Development of Sexual Interest in Adolescents: Transformative & Practical Implications

By Norbert Ralph,  PhD, MPH

Adolescence is the period between puberty and full sexual maturity, characterized by rapid, transformative development of sexual interests (Blakemore, 2018). This phase is pivotal in understanding youth with problematic sexual behaviors (PSB). Harry Stack Sullivan referred to this as the "lust dynamism," a powerful motivational force emerging in early adolescence (Sullivan, 1953), marking a shift from Platonic to erotic possibilities in relationships. Although sexual reactions begin in infancy, they undergo qualitative changes during adolescence (American Academy of Pediatrics, 2016). This shift fundamentally alters how adolescents perceive the world, as illustrated by Mark Twain’s Huck in The Adventures of Huckleberry Finn illustrates this transformation.

"That evening when I thought it all over I said to myself, I reckon a body can think a good deal about a girl and not really know it. But there I was, thinking about her all the time, and wishing she was right there next to me, and I felt good just thinking about it" (Twain, 1884).

Changes in behavior and thinking occur with this paradigm shift. Fortenberry (2013) reported that in one sample, 6% of 9–10-year-old boys reported sexual fantasies, increasing to 66% among 13–14-year-olds. Less than 2% of 9–10-year-olds expressed interest in sexual intercourse, compared to 12% of 13–14-year-olds. Among 511 American 6th, 7th, and 8th graders, 56% reported at least one current crush, with more girls having crushes (61%) than boys. Robbins et al. (2011) found that across adolescent age groups, more males (73.8%) reported masturbation than females (48.1%). Among males, masturbation increased with age: 62.6% of 14-year-olds reported prior occurrences compared to 80% of 17-year-olds. Recent masturbation in the past month also increased with age in males: 42.9% of 14-year-olds compared to 67.6% of 17-year-olds.

During adolescence, a paradigm shift in relationships and sexuality occurs, involving: 1. Hormonal, 2. Brain, and 3. Anatomical Changes, which interact in a systematic and coordinated fashion. Biologists refer to this as multicausality: different factors contribute to a single functional outcome—an adult human with sexual interests and behaviors.

•    Hormonal: Kelsey et al. (2014) reported that average male levels of testosterone increase approximately a hundredfold from ages 7–10 to 13–17. Increases are linked to sexual exploration and experimentation (Fortenberry, 2013), and also impulsivity and preference for immediate rewards (Laube et al., 2017).

•     Brain: Although a 10-year-old’s brain size and shape are similar to an 18-year-old’s, differentiation and pruning of connections change markedly (Peterson & Schiff, 2021). Blakemore and Choudhury (2006) note the limbic system in young adolescents is hypersensitive to rewards compared to adults. Frere, Vetter, Artiges, et al. (2020) associate changes in the amygdala and hippocampus with developing sexual interest. Brain areas for judgment, impulse control, and planning—linked to prefrontal cortex development—mature until age 25 and beyond (Steinberg, 2014). This mismatch between reward and control systems resembles a car with a sensitive accelerator and weak brakes. This mismatch aligns with Canadian data showing the peak age for harmful behaviors by juveniles against children is 13, followed by 14, about twice the rate of neighboring age groups (Statistics Canada, 2012).

•    Anatomical: Physical and sexual maturation are major areas of change during adolescence. Between ages 10 and 18, males on average double in weight, grow a foot, and triple in grip strength (Tanner, 1962; Malina et al., 2004). Changes in sexual anatomy are conceptualized through Tanner Stages (Marshall & Tanner, 1970). For males, these changes include pubic, armpit, and facial hair growth, as well as testicular and penile development. Penis size nearly triples from ages 10 to 18 (Ponchiett et al., 2001). Males ages 9–14 have immature reproductive systems and are generally infertile; by ages 15–18, most develop the potential to father children (Nieschlag & Behre, 2001). There are different but equally significant changes for females.

Adolescence marks a high-risk period for PSB due to the paradigm shift to adult sexual interests. Describing these multisystem changes helps youth with a history of PSB and their families understand these behaviors and how to manage them better. They benefit by knowing that decision-making can be impaired by strong emotions like sexual interests, which can significantly weaken judgment and impulse control (Insel & Tabashneck, 2022). In my clinical experience, factors like prior sexual trauma and exposure to problematic pornography may accentuate PSB. This helps not only understanding PSB but also strategies to prevent them in the future.

In summary, understanding the dramatic development of sexual interest and motivations in early adolescence is useful for clinicians, youth, and families. It helps give an understanding regarding PSB causes, the development of safety and management plans, and prevent future issues. Managing sexual interests involves understanding their strength, development, and effects on judgment, and also how they can be part of a fulfilling life.

Dismantle the frame: Reflections on a scoping review of the SSA literature

By Peter Yates, Ph.D., Eve Mullins, Ph.D., Stephanie Kewley, Ph.D., & Amy Adams, M.A.

Background and introduction

A recent national survey in Australia found that 1.6% of the population had been sexually abused by a sibling, which if replicated would equate to over one million people in the UK and over five million people in the USA (Mathews et al., 2024). As with other forms of child sexual abuse, sibling sexual abuse is likely to have a long-term impact on children harmed and adult survivors (Cole, 1990; Cyr et al., 2002; Rudd and Herzberger, 1999; Tyler 2011), and it is also likely to have significant and long-term consequences for the child responsible for the harm, for their parents, other siblings, and the wider family (Archer et al., 2020; Tener et al., 2018; Yates, 2017). Despite being so harmful and widespread, it remains under-recognised (Noble, 2022) and many children are left unprotected and unsupported (Yates & Allardyce, 2021). There has been only one review of a small number of papers (Bertele and Talmon, 2021) since the narrative review carried out by Tidefors et al. (2010), so we set out to conduct a thorough review of the literature on sibling sexual abuse in order to inform policy and practice, and to set an agenda for further research in this area.

What we did

We searched for empirical literature on sibling sexual abuse through academic and grey literature databases, excluding things like case summaries and practice guidance to focus solely on research studies. We found 91 papers since 1980 that reported on sibling sexual abuse as the primary focus of the study, so this review represents the most comprehensive overview of the current body of knowledge in this field to date. Having read the papers carefully and extracted the data, we conducted our analysis using the PAGER framework (Patterns, Advances in knowledge, Gaps in knowledge, Evidence for practice and Research recommendations) (Bradbury-Jones et al., 2022). The full review can be found at Yates et al., (2024).

What we found

Despite previously having what we thought was a thorough knowledge of the subject, we found a number of surprises. Sibling sexual abuse is commonly thought of as older brothers abusing younger siblings in the context of a ‘dysfunctional’ family (Why else would children be behaving in such a harmful sexual way?). Professional guidance bears out this trope, giving professionals criteria to be able to recognise when sexual behaviours between siblings are harmful and the risk factors around this. However, in our review we found challenges to this stereotype, calling into question how we understand sibling sexual abuse and the research-knowledge cycle that perpetuates this understanding.

Age differences are often cited as a way to differentiate abusive from other forms of children’s sibling sexual behaviour (e.g. Yates and Allardyce, 2021), with a gap of 2-5 years being regularly cited as an indicator of abuse and of the older child being responsible for that abuse. However, nine papers in our sample reported examples of the child responsible being younger than the child harmed, and many others recorded a gap of less than 2 years Importantly, in some research, an age gap has been used as a criterion or as part of the definition of SSA, therefore perpetuating an idea that age difference is necessary for the sexual behaviours to be abusive. Relying on age differentials to make sense of children’s sibling sexual behaviour therefore risks not only mis-identifying behaviours as non-abusive, but also making incorrect assumptions about which child is responsible.

Similarly, most of what we know about sibling sexual abuse concerns the abuse by boys of their sisters and, to a lesser extent, their brothers. Indeed, much of the early research only focussed on Brother-Sister dyads.  As such, we know very little about girls abusing their brothers or sisters. Official records such as social services case files and law enforcement reports suggest that the vast majority of sibling sexual abuse involves boys as the children responsible. Krienert and Walsh (2011), for example, found that 92.2% of 13,013 incidents reported to law enforcement in the United Sates concerned boys as the children responsible, and only 7.8% concerned girls. However, a very different picture emerges from survivor reports – albeit that sample sizes are much smaller. An online survey of 33 survivors by McDonald and Martinez (2017) found 19% of the abuse involved girls as the children responsible, and a study of 43 survivors by McGrath et al. (2008) found 16.2% involved girls. This suggests that up to a fifth of sibling sexual abuse may involve girls as the children responsible - a significant proportion - yet this abuse is officially reported less often and we know little about the characteristics of these girls who display such harmful sexual behaviours. There is evidence, however, that sisters’ sexual behaviours towards their siblings can have long lasting negative impacts even if not characterised as abusive (O’Keefe et al., 2014; Stroebel et al., 2013). Does the prevailing understanding that this is predominantly a behaviour instigated by boys leave us blind to seeing girls’ sexual behaviours towards their siblings as abusive?  To what extent would our understanding of the phenomenon of sibling sexual abuse – its characteristics, its aetiology – and our responses to it be altered, if we had a much deeper understanding of girls as the children responsible?

Finally, families in which sibling sexual abuse has taken place often share similar characteristics, such as high levels of parental conflict and domestic abuse, parental affairs and parental physical and/or emotional absence. These are the families that come to the attention of the authorities. However, we know very little about sibling sexual abuse that takes place in families which do not share these characteristics, where there are no obvious family problems and when the children responsible do not have a history of experiencing abuse. The research indicates sibling sexual abuse can and does happen in families where there are no evident issues. Grant et al.’s (2009) study of 38 boys, for example, found that 29% were not known to have experienced any form of abuse. Again, if we knew more about the dynamics in these situations, how would that alter our understanding of sibling sexual abuse and improve our responses?

Our overall sense of the research literature is that it has been shaped by particular lenses, or frames. Frames are like mental filters through which we perceive and interpret the world, and one of the features of frames is that when we encounter evidence that does not fit the frame, we tend not to perceive the evidence at all or otherwise do not give it due attention (Yates, 2020). Sibling sexual abuse appears to have been framed in the literature and guidance as an issue of older brothers abusing their younger siblings within the context of other family abuse and stress. As a body of research, insufficient attention has then been given to abusive sibling sexual behaviour by girls, younger siblings and in families where there is no apparent stress. Our understanding of this phenomenon would be improved if we were to pay more attention to the issues that do not fit our convenient ways of framing it.

Final reflections

Having worked in this field for some time, we thought that we had a good grasp of what is known about this subject. Interrogating the literature in this thorough way, however, has challenged some of our assumptions, some of our taken-for-granted knowledge, and raised questions about how we know what we think we know. It isn’t simply a matter of research being of variable quality; rather the body of research frames this subject in particular ways that leaves some important questions unasked, let alone unaddressed. We hope that future research, building on this body of existing knowledge, will open up new horizons in this field, break new ground, and dismantle our existing ways of framing this subject.

References

Archer, E., Nel, P. W., Turpin, M., & Barry, S. (2020). Parents' perspectives on the parent-child relationship following their child's engagement in harmful sexual behaviour. The Journal of Sexual Aggression, 26(3), 359-371.

 

Bertele, N., & Talmon, A. (2021). Sibling sexual abuse: A review of empirical studies in the field. Trauma, violence & abuse, 15248380211030244.

Bradbury-Jones, C., Aveyard, H., Herber, O. R., Isham, L., Taylor, J., & O'Malley, L. (2022). Scoping reviews: the PAGER framework for improving the quality of reporting. International Journal of Social Research Methodology, 25(4), 457-470.

 

Cole, A. V. (1990). Brother-sister sexual abuse: Experiences, feeling reactions, and a comparison to father-daughter sexual abuse. ProQuest Information & Learning.

 

Cyr, M., Wright, J., McDuff, P., & Perron, A. (2002). Intrafamilial sexual abuse: Brother-sister incest does not differ from father-daughter and stepfather-stepdaughter incest. Child Abuse & Neglect, 26(9), 957-973.

 

Grant, J., Indermaur, D., Thornton, J., Stevens, G., Chamarette, C., & Halse, A. (2009). Intrafamilial adolescent sex offenders: psychological profile and treatment. Trends and issues in crime and criminal justice (375), 1.

 

Krienert, J. L., & Walsh, J. A. (2011). Sibling sexual abuse: An empirical analysis of offender, victim, and event characteristics in National Incident-Based Reporting System (NIBRS) data, 2000–2007. Journal of Child Sexual Abuse: Research, Treatment, & Program Innovations for Victims, Survivors, & Offenders, 20(4), 353-372.

 

Mathews, B., Finkelhor, D., Pacella, R., Scott, J., Higgins, D.J., Meinck, F., Erskine, H., Thomas, H.J., Lawrence, D., Malacova, E., Haslam, D.M. and Collin-Vezina, D. (2024). Child sexual abuse by different classes and types of perpetrator: Prevalence and trends from an Australian national survey. Child Abuse and Neglect (147)

 

McDonald, C., & Martinez, K. (2017). Victims’ retrospective explanations of sibling sexual violence. Journal of Child Sexual Abuse: Research, Treatment, & Program Innovations for Victims, Survivors, & Offenders, 26(7), 874-888.

 

McGrath, T. M. (2008). The Long Term Psychological Effects For Survivors Of Sibling Incest And Their Capacities To Have Adult Relationships That Are Intimate And Autonomous Seton Hall University Dissertations and Theses (ETDs). 1640.

 

Noble, A. (2022). Awareness and understanding of SIBLING SEXUAL ABUSE amongst professionals in frontline sectors in England and Wales. internal-pdf://2931589147/SARSAS SIBLING SEXUAL ABUSE Professional Survey Report_ - Marc.pdf

 

O'Keefe, S.L., Beard, K.W., Swindell, S., Stroebel, S.S., Griffee, K. and Young, D.H. (2014) 'Sister-brother incest: Data from anonymous computer assisted self interviews', Sexual Addiction & Compulsivity, 21(1), pp. 1–38.

 

Rudd, J. M., & Herzberger, S. D. (1999). Brother-sister incest—father-daughter incest: a comparison of characteristics and consequences. Child Abuse & Neglect, 23(9), 915-928.

 

Stroebel, S.S., O'Keefe, S.L., Griffee, K., Kuo, S.Y., Beard, K.W. and Kommor, M.J. (2013) 'Sister-Sister Incest: Data from an Anonymous Computerized Survey', Journal of Child Sexual Abuse, 22(6), pp. 695–719.

 

Tener, D., Lusky, E., Tarshish, N., & Turjeman, S. (2018). Parental attitudes following disclosure of sibling sexual abuse: A child advocacy center intervention study. American Journal of Orthopsychiatry, 88(6), 661-669.

 

Tidefors, I., Arvidsson, H., Ingevaldson, S., & Larsson, M. (2010). Sibling incest: A literature review and a clinical study. Journal of Sexual Aggression, 16(3), 347-360.

 

 

Tyler, A. (2011). A Comparison of Father-, Stepfather-, and Brother-Perpetrated Incest Abuse of Incarcerated Women and Girls. University of Colorado at Boulder.

 

Yates, P. (2017). Sibling sexual abuse: Why don't we talk about it? Journal of Clinical Nursing, 26(15-16), 2482-2494.

 

Yates, P. (2020). “It’s just the abuse that needs to stop”: Professional framing of sibling relationships in a grounded theory study of social worker decision-making following sibling abuse. Journal of Child Sexual Abuse 29(2), pp. 222-245.

 

Yates, P., & Allardyce, S. (2021). Sibling sexual abuse: A Knowledge and Practice Overview. Centre of Expertise on Child Sexual Abuse.

 

Yates, P., Mullins, E., Adams, A. and Kewley, S. (2024) Sibling sexual abuse: What do we know? What do we need to know? Stage 1 analysis of a 2-stage scoping review. Child Abuse and Neglect. https://doi.org/10.1016/j.chiabu.2024.107076

 

 

Tackling and preventing inter-partner abuse in young people through evidence based relationships and sex education

By Sophie King-Hill, Ph.D., & Kieran McCartan, PhD.

Editor’s note: This is an extended version of a blog post by the authors for the conversation - Kieran 

A new report by the Youth Endowment Fund (YEF) has demonstrated that 49% of children and young people aged between 13-17 have experienced violent or controlling behaviours when in a relationship. This is based on a survey of 10,000 young people in England and Wales, of which 27% have been in a relationship in the past year. The survey outlines that children and young people who are excluded from school, those who are involved in gangs and/or exploitation, those with special educational needs (SEN) and those supported by a social worker are at higher risk of experiencing inter-relationship violence and control. The violent and controlling behaviours include forced sexual activity, physical violence, causing fear of breaking up and/or disagreeing with a partner, and explicit content of themselves being shared online. Additionally, 27% of the sample stated that they had experienced threats or images of sexual assault and 33% had been exposed to content involving violence against women and girls.

The importance of Prevention

The findings of the study paint a concerning picture as to the position of young people in England and Wales and highlights the reality that enough is not being done in relation to prevention and early intervention. Evidence highlights that effective prevention of harm and abuse is important in all domains of life and that with the correct knowledge, skills and intervention proactive work can be carried out to reduce the risk and impact of social harms. Current policy and practice guidance argues that there needs to be better integration between health and justice so that a developmental, life-course approach can be taken to understanding social issues and deliver the correct intervention to the right population in the most appropriate ways. Therefore, consideration needs to be given different populations are engaged with, underpinned by evidence. In the context of young people and peer harm and abuse it means hearing and valuing the voice of young people so that relationship and sex education suits their needs, is grounded in their lived experiences, and helps them safeguard themselves and others. However, many current policies and resources on the prevention of sexual abuse are focused on adults (see 2PS, ECPAT and EU for more information) but this focus is starting to shift to include and talk to CYP about their problematic and concerning behaviour (see Moore centre and Lucy Faithful Foundation, Together for Childhood for more information).

The findings also highlight that violent and controlling behaviours are embedded in a complex intersection of issues requiring multi-level solutions. Although this is not a new idea, it is important to reiterate. Further, it encourages us to think about our responses to violent and controlling behaviours across all levels of society (i.e., individual interpersonal, community, societal) and across all the populations within society, and how best to deliver these messages and interventions. A key aspect of addressing these issues is through robust, evidence-based, relationships, sex and health education. The Youth Endowment study also demonstrated that these were lacking, with only 55% having lessons on consent and only 40% having education on healthy relationships and recognising unhealthy relationships. It is important to recognise that while the content of the relationship and sex education is important, equally important are the skills and knowledge of those delivering the education.

The importance of relationships and sex education

It is evident that we are failing many children and young people through the lack of robust, incremental, research-based education on sex and relationships. Research in this area demonstrates that many children and young people are receiving education on sex and relationships that is too little too late, and schools are teaching students what they already know. Only 39% of children and young people in the Youth Endowment study who reported experiencing violence and controlling behaviour stated that they had received sessions on consent, with only 31% of this subgroup receiving sessions on sexual harassment. This is in the context of the 2021 Ofsted rapid review (involving interviews with  900 pupils in England, who reported that sexual harassment is a common aspect of school life for a majority of pupils) and the Everyone’s Invited website, which has received over 50,000 testimonials of sexual harassment and violence in schools since it began in 2021. Additionally, over half of the 106,984 child sexual abuse cases recorded across the 42 police forces in England and Wales in 2022 where offences committed by young people aged between ten and 17; which was a rise from the previous year previous figures.

Recommendations

First, it is important for educators to involve parents and carers in these conversations to ensure that consistent messages are being received across the school and home contexts.

Schools and educational establishments need to create safe spaces for learning and open, frank conversations with children and young people about both healthy and toxic relationships. These can be both formal sessions and informal learning contexts but must be centred around non- judgemental approaches. This can be fostered through group agreements that encompass both the young people and the educators.

Bystander intervention is another approach that has gained traction in public discourse in recent decades. However, this must be considered carefully, as young people can risk putting themselves in psychologically and physically damaging situations. Additionally, most bystander intervention programs are designed for the physical environment and with children and young people living their lives across online and offline environments what does an online/digital version of bystander intervention look like.

 

More work need to be completed with young men and boys as some of the highest reports of sexual abuse and violence comes from girls aged 15-17 and carried out by men and boys. This needs to be carried out with the best interest of all genders in mind and to be free from blame and judgement, rather including young men and boys in being part of the solution and teaching them aspects that they need to know. It is also useful to be aware that the term 'violence against women and girls' immediately takes boys out of the discussions around being victims of all forms of violence themselves.

The changing landscape of children and young peoples relationships

Understanding the seamless interplay in the online and offline worlds for young people should also be at the forefront of sessions on healthy relationships. This learning, by professionals can only come from the perspectives of children and young people themselves. One of the most important aspects of approaching sessions such as these are the voices of young people, who are experts in both the digital and non-digital world around them and how these two aspects interconnect and what they need from professionals to understand and negotiate these worlds. With the introduction of the Online Safety Act over the next year there is an opportunity to do some more development in this area and really understand what online support looks like and how problematic behaviours transition across the real world/digital world interface. With the development of services, like Shore by the Lucy Faithful Foundation, we can see that professionals and policymakers are starting to develop resources for the prevention of sexual abuse ion CYP.

Conclusions

What is clear is that what we are currently doing is not working and many children and young people are suffering as a consequence. Early, robust, young person-led relationships, as well as health and sex education can be a vital step to reducing the adverse outcomes seen in the YEF report. The challenge that the YEF report indicates that engagement and work in this area needs to move forward. Byn taking a public health approach conversations can be opened up in new and different ways that allow us to think outside of the box and do something innovative. For too long the conversation about relationships and sex education has been separate to other aspects of the lives of children and young people. Young people need to be spearheading work in this area, supported by professionals, to ensure positive outcomes in all areas of relationships and sex.

 

Methodological Differences in Risk Assessments

 By Sharon M. Kelley

Sand Ridge Secure Treatment Center – Evaluation Unit, Madison, Wisconsin

A few years ago, at a conference in Australia, Katie Gotch, MA, LPC asked me how I would characterize my research. I replied, “Things that annoy Sharon Kelley.” A joke of course but with some level of truth since there are questions I have had to answer in court but did not know (e.g., what is the rate of undetected sexual offending?). I would characterize the focus of my research as best practices in risk assessment. As part of this, I have published and co-published articles on static and dynamic risk tools, protective factors including the Structured Assessment of Protective Factors against Sexual Offending (SAPROF-SO), undetected sexual offending in risk assessment, practical guidance in applying time free and long-term risk estimates, and potential differences in evaluators’ judgment outside of empirically predictive factors. I suppose when some professionals are persistently not attending to best practices in the field, I can sometimes find this annoying, too (I am not a perfect human). This is not to say people cannot have different opinions than me. Absolutely. Which risk tool is better for a particular population or referral question? That is certainly debatable. When is a brand-new methodology ready for use? It certainly depends on a variety of factors (e.g., Does it need to meet admissibility standards in court? Is one using it for a treatment needs assessment versus an assessment that considers the ultimate risk probability?) There are plenty of issues still arguably up for debate especially in certain contexts. Where I struggle is around issues, which I believe have been previously debated for the past decade, and where there are undoubtedly sufficient empirical studies that should largely resolve the argument, and still the dead horse in not yet in the ground. I would like to talk about some of those issues.

Not Using a Measure of Dynamic Risk

There was some discussion of this in professional circles recently, and I want to expand on this discussion. The meta-analysis by Mann et al. (2010) on dynamic risk factors / criminogenic factors / psychologically meaningful factors was, by all accounts, an important and oft cited study. According to Google Scholar, it has been cited 1,326 times since the article became available. At the time the paper was written – over a decade ago – the authors noted that formal measures of dynamic risk factors (DRF) were “still sufficiently underdeveloped that important questions remain concerning the conceptual foundations of these scales, whether they target the most relevant factors and the extent to which it is possible to associate recidivism rates with specific scores.” This made sense in 2010; tools like the STABLE-2007 and VRS-SO had only been in circulation for a few years and did not offer the type of norms and validation studies they have now. It was also important to explore any potential DRFs that had insufficient studies when earlier meta-analyses were conducted. However, the Mann et al. (2010) article was never meant to replace a formal measure of dynamic risk. Indeed, the authors make the final conclusions:

First, evaluators should avoid being overinfluenced by the presence of any single risk factor, however floridly manifested. Second, only relatively comprehensive assessment of a range of psychological risk factors will make it possible for this kind of assessment to have useful predictive power. Third, this is precisely the kind of situation (a relatively large number of risk factors, each making only a small contribution to prediction) in which mechanical integration of risk factors can be expected to outperform human judgment (Kahnemann & Klein, 2009).

The authors were directly telling us not to use this paper in lieu of a formal risk tool. As the authors alluded to in their conclusion, using an “empirically-guided” approach to risk assessment involves the evaluator attending to the risk factors listed in the Mann et al. (2010) article but assigning their own definition and coding instructions to the factor as well as its predictive weight and importance. There is no reliability between evaluators, no reliability within evaluators (i.e., the same evaluator can be inconsistent in how this is applied between cases), no known predictive validity, and no known error rate. Further, evaluators can be unduly influenced by one or two factors despite the Mann et al. (2010) article clearly specifying that none of these factors are hugely predictive by themselves or “super factors.” Meanwhile, there are well established and validated mechanical instruments that measure DRFs. This includes studies in a variety of samples, independent validation studies, published test manuals, known error rates, general acceptance in the field, and sufficient reliability and validity. Why professionals opt for a method that has been shown to be less predictive and potentially more fraught with problems and influences not related to prediction (e.g., differences among the evaluators themselves) continues to puzzle me.

Double Counting Risk Factors and Clinical Overrides

The second issue I sometimes see is when evaluators use a formal measure of DRFs but override the result. This is done in one of several ways. First, the evaluator will identify a clinical factor that appears especially important in the treatment needs/risk profile and see it as needing to have additional predictive weight to account for its perceived importance. Take, for example, an individual who is demonstrating a high sexual drive, which raises concerns. The evaluator scores the Static-99R and a DRF tool like the STABLE-2007. The evaluator assigns high scores (2) for both Sex Drive and Sex as Coping among several other items relevant to risk. When integrating the Static-99R and STABLE-2007 scores, the evaluator finds the individual to be in the average risk range. Yet, in the evaluation report, the evaluator concludes that this is likely to be an underestimation given that the individual is preoccupied with pornography and has a high rate of masturbation in their current setting. This might also be linked to the individual having a high sexual drive at the time of past sexual offenses, so the evaluator specifies this is especially risk relevant. What the evaluator is doing is using the relevant data that justifies giving the individual a score of “2” and then adding the same data as if it is a separate risk factor that will incrementally contribute to risk. There is no empirical study I can think of that would support this methodology. Here the evaluator is treating this as a “super factor,” even though Mann et al. (2010) found no such evidence of super factors.

Second, the evaluator will identify the person as having “unique” features outside the tool’s sampling frame (aka the individual is a “black swan” which justifies an override. This is usually done for men over the age of 60 for whom the evaluator continues to see as risky and not aging in a “normal” manner. The conclusion is to disregard the protective effect of age, which has otherwise been repeatedly identified as an important predictive variable even when the index offense occurred when they were in their 60s (see Jeff Sandler’s work). Without diving too deep, any conclusion by the evaluator that their case is unique should be done rarely, with caution, and with good justification. If one is finding “black swans” frequently, it’s probably not a black swan. 

Third, when considering clinical overrides, this should be well justified. Sometimes overrides are understandable. Within their ATSA Forum article (2021, Vol. 34, Issue 1), Hanson and Thornton mention exceptional factors or Meehl’s broken leg factors that could invalidate actuarial assessments. This includes “clear evidence that the individual has decided to reoffend” or is imminently at risk for reoffending. This can include actively setting up an offense that would happen imminently or making statements about intention to reoffend. A clinical override should not be used because the individual is demonstrating DRFs that are already captured in a formal dynamic tool.

Evaluators may wish to disagree with me. Perhaps they might argue that clinical judgment separate from scoring DRFs is of critical importance in risk assessments and provides predictive value above and beyond formal tools. However, since a succession of studies have found clinical overrides not to improve prediction, the person making this clinical judgment needs to show why their clinical judgment is far superior to other clinicians. 

Overall, the impact of evaluators relying on empirically-guided clinical judgment or “super factors” when completing high stakes assessments is potentially far more concerning in court than contending with admissibility issues related to established DRF tools like the STABLE-2007 or the VRS-SO. Evaluators appear to have internal differences that contribute to risk assessment conclusions especially when using less structured techniques (i.e., research by Marcus Boccaccini and Daniel Murrie among others). Rachel Kahn, myself, and others at Sand Ridge found this includes over-weighting risk factors as well as factors not empirically related to risk. Further, we found that some evaluators tend to be more risk-sensitive despite available base rates of sexual recidivism. As a result, the assessment outcome was best predicted by the evaluator assigned to the case. Risk assessments, especially in high stakes settings, should not be about the luck of the draw. After more than a decade of research, we can do better.

Addressing Harmful Sexual Behavior in Youth: Insights from the NL-ATSA Conference

By Minne De Boeck, Nina Stalpaert, Zohra Lkasbi, & Kasia Uzieblo

Sexual offenses committed by young people often remain underexplored in the forensic field. However, addressing this issue is essential due to significant differences between adult and youth offenders, including the underlying characteristics, motivations, recidivism rates, and treatment needs. To spotlight this critical topic, NL-ATSA, the Dutch-speaking association for the prevention of sexual offenses, organized a specialized conference on November 7, 2024, at the University of Antwerp. The event focused on individuals under 23 years old who have exhibited harmful sexual behavior (HSB). Both national and international experts shared their knowledge and experiences on the prevention, guidance, and treatment of these individuals.

Youth and Harmful Sexual Behavior: Prevention and Treatment

Stuart Allardyce, Director of Research at the Lucy Faithfull Foundation and Stop It Now! UK and Ireland, opened the conference with a presentation on prevalence rates and the unique characteristics of this group. Global studies reveal that 18% of girls and 7.6% of boys report being victims of sexual abuse, with a significant portion—between one-third and half—of these offenses committed by minors. Allardyce highlighted key patterns within HSB cases: Most offenses are committed by boys, many of them have experienced abuse themselves, victims are predominantly girls and the majority occur within domestic settings.

Not all HSB qualifies as abuse; one-third falls into the broader category of inappropriate behavior. Interestingly, there is limited overlap between adolescent and adult sexual offenders. Adolescent behavior is often situational and opportunistic rather than rooted in deviance, although persistent adult offenders often begin in adolescence.

Allardyce underscored the profound impact of HSB not only on victims but also on the young offenders and their families. Crucially, he stressed the importance of recognizing these individuals as children first. This necessitates a holistic and child-centered approach tailored to their developmental stage. He advocated for avoiding stigmatizing labels like "young sexual offenders," instead referring to them as "young people exhibiting harmful sexual behavior."

Despite research indicating low recidivism rates for new sexual offenses among youth, these individuals often struggle with forming healthy relationships and achieving stability later in life. Effective interventions should, therefore, not only aim to reduce recidivism but also focus on broader developmental goals and the overall well-being of these youths.

Allardyce outlined several key principles for effective interventions:

• Trauma-informed and systemic approaches;
• Contextualized support;
• Prioritization of the young person’s broader development;
• Strong relationships between professionals and young people, as genuine care and active listening foster trust;

·       Ongoing aftercare to address challenges these young people may encounter later, such as in relationships or the workplace;

Preventive measures, including comprehensive sexual education and early identification of risk factors—such as past victimization, antisocial tendencies, poor sexual boundaries, and problematic pornography use—are equally critical to addressing HSB in youth.

He also emphasized the importance of self-care for professionals working with this population to maintain their capacity for support.

Recidivism and Desistance in Young Sexual Offenders

Chantal van den Berg, criminologist and researcher at the University of Amsterdam, presented her extensive longitudinal research (>20 years) on youth sexual offenders. Her study explored the factors contributing to sexual delinquency, their lives following the offense, and the impact of stigma and social context.

Van den Berg’s findings challenge the stereotype of the chronically reoffending young sexual offender. Over 20 years, only 7.7% of the studied individuals reoffended sexually. Familial factors, such as upbringing and substance use, alongside personal traits like low self-esteem, were significant contributors to delinquent behavior.

Among recidivists, those who reoffended sexually often had a history of similar offenses, while non-sexual recidivists tended to commit a broader range of crimes. Stigma and social context, including responses from parents and schools, played a substantial role in their trajectory. Parents often reported difficulties with constant monitoring but appreciated treatment efforts despite the challenges.

Van den Berg stressed the importance of interventions addressing both individual traits and the social context to prevent recidivism effectively.

Practical Approaches in Treating Harmful Sexual Behavior

The youth team from I.T.E.R., a Flemish treatment center for sexual deviance and prevention, presented their structured approach to addressing HSB in residential settings. Their method, referred to as “the sex reflex,” revolves around:

1. Encouraging open conversations about sexuality;
2. Supporting the healthy sexual development of youth;
3. Appropriately responding to problematic or harmful sexual behavior.

The approach balances safety with allowing space for exploration and emphasizes a positive perspective on sexuality. It also involves creating safety plans to guide recovery following incidents, helping professionals foster secure environments. Regular evaluation of interventions ensures they remain clear, concrete, and future-oriented.

Self-care for professionals, multidisciplinary collaboration, and fostering the youth's perspective are also central to this approach, which aims to build confidence and reduce apprehension in addressing HSB.

The Viersprong, a Dutch specialized treatment center for people who exhibit personality disorders, shared their application of Multi-Systemic Therapy for Problem Sexual Behavior (MST-PSB). This family-centered therapy focuses on creating safety, fostering accountability, and restoring family dynamics. The approach involves identifying risk factors, creating safety plans, and fostering acknowledgment of the behavior by both the young person and their family. Where appropriate, reunification with victims may also be facilitated. MST-PSB has shown promising results, including reduced recidivism, fewer out-of-home placements, and improved parenting skills.

Conclusion

The NL-ATSA conference highlighted the importance of a holistic approach to addressing harmful sexual behavior in youth. Such interventions must focus on the development and recovery of the young person, prioritizing both recidivism prevention and their overall well-being. Central to this is a systemic understanding of the individual’s context and the challenges they face. By fostering supportive environments and emphasizing developmentally appropriate, trauma-informed care, we can create pathways for young people to heal, grow, and build positive futures.