Abstract
More than a third of all sexual crimes are committed by adolescents. In addition, many adolescents struggle with problematic sexual behaviors (PSB) that may not rise to a criminal offense, but cause harm to themselves and those around them. A significant number of these adolescents also have histories of their own trauma; yet there are no treatment models that integrate both PSB and trauma into one comprehensive treatment for this population. This qualitative study’s aim was to use the expertise of clinicians who work with adolescents with PSB as well as clients and their caregivers who had completed PSB treatment to understand what they believe are the necessary components and elements needed for an integrated model that seeks to simultaneously address both PSB and the consequences of traumatic experiences. Twenty-six mental health professionals and one former client and his caregiver participated in focus groups (three with clinicians and one with the caregiver and former client) to share their experiences and expertise regarding an integrated model. The thematic analysis procedure yielded six major themes: family, external systems, treatment structure, therapeutic themes, specialized PSB targets, and trauma and PSB integration. Each of these major themes was comprised of subthemes that are presented as well. Implications for practice and future research are discussed, including that clinicians could benefit from guidance and structure to assist them in structuring their interventions to address the multiple needs of their clients that seek to reduce their risk of reoffending while simultaneously enhancing the quality of their lives.
Similar content being viewed by others
References
Allen, B. (2018). Implementing trauma-focused cognitive-behavioral therapy (TF-CBT) with preteen children displaying problematic sexual behavior. Cognitive and Behavioral Practice, 25(2), 240–249.
Association for the Treatment and Prevention of Sexual Abuse (2023). Adolescents and children Retrieved 1/12/2023, from https://www.atsa.com/learn/adolescents.
ATSA (2017). ATSA practice guidelines for assessment, treatment, and intervention with adolescents who have engaged in sexually abusive behavior. Available from: https://www.atsa.com/Members/Adolescent/ATSA_2017_Adolescent_Practice_Guidelines.pdf
Baglivio, M. T., Epps, N., Swartz, K., Huq, M. S., Sheer, A., & Hardt, N. S. (2014). The prevalence of adverse childhood experiences (ACE) in the lives of juvenile offenders. Journal of Juvenile Justice, 3(2), 1–23.
Bloom, S., & Farragher, B. (2013). Restoring sanctuary: A new operating system for trauma-informed systems of care. Oxford University Press.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.
Brown, A., & Yoder, J. (2020). Symptoms of post-traumatic stress and sexual concerns: The intermediary effects of executive functioning on profiles of youth who have sexually harmed. Journal of Interpersonal Violence, 37(21–22)https://NP20236-NP20258.
Brown, A., Yoder, J., & Fushi, K. (2022). Trauma and maternal caregivers as risks for executive function deficits among youth who have sexually harmed. Sexual Abuse, 34(1), 24–51.
Burla, L., Knierim, B., Barth, J., Liewald, K., Duetz, M., & Abel, T. (2008). From text to codings: Intercoder reliability assessment in qualitative content analysis. Nursing Research, 57(2), 113–117.
Burton, D. L. (2003). Male adolescents: Sexual victimization and subsequent Sexual Abuse. Child and Adolescent Social Work Journal, 20(4), 277–296. https://doi.org/10.1023/A:1024556909087.
Burton, D. L. (2012). Social learning theory and sexual aggression. In C. Figley R. (Ed.), Encyclopedia of trauma: An interdisciplinary guide (pp. 632–637). Sage.
Burton, D. L., Demuynck, S., & Yoder, J. (2016). Executive dysfunction predicts delinquency but not characteristics of sexual aggression among adolescent sexual offenders. Sexual Abuse: A Journal of Research and Treatment, 28, 707–721. https://doi.org/10.1177/1079063214556357.
Burton, D. L., Duty, K. J., & Leibowitz, G. S. (2011). Differences between sexually victimized and nonsexually victimized male adolescent sexual abusers: Developmental antecedents and behavioral comparisons. Journal of Child Sexual Abuse, 20(1), 77–93. https://doi.org/10.1080/10538712.2011.541010
Caldwell, M. F. (2016). Quantifying the decline in juvenile sexual recidivism rates. Psychology Public Policy and Law, 22(4), 414.
Center for Disease Control (2016). Adverse childhood experiences (ACEs)https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fviolenceprevention%2Facestudy%2Findex.html.
Chard, K. M. (2005). An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood Sexual Abuse. Journal of Consulting and Clinical Psychology, 73(5), 965.
Chorpita, B. F., Daleiden, E. L., & Collins, K. S. (2014). Managing and adaptive practice: A system for applying evidence in clinical care with youth and families. Clinical Social Work Journal, 42, 134–142. https://doi.org/10.1007/s10615-013-0460-3.
Chorpita, B. F., Park, A., Tsai, K., Korathu-Larson, P., Higa-McMillan, C. K., Nakamura, B. J., Weisz, J. R., & Krull, J. (2015). Balancing effectiveness with responsiveness: Therapist satisfaction across different treatment designs in the child STEPs randomized effectiveness trial. Journal of Consulting and Clinical Psychology, 83(4), 709.
Cohen, J. A., & Mannarino, A. P. (2008). Trauma-focused cognitive behavioural therapy for children and parents. Child and Adolescent Mental Health, 13(4), 158–162.
Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents (2nd ed.). Guilford Publications.
Corbin, J. M., & Strauss, A. (2008). Basics of qualitative research: Techniques and procedures for developing grounded theory. Sage.
Deblinger, E., Mannarino, A. P., Cohen, J. A., Runyon, M. K., & Heflin, A. H. (2015). Child Sexual Abuse: A primer for treating children, adolescents, and their nonoffending parents. Oxford University Press.
Dierkhising, C. B., Ko, S. J., Woods-Jaeger, B., Briggs, E. C., Lee, R., & Pynoos, R. S. (2013). Trauma histories among justice-involved youth: Findings from the national child traumatic stress network. European Journal of Psychotraumatology, 4(1), 20274. https://doi.org/10.3402/ejpt.v4i0.20274.
Fanniff, A. M., & Becker, J. V. (2006). Specialized assessment and treatment of adolescent sex offenders. Aggression and Violent Behavior, 11(3), 265–282.
Finkelhor, D., Ormrod, R., & Chaffin, M. (2009). Juveniles who commit sexual offenses against minors. (). U. S. Department of Justice.
Foa, E. B. (2011). Prolonged exposure therapy: Past, present, and future. Depression and Anxiety, 28(12), 1043–1047. https://doi.org/10.1002/da.20907.
Ford, J. D., Chapman, J. F., Hawke, J., & Albert, D. (2007). Trauma among youth in the juvenile justice system: Critical issues and new directions. National Center for Mental Health and Juvenile Justice, 6, 2007.
Glaser, B. G. (1965). The constant comparative method of qualitative analysis. Social Problems, 12(4), 436–445.
Gomez, M. (2022). Your child is not a pedophile’: Effectively addressing problematic sexual behaviors in children and adolescents. The Brown University Child and Adolescent Behavior Letter, 38(7), 1–5.
Grady, M. D., Levenson, J. S., & Bolder, T. (2017). Linking adverse childhood effects and attachment: A theory of etiology for sexual offending. Trauma Violence & Abuse, 18(4), 433–444.
Grady, M. D., Levenson, J. S., Glover, J., & Kavanagh, S. (2022a). Is sex-offending treatment trauma-informed? Exploring perspectives of clinicians and clients. Journal of Sexual Aggression, 28(1), 60–75.
Grady, M. D., Levenson, J. S., Glover, J., Kavanagh, S., & Carter, K. (2022b). Hurt people hurt other people: The link between past trauma and sexual offending. Sexual Offending: Theory Research and Prevention, 17, 1–28.
Grady, M. D., Yoder, J., & Brown, A. (2021). Childhood maltreatment experiences, attachment, sexual offending: Testing a theory. J Interpers Violence, 36(11–12), NP6183–NP6217. https://doi.org/10.1177/0886260518814262.
Grady, M. D., Yoder, J., Deblinger, E., & Mannarino, A. P. (2023). Developing a trauma focused cognitive behavioral therapy application for adolescents with problematic sexual behaviors: A conceptual framework. Child Abuse & Neglect, 140, 106139. https://doi.org/10.1016/j.chiabu.2023.106139.
Hecker, T., Hermenau, K., Crombach, A., & Elbert, T. (2015). Treating traumatized offenders and veterans by means of narrative exposure therapy. Frontiers in Psychiatry, 6, 80.
Hekler, E., Tiro, J. A., Hunter, C. M., & Nebeker, C. (2020). Precision health: The role of the social and behavioral sciences in advancing the vision. Annals of Behavioral Medicine, 54(11), 805–826.
Hindman, J., & Peters, J. M. (2000). Polygraph testing leads to better understanding adult and juvenile sex offenders. Fed Probation, 65, 8.
Hudson, S. M., & Ward, T. (2000). Interpersonal competency in sex offenders. Behavior Modification, 24, 494–527.
Hudson, S. M., Ward, T., & McCormack, J. C. (1999). Offense pathways in sexual offenders. Journal of Interpersonal Violence, 14, 779–798.
Jäggi, L. J., Mezuk, B., Watkins, D. C., & Jackson, J. S. (2016). The relationship between trauma, arrest, and incarceration history among black americans: Findings from the national survey of American life. Society and Mental Health, 6(3), 187–206.
Jespersen, A. F., Lalumière, M. L., & Seto, M. C. (2009). Sexual Abuse history among adult sex offenders and non-sex offenders: A meta-analysis. Child Abuse & Neglect, 33(3), 179–192. https://doi.org/10.1016/j.chiabu.2008.07.004. http://dx.doi.org.proxycu.wrlc.
Johnston, C., Dorahy, M. J., Courtney, D., Bayles, T., O&Amp, Apos, & Kane, M. (2009). Dysfunctional schema modes, childhood trauma and dissociation in borderline personality disorder. Journal of Behavior Therapy and Experimental Psychiatry, 40(2), 248–255. https://doi.org/10.1016/j.jbtep.2008.12.002.
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.
Kolb, S. M. (2012). Grounded theory and the constant comparative method: Valid research strategies for educators. Journal of Emerging Trends in Educational Research and Policy Studies, 3(1), 83–86.
Leahy, R. L. (2015). Emotional schema therapy. The Guilford Press.
Letourneau, E. J., & Armstrong, K. S. (2008). Recidivism rates for registered and nonregistered juvenile sexual offenders. Sexual Abuse, 20(4), 393–408. https://doi.org/10.1177/1079063208324661.
Letourneau, E. J., & Borduin, C. M. (2008). The effective treatment of juveniles who sexually offend: An ethical imperative. Ethics & Behavior, 18(2–3), 286–306.
Levenson, J. S. (2020). Translating trauma-informed principles into social work practice. Social Work, 65(3), 288–298.
Levenson, J. S., & Grady, M. D. (2016). The influence of childhood trauma on sexual Violence and sexual deviance in adulthood. Traumatology, 22(2), 94–103. https://doi.org/10.1037/trm0000067.
Levenson, J. S., & Willis, G. M. (2019). Implementing trauma-informed care in correctional treatment and supervision. Journal of Aggression Maltreatment & Trauma, 28(4), 481–501.
Levenson, J. S., Baglivio, M. T., Wolff, K. T., Epps, N., Royall, W., Gomez, K. C., & Kaplan, D. (2017a). You learn what you live: Prevalence of childhood adversity in the lives of juveniles arrested for sexual offenses. Advances in Social Work, 18(1), 313–334.
Levenson, J. S., Willis, G. M., & Prescott, D. (2017b). Trauma-informed care: Transforming treatment for people who sexually abuse. Safer Society Press.
Levenson, J. S., Grady, M. D., Lasoski, H., & Collins, K. T. (2023). Learning from consumers of mandated sex-offending programs: It’s not treatment, I wish it was. Sexual Abuse.
Malvaso, C. G., Proeve, M., Delfabbro, P., & Cale, J. (2020). Characteristics of children with problem sexual behaviour and adolescent perpetrators of Sexual Abuse: A systematic review. The Journal of Sexual Aggression, 26(1), 36–61. https://doi.org/10.1080/13552600.2019.1651914.
Maniglio, R. (2011). The role of childhood trauma, psychological problems, and coping in the development of deviant sexual fantasies in sexual offenders. Clinical Psychology Review, 31(5), 748–756. https://doi.org/10.1016/j.cpr.2011.03.003.
Marshall, W. L., Ward, T., Mann, R. E., Moulden, H., Fernandez, Y. M., Serran, G., & Marshall, L. E. (2005). Working positively with sexual offenders: Maximizing the effectiveness of treatment. Journal of Interpersonal Violence, 20(9), 1096–1114. https://doi.org/10.1177/0886260505278514.
McGrath, R. J., Cumming, G. F., Burchard, B. L., Zeoli, S., & Ellerby, L. (2010). Current practices and emerging trends in sexual abuser management: The safer society 2009 north American survey. Safer Society Press.
Olson, J. D., McAllister, C., Grinnell, L. D., Walters, G., K., & Appunn, F. (2016). Applying constant comparative method with multiple investigators and inter-coder reliability. Qualitative Report, 21(1), 26–42.
Radford, L., Corral, S., Bradley, C., Fisher, H., Bassett, C., Howat, N., & Collishaw, S. (2011). Child abuse and neglect in the UK today.
Schladale, J. (2006). Family matters: The importance of engaging families in treatment with youth who have caused sexual harm. Current Perspective: Working with Sexually Aggressive Youth and Youth with Sexual Behavior Problems, 493–514.
Seto, M. C., & Lalumière, M. L. (2010). What is so special about male adolescent sexual offending? A review and test of explanations through meta-analysis. Psychological Bulletin, 136, 526–575. https://doi.org/10.1037/a0019700.
Shapiro, F. (2002). EMDR as an integrative psychotherapy approach: Experts of diverse orientations explore the paradigm prism. American Psychological Association.
Shapiro, F. (2017). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures. Guilford Publications.
Shivy, V. A., & Guion, D. B. (2012). Childhood trauma and the juvenile justice system. In C. R. Figley (Ed.), Encyclopedia of trauma: An interdisciplinary guide (pp. 81–84). Sage.
Shlonsky, A., Albers, B., Tolliday, D., Wilson, S. J., Norvell, J., & Kissinger, L. (2017). Rapid evidence assessment: Current best evidence in the therapeutic treatment of children with problem or harmful sexual behaviours, and children who have sexually offendedhttps://apo.org.au/sites/default/files/resource-files/2017-05/apo-nid92426.pdf.
Simons, D. A., Wurtele, S. K., & Durham, R. L. (2008). Developmental experiences of child sexual abusers and rapists. Child Abuse & Neglect, 32, 549–560. https://doi.org/10.1016/j.chiabu.2007.03.027
Substance Abuse and Mental Health Services Administration (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach Unpublished manuscript.
Thomas, J. (2010). Family therapy: A critical component in treatment of sexually abusive youth. Juvenile Sexual Offending: Causes Consequences and Correction, 357–379.
Van Wijk, A., Vermeiren, R., Loeber, R., Hart-Kerkhoffs, L., Doreleijers, T., & Bullens, R. (2006). Juvenile sex offenders compared to non-sex offenders: A review of the literature 1995–2005. Trauma Violence & Abuse, 7(4), 227–243.
Ward, T. (2014). The explanation of sexual offending: From single factor theories to integrative pluralism. Journal of Sexual Aggression, 20(2), 130–141. https://doi.org/10.1080/13552600.2013.870242.
Ward, T., & Beech, A. R. (2008). An integrated theory of sexual offending. In D. R. Laws, & W. T. O’Donohue (Eds.), Sexual deviance: Theory, assessment, and treatment (2nd ed., pp. 21–36). Guilford Press.
Ward, T., & Hudson, S. M. (2000). A self-regulation model of relapse prevention. In D. R. Laws, S. M. Hudson, & T. Ward (Eds.), Remaking relapse prevention with sex offenders: A sourcebook (pp. 79–101). Sage Publications, Inc.
Ward, T., & Keenan, T. (1999). Child molesters’ implicit theories. Journal of Interpersonal Violence, 14(8), 821–838.
Yoder, J., & Brown, S. (2015). Challenges facing families of sexually abusive youth: What prevents service engagement? Victims & Offenders, 10(1), 29–50.
Yoder, J., Dillard, R., & Leibowitz, G. S. (2018). Family experiences and sexual victimization histories: A comparative analysis between youth sexual and nonsexual offenders. International Journal of Offender Therapy and Comparative Criminology, 62(10). https://doi.org/10.1177/0306624X17738063
Yoder, J., & Grady, M. D. (2022). Clinical needs and applications among those who work with individuals who commit sexual offenses. Unpublished manuscript.
Yoder, J., Grady, M., Precht, M. (2019). Relationships between early life victimization, antisocial traits, and sexual violence: Executive functioning as a mediator. Journal of Child Sexual Abuse, 28(6), 667–689. https://doi.org/10.1080/10538712.2019.158881
Yoder, J., & Precht, M. (2020). Victimization experiences and executive dysfunction as discriminating risk indicators for youth offender typologies. International Journal of Offender Therapy and Comparative Criminology, 64(1), 63–82.
Yoder, J., & Ruch, D. (2016). A qualitative investigation of treatment components for families of youth who have sexually offended. Journal of Sexual Aggression, 22(2), 192–205.
Yoder, J., Grady, M. D., & Dillard, R. (2019a). Maternal caregiving practices and Child Abuse experiences as developmental antecedents to insecure attachments: Differential pathways between adolescents who commit sexual and non-sexual crimes. Sexual Abuse, 31(7), 837–861. https://doi.org/10.1177/1079063218784557.
Yoder, J., Grady, M. D., & Precht, M. (2019b). Relationships between early life victimization, antisocial traits, and sexual Violence: Executive functioning as a mediator. Journal of Child Sexual Abuse, 28(6), 667–689. https://doi.org/10.1080/10538712.2019.1588819.
Yoder, J., Hodge, A. I., & Ruch, D. (2019c). Intra-and extra-familial victimization experiences: Differentiating between incarcerated serious youth offenders and youth rapists. Journal of Interpersonal Violence, 34(15), 3199–3228.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Grady, M.D., Yoder, J., Jones, S.N. et al. Seeking an Integrated Approach to Trauma and Problematic Sexual Behaviors in Adolescents: Learning from Practitioners. Journ Child Adol Trauma (2023). https://doi.org/10.1007/s40653-023-00604-3
Accepted:
Published:
DOI: https://doi.org/10.1007/s40653-023-00604-3