By Norbert Ralph, PhD, MPH, San Leandro, CA
An important part of treating youth with problematic sexual behaviors (PSB) is helping them and their parents understand contributing factors. Various treatment models have been developed to address causal factors contributing to PSB, including relapse prevention (Steen, 1999), cognitive-behavioral interventions (Hunter, 2011), trauma-focused therapies (NCSBY, 2019), the Good Lives Model (Van Damme et al., 2017), dialectical behavior therapy (Birgersson, 2024), and Multisystemic Therapy (Satodiya, 2024).
The National Center on the Sexual Behavior of Youth identifies factors such as family adversity, child vulnerabilities, modeling of coercion, and modeling of sexual behavior (NCSBY, n.d.). Bonner (2009), in her pamphlet Taking Action: A Support for Families of Adolescents with Illegal Sexual Behavior, identifies contributing factors such as curiosity/experimentation, impulsivity, immaturity, delinquency/aggression, psychological problems, exposure to sexual materials, sexual abuse, and sexual attraction to children. Finkelhor, Ormrod, and Chaffin (2009) mention immature impulse control, cognitive distortions, and delayed moral development. Ralph (2015) emphasizes delays in prosocial reasoning and psychosocial maturity as contributing factors to PSB.
In clinical settings, parents are often in extreme distress, seeking to understand these behaviors and asking, "Did we do something wrong?" They worry whether these behaviors will continue or escalate. Parents benefit from clear, relevant, evidence-based, and compassionate answers about why PSB occurred and how to prevent it.
Framing PSB partly in terms of developmental factors and psychosocial immaturity is useful. Adolescents are developmentally different from adults, as recognized by the juvenile justice system and Supreme Court rulings (Steinberg, 2014). Adolescents, while responsible for their actions, are "less guilty" due to immaturity. Research shows that youth with delayed psychosocial maturity have a higher risk for probation involvement (Férriz et al., 2018). Also, as youth mature psychosocially, they are less likely to engage in criminal behaviors (Steinberg, Cauffman, & Monahan, 2015).
I use a practical example: comparing adults and teens swimming in a pool. Adults stay in their lanes, while teens often swim into others' lanes, motivated by having fun with friends. This behavior illustrates how adolescents may not fully understand social rules or respect others' boundaries. This immaturity is reflected in crime statistics, where the peak rate of PSB in Canadian data occurs at ages 13 and 14 (Allen, 2016). Adolescents' brains are highly responsive to rewards and novelty, but impulse control doesn't fully develop until the mid-20s (Steinberg, 2014). This biological mismatch, combined with heightened sexual development during adolescence, creates a vulnerable period for risky behaviors, including PSB.
Research shows that recidivism rates for PSB are low—around 3–5% in some studies—likely due to increased psychosocial maturity over time (Caldwell, 2016; Lussier et al., 2024). Effective psychosocial interventions that promote prosocial development may help reduce general delinquency and PSB (Kettrey & Lipsey, 2018). The right type and amount of treatment, especially if started promptly, contributes to positive outcomes. Following the Goldilocks principle of "not too much and not too little" treatment is essential (Peck et al., 2023).
In my experience, explaining factors like brain development, psychosocial immaturity, and the potential for positive outcomes with effective treatment has been immensely helpful for parents. They often gain a clearer understanding that their child's immaturity contributed to the behavior, which eases fears and helps them develop a constructive path forward. Shifting from a narrative of fear to a developmental, evidence-based explanation helps parents feel more hopeful and less burdened by pessimistic scenarios.
This developmental perspective is also helpful for adolescents. Many youth express deep regret and confusion about their actions, often saying they don’t know why they did what they did. Like their parents, they are overwhelmed by distressing thoughts about their behavior. By providing a developmental framework, I help them understand that immature thinking and poor judgment contributed to their actions. This understanding doesn't absolve them of responsibility but fosters self-compassion for their younger selves, who lacked awareness of the harm they were causing. It helps them see their history of PSB will not define who they are and understand how treatment will help them develop more effective, prosocial responses.
This approach also provides youth with a more optimistic view of their future. As they engage in treatment and develop problem-solving skills, they build a healthier self-image and hope for a better future. Many youth, through counseling, understand that their actions don’t define their future. With time and support, they develop better decision-making skills, become more prosocial, and reduce the likelihood of harmful behaviors. They see a realistic hope for a positive, rewarding life.
Framing
PSB as a result of psychosocial immaturity helps parents understand these
behaviors and reduces fear while fostering self-compassion and optimism in
youth. With proper treatment and maturation, recidivism rates are very low.
This approach shifts families from fear to understanding, providing a realistic
basis for hope and a positive, prosocial future for the youth.
References
Allen, M. (2016). Young adult offenders in Canada, 2014. Juristat, 36(1), 1-8. Statistics Canada. https://www150.statcan.gc.ca/n1/en/pub/85-002-x/2016001/article/14561-eng.pdf?st=ZbsUpckq
Birgersson, A. (2024, April 17). Using dialectical behavior therapy in schools and mental health counseling [On-demand training]. Safer Society Continuing Education Center. https://safersociety.org/using-dialectical-behavior-therapy-in-schools-and-mental-health-counseling-not109-a/
Bonner, B. (2009). Taking action: A support for families of adolescents with illegal sexual behavior. Safer Society Press.
Caldwell, M. F. (2016). Quantifying the decline in juvenile sexual recidivism rates. Psychology, Public Policy, and Law, 22(4), 414–426. https://doi.org/10.1037/law0000094
Férriz Romeral, L., Sobral Fernández, J., & Gómez Fraguela, J. (2018). Moral reasoning in adolescent offenders: A meta-analytic review. Psicothema, 30(3), 289-294.
Finkelhor, D., Ormrod, R., & Chaffin, M. (2009). Juveniles who commit sex offenses against minors (NCJ 227763). Office of Juvenile Justice and Delinquency Prevention. https://www.ojp.gov/pdffiles1/ojjdp/227763.pdf.
Hunter, J. A. (2011). Cognitive-behavioral treatment of adolescent sexual offenders: Theoretical and practical considerations. In M. C. Calder (Ed.), Contemporary practice with young people who sexually abuse: Evidence-based developments (pp. 123-145). Russell House Publishing.
Kettrey, H. H., & Lipsey, M. W. (2018). The effects of specialized treatment on the recidivism of juvenile sex offenders: A systematic review and meta-analysis. Journal of Experimental Criminology, 14(3), 361–387. https://doi.org/10.1007/s11292-018-9329-3
Lussier, P., McCuish, E., Chouinard Thivierge, S., & Frechette, J. (2024). A meta-analysis of trends in general, sexual, and violent recidivism among youth with histories of sex offending. Trauma, Violence, & Abuse, 25(1), 54–72. https://doi.org/10.1177/15248380231162469
National Center on the Sexual Behavior of Youth (NCSBY). (n.d.). Problematic sexual behavior: Protective factors and vulnerabilities [PDF]. https://www.ncsby.org/sites/default/files/Problematic%20Sexual%20Behavior%20-Protective%20Factors%20and%20Vulnerabilities%20(1).pdf
National Center on the Sexual Behavior of Youth (NCSBY). (2019). Implementing trauma-focused cognitive behavioral therapy for children with problematic sexual behavior. Oklahoma TF-CBT. https://oklahomatfcbt.org/wp-content/uploads/2019/05/Implementing-TF-CBT-for-Children-with-PSB-H.pdf
Peck, R. W., Shahin, M. H., & Vinks, A. A. (2023). Precision dosing: The clinical pharmacology of Goldilocks. Clinical Pharmacology & Therapeutics, 113(4), 685–686. https://doi.org/10.1002/cpt.2112
Ralph, N. (2015). A follow-up study of a prosocial intervention for juveniles who sexually offend. Sex Offender Treatment.
Satodiya, R., Bied, A., Shah, K., Parikh, T., & Ash, P. (2024). A systematic review of Multisystemic Therapy in adolescent sex offenders. Journal of the American Academy of Psychiatry and the Law, 52(1), 117-123. https://doi.org/10.29158/JAAPL.230117-23
Steen, C. (1999). The relapse prevention workbook for youth in treatment (guided workbooks for juvenile sex offenders). Safer Society Press.
Steinberg, L. (2014). Age of opportunity: Lessons from the new science of adolescence. Houghton Mifflin Harcourt.
Steinberg, L., Cauffman, E., & Monahan, K. C. (2015). Psychosocial maturity and desistance from crime in a sample of serious juvenile offenders (NCJ No. 248391). Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice. https://www.ojjdp.gov/pubs/248391.pdf
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Damme, L., Fortune, C.-A., Vandevelde, S., & Vanderplasschen, W. (2017).
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Violent Behavior, 37, 179-189. https://doi.org/10.1016/j.avb.2017.10.005
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