resources Code, Title 3, Ch. 61, 

Sub. A, Sec. 61.0813). 

paraphilic (sexual deviation) disorders as well as 

helping youth to become more aware of patterns 

and strengthen non-problematic interests.8

Polygraph 

The purpose of a polygraph examination is to 

verify a perpetrator’s completeness regarding 

offense history and compliance with therapeutic 

directives and terms of supervision (Edson, 1991, 

Emerick and Dutton, 1993). The polygraph is 

used more often with adult offenders than with 

juveniles. To date, there is little research on the 

polygraph’s reliability and validity in the evaluation 

of sexually abusive youth. Research suggests 

that results potentially can be affected by a 

number of influences, including the client’s 

physical and emotional status, the client’s age and 

intelligence, and the examiner’s level of training 

and competency (Blasingame, 1998). Most 

practitioners using the polygraph indicate that the 

age threshold for use with juveniles is 

approximately 14 years old. 

 8

 Guidelines for appropriate clinical use of the plethysmograph 

can be found in the report of the National Task Force on 

Juvenile Sexual Offending (1993).

9
Arousal Conditioning and Psychopharmacologic 

Therapies 

Therapeutic techniques designed to change 

patterns of sexual arousal remain controversial. 

Studies examining the effectiveness of techniques 

such as arousal conditioning and drug therapies 

are inconsistent (Hunter and Goodwin, 1992). 

Concerns about the appropriateness of 

techniques exposing juveniles to physically or 

emotionally painful stimuli or involving 

masturbation render arousal conditioning

questionable (National Task Force on Juvenile 

Sexual Offending, 1993). While several reports 

about the use of drug therapy have appeared over

the past few years, little information exists about 

the safety and effectiveness of these drugs when

used on juveniles.9

 In particular, anti-androgens

and hormonal agents have typically not been used 

with individuals under the age of 18 because of 

their potential suppression of growth, and the 

other yet unknown long-term risk that they may 

present. Selective serotonin reuptake inhibitors 

(SSRIs) are helpful in reducing the frequency 

and/or intensity of sexual arousal and thoughts.10 

SSRIs are a class of antidepressant drugs known 

to cause a decrease in sexual arousal. Further 

research is examining the effectiveness of such 

drugs in reducing deviant sexual behavior. 

Legal and Clinical Concerns 

Subjecting juveniles to stricter penalties for sex 

offenses poses special legal and clinical

concerns. Legal issues can arise in the courtroom 

when determining if these youth have the capacity 

to understand their cases, to properly consult their 

attorneys, or to make sound decisions regarding 

their defense (Grisso, 1997). Clinical concerns

arise when clinicians place demands on their 

clients to divulge information that may incur 

additional restrictions or legal sanctions. Proper 

warning regarding the limits of confidentiality is 

necessary and may include referral to parents or 

attorneys prior to encouraging such disclosures. 

In many jurisdictions, clinicians develop policies 

with district attorneys to clarify the consequences 

of new disclosures in the course of treatment 

(National Task Force on Juvenile Sexual

Offending, 1993). Without these precautions, the 

reporting of such information may interfere with 

the development of the therapist/client 

 9

 These medications include ant-depressant and antiobsessional agents, as well as anti-androgen and hormonal 

agents. 

10 SSRIs include fluoxetine (Prozac), fluvoxamine, paroxetine, 

and sertraline. 

relationship, an essential component of the 

treatment process, and increase clinician 

vulnerability to civil suit (Hunter and Lexier, 1998). 

As with adult offenders, these policies must 

address harm done to victims identified through 

new disclosures and ways to offer assistance to 

these victims. 

Areas for Future Research 

Continued research is needed in each of the 

previously described areas. Research on etiology 

is especially important to the development of 

prevention programming for high-risk youths. 

Presently, the National Center for Child Abuse 

and Neglect is funding two demonstration projects 

to evaluate treatment outcomes for pre-pubescent 

children with sexual behavior problems. Studies 

on effective supervision strategies for sexually 

abusive youth are clearly needed. Treatment 

outcome studies that examine both individual and 

program characteristics associated with positive 

treatment outcomes are also needed. Research 

should focus on early identification of youths 

demonstrating patterns of escalating aggression 

and violence. The U.S. Department of Justice, 

Office of Juvenile Justice and Delinquency 

Prevention’s currently funded research on the 

creation of a typology of juvenile sexual offending 

behavior will help mental health and criminal 

justice professionals better understand the major 

subtypes of sexually abusive youth and the most 

effective intervention strategies for these groups. 

Recommendations for Practice 

The following suggestions may be used as 

guidelines for the ethical and effective treatment 

of juveniles who abuse (Hunter and Lexier, 

1998). 

Clinical Assessments: When possible, clinicians

should conduct evaluations after adjudication and 

before sentencing. Clinical assessments should 

help determine required level of care, 

identification of treatment goals and objectives, 

and estimated risk of reoffending. Clinical 

assessment should not be directed at 

determination of innocence or guilt. 

Clinicians’ Roles: Clinicians should carefully 

explain their role, as well as the limits of 

professional confidentiality, to juvenile clients and 

their family prior to conducting a clinical interview 

or administering assessment tests. Furthermore, 

it is strongly recommended that consent forms, 

10
releases, and/or waivers addressing these issues 

be signed by clients and their families. It is also 

prudent to review the above issues with clients’ 

defense attorneys and/or guardian ad litems 

representing the youths. 

Consent Forms: Clinicians should consider 

developing additional consent forms to cover the 

use of more controversial assessment or 

treatment procedures (e.g. phallometric

assessment, aversive conditioning, and “off-label” 

use of medications). These consent forms should 

be specific to the procedure and clearly identify 

any potential risks associated with it. Clients 

should understand that these procedures are 

voluntary and that they are free to decline them. 

Phallometric and Polygraph Assessments: 

Phallometric and polygraph assessments should 

be administered judiciously. Phallometric 

assessment is best limited to males 14 years of 

age or older with extensive histories of sexual 

offending, and/or those who self-report deviant 

sexual arousal and interest patterns. This 

procedure should only be used with the full, 

informed consent of the youth, their parent(s) or

guardian, and preferably the referral agency. 

Furthermore, it should only be used with those 

who admit to their offenses and should generally 

be conducted with auditory stimuli specifically 

designed for sexually abusive youth. 

Risk Assessment: Clinicians should exercise 

caution in rendering judgments of risk that 

individual juveniles represent for further sexual 

offending. This is especially true when these 

judgments will figure prominently in legal

dispositions. Such assessments should state that 

they reflect the best available predictive

information on these issues, but that empirical 

support for risk models is tentative at present. 

Treatment Plans: Clinicians should demonstrate 

sensitivity to developmental issues in assessing 

juveniles with sexual behavior problems and 

formulating intervention plans. Treatment plans 

should be comprehensive, reflecting a holistic 

understanding of youths, family systems, and 

sociocultural environment in which they live. 

Supervision Strategies: Sexually abusive youth 

have always been in the community, and have 

been increasingly identified and supervised by 

probation for many years. Only recently has the 

field moved toward the development of 

specialized strategies to manage this unique 

population. To be sure, this is an emerging area

and one where much is yet to be learned. 

However, many of the approaches commonly 

used with adult sex offenders (e.g., the use of 

specialized supervision staff, sex offender specific 

treatment providers, and the polygraph) are being 

adopted by juvenile supervision agencies around 

the country. Models of a team approach to sex 

offender management—teaming supervision 

agency staff with therapists, school personnel, 

victim advocates and others to work closely with 

the offender, his/her family, and victim(s)—are 

emerging as among the most promising

approaches to sex offender supervision.

Conclusion 

Adolescents account for a significant percentage 

of the sexual assaults against children and 

women in our society. The onset of sexual 

behavior problems in juveniles appears to be 

linked to a number of factors, including child 

maltreatment and exposure to violence. 

Emerging research suggests that, as in the case 

of adult sex offenders, a meaningful distinction 

can be made between juveniles who target peers 

or adults and those who offend against children. 

The former group appears generally to be more 

antisocial and violent, although considerable 

variation exists within each population. Although 

available research does not suggest that the 

majority of sexually abusive youth are destined to 

become adult sex offenders, legal and mental 

health intervention can have significant impacts

on deterring further sexual offending. Currently, 

the most effective intervention consists of a 

combination of legal sanctions and specialized

clinical programming. 

Acknowledgments 

The Center for Sex Offender Management would 

like to thank Dr. John Hunter for principal 

authorship of this article. CSOM would also like to 

thank Gail Ryan and Lloyd Sinclair for their 

comments and contributions to this document. 

Edited by Madeline M. Carter and Scott Matson, 

Center for Sex Offender Management. 

11
Contact 

Center for Sex Offender Management 

8403 Colesville Road, Suite 720 

Silver Spring, MD 20910 

Phone: (301) 589-9383 

Fax: (301) 589-3505 

Email: askcsom@csom.org 

Internet: www.csom.org 

Resources 

Association for the Treatment of Sexual Abusers 

Connie Isaac, Executive Director

4900 S.W. Griffith Drive, Suite 274 

Beaverton, OR 97005 

Phone: (503) 643-1023 

Fax: (503) 643-5084 

Email: atsa@atsa.com. 

Internet: www.atsa.com 

Jefferson County, Colorado Juvenile Sex Offender 

Program 

SAFE-Jeffco 

Chris Labonov-Rostovsky 

C/O RSA 

1410 Vance Street, Suite 107 

Lakewood, CO 80215 

Phone: (303) 232-5749 

Email: RSAINC@prodigy.net 

National Adolescent Perpetration Network 

Gail Ryan, M.A. 

Kempe Children's Center

1825 Marion Street 

Denver, CO 80218 

Phone: (303) 864-5252 

Fax: (303) 864-5179 

Email: Kempe@KempeCenter.org. 

Internet: www.kempecenter.org

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15

This project was supported by Cooperative Agreement No. 97-WT-VX-K007, awarded by the Office of Justice Programs, U.S. 

Department of Justice. Points of view in this document are those of the author and do not necessarily represent the official 

position or policies of the U.S. Department of Justice.