By Norbert Ralph, PhD, MPH
Best practices for the treatment of youth with problematic sexual behavior (YPSB) include the use of the principles of risk, need, and responsivity. The last of these, the responsivity principle, is described by ATSA (2017) as interventions that take into account personal strengths, developmental stage, education, and motivation. As a neuropsychologist who assesses learning disabilities, I believe that an important part of assessment and also treatment planning is to understand the reading level of a youth. Written materials are routinely part of treatment including consents, worksheets, and workbooks. Some relevant information was provided by a survey of California adolescent treatment providers (Ralph, 2013) which identified that 41.9% used, for example, Pathways by Kahn (Kahn, 2011).
What are reading levels in YPSB? Lewis, Shanok, and Pincus (as cited in Ferrara and McDonald, 1996) compared juveniles who had sexually offended with another juvenile population with violent but nonsexual offenses. They found the two groups did not differ on IQ testing regarding full-scale, verbal, or performance measures. However, they found that juveniles with sexual offenses scored 5.59 years below grade level and the comparison group 3.95 years.
In my clinical experience reading levels can be readily assessed using reading tests in less than 10 minutes. As an administrator for psychological testing for the juvenile courts in San Francisco, I found few psychologists in court-ordered testing would choose to assess reading levels. They didn't view this as part of their role even though this information wasn't available readily in any records. I found many youth that I assessed as having a reading disorder that had not previously been identified through the school system. I was careful to make sure such youth were referred for an IEP assessment and possibly specialized services to help promote their educational and prosocial development.
Reading level has profound implications not only in a youth's ability to use written curriculum but their academic and life experiences. Many occupational and even social opportunities are limited due to reading levels and this also has an impact on the youth's self-image and view of future life possibilities. One study found that youth identified with a reading disorder at age 7 were 56% less likely to obtain a higher income than those with average or above reading skills (McLaughlin, Speirs, & Shenassa, 2014). Authoritative guidelines for youth specifically recommend an assessment that includes reading level (California Sex Offender Management Board, 2022).
Understanding the reading level of materials for youth is important in several respects. Reading levels can be estimated using such measures as the Flesch–Kincaid Grade Level (FKGL) which can be calculated using a computer. This measure gives an estimate of the grade reading level of documents and was used by the U.S. Army to rate the difficulty of technical manuals (Wikipedia, 2023).
The readability of written materials is relevant in several areas. Youths routinely sign consent to treatment or release of information forms. These forms should be comprehensible to most youth. For example, one California County's consent form had an FKGL of 11.0 and the authorization for the release of protected health information was 11.5. A private practice group's adolescent consent form had an FKGL of 12.7.
It's also important to consider the reading level of workbooks or materials for juveniles since this will be an indicator of how well they can be understood and used. For illustrative purposes, several workbooks were analyzed using this methodology. One well-designed workbook available as a PDF online had an FKGL of 7.5. A sample chapter on controlling impulses from a widely used workbook had an FKGL of 7.1. A workbook by the author, Being a Pro, (Ralph, 2016) had a FKGL of 5.5. For comparison, the reading level of this document is 12.7.
Let's use the upper and lower limits of this very modest sample, with a FKGL of 5.5 and 7.5 grade levels to consider comfortable reading levels for the average 14-year-old juvenile on probation whose approximate grade level would be 8.0. Using the data from Ferrara and McDonald (1996) and the estimate of juveniles on probation being four years below grade level in reading, then the average reading grade level of the 14-year-old on probation would be 4.0. According to broader educational research, such as Chall and Conard (1991), students who are proficient readers can read at a level one to one and a half grades above their current grade. So if treatment reading material had an FKGL of 5.5, the average probation youth in this hypothetical scenario could comprehend this material but not one with an FKGL of 7.5.
In summary, an important part of the responsivity principle is assessing the reading level of youth in treatment and also additionally the reading level required by consent and treatment methods. A mismatch in these areas would likely lead to less successful outcomes.
References
Association for the Treatment of Sexual Abusers. (2017). ATSA practice guidelines for assessment, treatment, and intervention with adolescents who have engaged in sexually abusive behavior. Retrieved from ATSA.
California Sex Offender Management Board. (2022). Guidelines for treating and supervising youth who have committed a sexual offense. Retrieved from https://casomb.org/pdf/CASOMB_Guidelines_for_Youth_2022_v1.pdf.
Chall, J. S., Conard, S. S., & Harris-Sharples, S. (1991). Should textbooks challenge students? The case for easier or harder textbooks. New York: Teachers College Press.
Ferrara, M.L., and McDonald, S. 1996. Treatment of the Juvenile Sex Offender: Neurological and Psychiatric Impairments. Northvale, NJ: Jason Aronson.
Kahn, T. J. (2011). Pathways: A guided workbook for youth beginning treatment (4th ed.). Safer Society Press.
McLaughlin, M. J., Speirs, K. E., & Shenassa, E. D. (2014). Reading disability and adult attained education and income: Evidence from a 30-year longitudinal study of a population-based sample. Journal of Learning Disabilities, 47(4), 374-386.
National Center for Educational Statistics. (2024). Nation’s report card. https://nces.ed.gov/nationsreportcard/
Ralph, N. (2013). An online survey of JSO practice characteristics and methods. California Coalition on Sexual Offending. Retrieved from https://ccoso.org/sites/default/files/CCOSO%20JSO%20Survey%2010%208%2012.pdf
Ralph, N. (2016). Being a Pro: Promoting prosocial development in youths. Safer Society Press.
Wikipedia. (2023). Flesch–Kincaid readability tests.
In Wikipedia, The Free Encyclopedia. Retrieved from
https://en.wikipedia.org/wiki/Flesch%E2%80%93Kincaid_readability_tests
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