Reading time: 2 minutes, 47 seconds
Assessing inappropriate sexual behaviours in adolescents should be developmentally and trauma informed. Best practice standards require that evaluators understand adolescent sexual development and stay current on risk assessment principles, areas of inquiry, and the reliability of risk assessments.
Drs. Shoshanna Must and Ivan Kruh emphasized this point during their November 7 session of the International Forensic Psychiatry Lecture Series on assessing inappropriate sexual behaviour in adolescents. (You can watch a recording of the lecture online.)
Words Matter
For adolescents, problematic sexual behaviours (PSB) include child-initiated actions that are age and developmentally inappropriate or pose potential harm to themselves or others. These behaviours range from excessive masturbation to more extreme examples, such as viewing child sex abuse imagery or committing sexual assault.
Drs. Must and Kruh avoid the term “juvenile sex offender” because it is not person-first language and promotes harmful stereotypes. Research from the Association for the Treatment and Prevention of Sexual Abuse (ATSA.com) showed that an average of five per cent of adolescents with PSB re-offended two to five years later, and seven per cent five to 10 years later.
Assessment Tools
The speakers suggest a risk–needs–responsivity (RNR) model when assessing risk, which ensures that:
- Adolescents with the highest risk receive the most intensive monitoring and services.
- Treatment targets changeable risk factors that influence re-offending.
- The adolescents’ learning style, motivation, and mental health needs are considered (e.g., treating their depression before the PSB).
RNR risk assessment tools for adolescents with PSB have existed for 25 years. However, a meta-analysis of 33 studies with nearly 6,200 adolescents found that these standard assessments (e.g. ERASOR, JSOAP) and adult risk assessment tool Static-99 performed poorly when assessing the risk of sexually reoffending.
Shift Toward Strength-Based Assessments
Rather than predicting re-offending, assessments heavily focus on protective factors and consider treatment needs (i.e. risk). This includes narrative formulations describing the pathway to the sexual behaviour. Interventions focus on helping adolescents be more resilient by developing internal mechanisms, facilitating family or caregiver support, managing their PSB, and promoting healthy relationships.
The Protective and Risk Observations for Eliminating Sexual Offense Recidivism tool is one example of this shift. It evaluates 20 changeable polar-opposite items for risk and protective factors, such as attitude toward a healthy sexual future. The item is viewed as ends of the same spectrum, as you can see below:
- Risk factors: Hopelessness about a healthy sexual future, and abuse-supportive sexual beliefs and attitudes.
- Protective factors: Hopefulness about a healthy sexual future, and respectful and age-appropriate beliefs and attitudes about sex.
Adolescent Brain and Sexual Development
Unlike adults, adolescents’ brains are still developing until their early 20s. Also common in adolescence are unstable emotions, sensation-seeking, risk-taking, and impulsivity, resulting in poor decision-making. These same factors affect their sexual development.
As young people mature, these tendencies naturally decrease, contributing to low rates of re-offending regardless of intervention.
Trauma-Informed Approach
While adolescents with PSB have higher rates of sexual trauma than the general population, most have not been sexually abused. However, Dr. Must recommends trauma screening to explore neglect and adverse childhood experiences.
Rather than asking “What did you do?” Dr. Must asks “What happened to you?” — shifting the focus to the underlying causes of the behaviour through a trauma lens.
Research found that nearly 80 per cent of males and 45 per cent of females ages 16 and 17 years reported that they masturbate. Masturbation is a healthy example of sexual development; an adolescent who has chosen not to masturbate may signal something has changed, which should be explored.
Conversely, high sexual preoccupation — such as continuing to masturbate despite negative consequences — can be a coping mechanism to avoid anxiety, guilt, or physical pain. Exploring the adolescents’ relationship to sexual self-pleasure can help inform potential motivations for problematic sexual behaviour.
Atypical sexual interests include arousal that is uncommon, such as arousal toward prepubescent children or interest in acts, aggression, coercion, force, or humiliation. While most adolescents with PSB do not have atypical sexual interests, when they do, it’s a significant risk factor for re-offending.
Written by Virginia St-Denis and approved by Drs. Shoshanna Must and Ivan Kruh.
