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Journal of Child & Adolescent Trauma logoLink to Journal of Child & Adolescent Trauma
. 2018 Dec 5;12(4):457–467. doi: 10.1007/s40653-018-0242-8

MEGA♪: Empirical Findings on the Preternatural: Sexually Violent and Predatory Sexually Violent Youth

L C Miccio-Fonseca 1,✉
PMCID: PMC7163815  PMID: 32318215

Abstract

Applied are empirical findings from two major studies employing the ecologically framed MEGA♪ risk assessment tool: MEGA♪Combined Samples Studies (N = 3901 [1979–2017] (Miccio-Fonseca 2017a, d) and MEGA♪Combined Cross Validation Studies (N = 2717). Samples consisted of male, female, and transgender-female sexually abusive youth, ages 4–19, including youth with low intellectual functioning of borderline or low average. Findings further support a previously presented nomenclature identifying two subsets overlooked by most contemporary risk assessment tools: sexually violent and predatory sexually violent youth (Miccio-Fonseca and Rasmussen Journal of Aggression Maltreatment & Trauma, 18, 106–128, 2009, 2014). MEGA♪Studies provided normative data, with cut-off scores (calibrated) according to age and gender, establishing four risk levels: Low, Moderate, High, and Very High. The fourth risk level, Very High, sets MEGA♪ apart from other risk assessment tools for sexually abusive youth, which are limited to three risk levels. Very High risk level definitively identifies the most dangerous youth, thus empirically supporting the nomenclature of sexually violent and predatory sexually violent youth.

Keywords: Adolescent sex offender, Sexually abusive youth, Violent sex offender, Sexually violent predator, MEGA risk assessment tool

Youth engaged in extraordinarily violent, and lethal sexual crimes (e.g., kidnapping, rape at knifepoint, torture, strangulation, stabbing, and murder) are aberrations, anomalies occurring infrequently (Miccio-Fonseca and Rasmussen 2009, 2014). The field has been unusually slow in recognizing them as distinct subtypes, evidenced by lack of studies, and no mention of this population in Practice Guidelines for Assessment, Treatment, and Intervention with Adolescents Who Have Engaged in Sexually Abusive Behavior by the national organization, Association for the Treatment of Sexual Abusers (ATSA 2017).

Miccio-Fonseca and Rasmussen (2009) established the only nomenclature to distinguish these dangerous youth as qualitatively distinct groups - youth who are sexually violent (YSV) and predatory sexually violent (YPSV). The nomenclature incorporates several ecologically based dynamic and static risk and protective factors that “apply idiosyncratically to each particular youth and include elements for assessing the high coercion shown by YSV and YPSV” (p. 120), intertwined within multifarious systems (e.g., neuropsychological functioning, family history and dynamics, relationships with peers and adults). It is empirically anchored on large representative samples (over 2200 youth) in validation and cross validation studies of the MEGA♪ risk assessment tool, (Miccio-Fonseca 2009, 2010, 2013a).

MEGA♪ assesses risk for coarse sexual improprieties and/or sexually abusive behaviors and protective factors in male, female and transgender-female youth ages 4 to 19 years, including youth with low intellectual functioning (Miccio-Fonseca 2009, 2010, 2013a). Coarse sexual improprieties are identified behaviors reflecting an unsophisticated awareness of psychosexual conditions, environments, or social situations. Youth with coarse sexual improprieties engage in sexual behaviors that are crude, indecent, outside the societal norms of propriety (e.g., crude sexual gestures, sexually suggestive and/or vulgar sexual comments, mooning, looking up skirts, a young child rubbing his or her genitals in public or trying to grab another’s genitals, a child looking over a stall in a public restroom) (Miccio-Fonseca 2010). Sexually abusive youths (adjudicated or non-adjudicated), engage in coarse sexual improprieties and/or sexually abusive behaviors that fall along a continuum of low, moderate, high, or very high (lethal) risk.

Two separate major studies (N = 3901–1979-2017; and N = 2717–1979-2017) were completed from large international diverse samples on MEGA♪ (Miccio-Fonseca 2017a, b, d). Study findings afford opportunity to examine evidence-based data on violent and predatory aspects of sexually abusive behavior in youth, and provide additional substantial empirical support for Miccio-Fonseca and Rasmussen’s nomenclature of two distinct subtypes of high risk, sexually dangerous youth.

Recognizing Very High Risk Sexually Abusive Youth

The terms sexually violent, or predatory sexually violent are usually applied to dangerous adult sex offenders, often eliciting vigorous objections and adverse responses from other professionals when referring to youth (e.g., “They’re not criminals?!”). The recoiling of using such terms on youth is most understandable. However, what shall we use to describe a very small group of youth who engage in egregious (infrequently committed) sexually violent crimes in which some are lethal? Civil commitment laws utilizing the term “sexually violent persons” (SVP) describe sex offenders who have “a mental abnormality or disorder that makes them likely to engage in future acts of sexual violence” (Caldwell 2013, p. 517). Juveniles can be subject to an SVP petition in several states, if adjudicated delinquent for a sexual felony offense (Fanniff et al. 2010, as cited in Caldwell). Of 198 juvenile sex offenders adjudicated for a sexually violent offense, Caldwell found 54 in a 4-year period “qualifying for SVP commitment and held for a final commitment hearing”; 4 were subsequently committed, one later “determined by a judge to be inappropriate for commitment” (p. 519).

Official data on youth committing sexually violent, and/or predatory sexually violent crimes are difficult to ascertain from crime statistics. Utilizing U.S. Department of Justice National Incident-based Reporting System (NIBRS) (sex crimes by 13,471 juveniles and 24,344 adults in 2004), Finkelhor et al. (2009) reported juveniles constitute 25.8% of total sex crimes, 35.6% against minors; many were older male adolescents (i.e., 46% ages 15–17, 16% children under 12, and 7% females). Finkelhor et al. did not specify how many were adjudicated for sex offenses, or type of violence used (i.e., unknown how many were sexually violent and/or predatory sexually violent).

Differentiating Adjudicated and Non-Adjudicated Sex and Non-sexual Offenders

Many studies, including comprehensive literature reviews comparing adolescents who offend sexually with those who offend non-sexually (e.g., Driemeyer et al. 2011), do not adequately discriminate sexually abusive youth according to the seriousness of crimes, or distinguish legal status (i.e., adjudicated or non-adjudicated). Studies often identify all youth as “adolescent/juvenile sex offenders” (e.g., Seto and Lalumière 2010; van Wijk et al. 2007). “Sex offenders” is a legal term, referring to individuals adjudicated in the criminal justice system. Referencing non-adjudicated youth this way is inappropriate, likely confounding the findings.

Addressing the field’s lack of differentiation of adjudicated and non-adjudicated youth is a proposed template distinguishing five ad hoc categories related to crimes committed: (a) non-delinquent youth; (b) non-adjudicated delinquent youth; (c) non-adjudicated sexually abusive youth; (d) adjudicated sex offenders whose crime history is predominantly composed of sex crimes and/or sexually related sex crimes; (e) adjudicated non-sexual offenders whose crime history is predominantly composed of non-sexual crimes (Miccio-Fonseca and Rasmussen 2014). Youth in the first two categories have no contact with law enforcement, while those in latter categories have come to the attention of law enforcement in some fashion and/or have gone through proceedings in juvenile or adult court systems. Youth absent law enforcement involvement are different from those with criminal history and/or adjudications. Youth with a criminal history, particularly if adjudicated, are more likely than non-delinquent and non-adjudicated delinquent youth to have a network of affiliations with negative peer groups, demonstrating a history of engaging in antisocial behaviors possibly observable in earlier years. Likely antisocial behaviors increased in gravity, consequentially crystalized into enduring, perhaps extensive, criminal activity extending well into adulthood.

Researchers debate whether male adjudicated adolescent sex offenders are similar (or different) from adjudicated male adolescent non-sexual offenders (see Seto and Lalumière 2010; van Der Put et al. 2013; van Wijk et al. 2007). Driemeyer et al.’s (2011) systematic literature review reported contradictory research. Seto and Lalumière’s (2010) 30-year meta-analysis of 59 studies compared 3855 male sex offenders and 13,393 male nonsexual offenders, (some of whom may have been sexually abusive), finding both similarities and distinct differences. Both types of youth offenders had several of the same risk variables: antisocial personality traits, antisocial attitudes (e.g., related to women), separation from parents, family communication problems, parent-child attachment, exposure to nonsexual violence in the family (i.e., spousal abuse, sibling abuse); exposure to nonsexual violence outside of the family, social incompetence (i.e., social skill deficits), conventional sexual experience, and level of intellectual functioning. However, adjudicated male adolescent sex offenders had less extensive criminal history and fewer conduct problems, fewer substance abuse problems, and less family history of criminality or substance abuse. They were more likely to have been sexually abused, exposed to sexual violence in their family, and/or experienced other types of abuse or neglect. They were more likely socially isolated, have early exposure to pornography, show more atypical sexual interests, and have more anxiety and/or problems with low self-esteem.

Seto and Lalumière’s (2010) meta-analysis provided descriptive data during a different Zeitgeist; most studies (73%) were published 1979 to 2000. Vast anthropological and sociological changes have since taken place worldwide, impacting psychosocial culture and/or psychosexual development. Computer technology opened up avenues of communications readily available in home, schools, institutions, and governments around the world. Education systematically integrated computers into the classroom, cultivating and embracing social networking nonexistent during 1979–2000. Psychosocial cultural values connected to sexuality, homosexuality, gender identity, marriage, courtship, fertility, and child rearing have expressively changed in today’s now interactive global society.

The complicated world of accessible cyberspace resulted in numerous social media platforms (e.g., Facebook, Twitter, Snap Chat, Instagram, Face Time, etc.), enabling almost instantaneous communication of diverse interests and activities, including the most intimate, sexuality. A survey of adolescents (13–19) by National Campaign to Prevent Teen and Unplanned Pregnancy (2008) evidences immeasurable changes in sexual knowledge and practices of youth. Findings reported 20% sent emails or text messages containing nude or nearly nude photos, 48% received sexually suggestive text messages, and 31% received nude or nearly nude photos from someone else. A later study (Martinez-Prather and Vandiver 2014) of the “sexting attitudes and behaviors” (p. 21) of 378 teenagers sampled from university college freshmen found that one-third had sent a sexting image of themselves to someone else using a cell phone. Madigan et al. (2018) meta-analysis of 39 studies (N = 110,380; (age range 11.9 years to 17 years); mean age = 15.16; 47.2% were male) found that the prevalence of sexting has increased, and increases as the youth ages. Such studies speak to the need to consider the youth’s involvement with sexting, or other sexual improprieties related to computer technology when assessing sexually abusive youth.

Youth Who Are Sexually Violent (YSV)

A comprehensive search of relevant databases (e.g., PsychInfo, MEDLINE, Criminal Justice Abstracts) found only two dated studies, consisting of small samples, examining some of the most violent aspects of adolescent sexual offending. Långström and Grann (2000) (N = 54 males, 2 females) found use of weapons and death threats not associated with sexual recidivism, but with general criminality (which included sexual offending). Likewise, Långström (2002) (N = 115 males, 2 females) reported use of weapons and death threats were associated with violent non-sexual recidivism, not sexual recidivism. Seto and Lalumière’s (2010) meta-analysis gave little focus on variables related to sexually violent and predatory sexually violent youth. Also, Gerhold et al. (2007) systematic review of male adolescent sex offenders (12 studies, N = 1315) did not examine the aforementioned variables.

Some research applied the term “violent sex offender” without distinguishing specific degrees in sex crimes committed and/or higher levels of risk, or considering adjudication status. Van Wijk et al. (2007) described their sample as “violent sex offenders” and “violent non-sex offenders” when official records used (i.e., Dutch police registration system for offenders) “does not contain information regarding convictions” (p. 1343). Youth, were alleged by police to have committed serious, violent sex offenses and non-sex offenses, according to statutory definitions (i.e., sex offenses = “rape or sexual assault”; violent offenses = “manslaughter, murder, assault, group violence” [p. 1344]). However, given the data recorded arrests and/or charges, not adjudications, some youth may indeed have been innocent, thus inappropriately referenced as “violent” or “non-violent” sex offenders. Identifying youth as “sex offenders” solely based on police records (prior to adjudication determining guilt or innocence) could overestimate seriousness, possibly portraying a youth’s offense as “violent” when it may not involve highly coercive elements specified in statutory definitions.

Youth Who Are Predatory and Sexually Violent (YPSV)

Predatory sexually violent youth commit sexually violent offenses against strangers or casual acquaintances (Miccio-Fonseca and Rasmussen 2009, 2014). A casual acquaintance is someone an offender knows by sight or briefly interacted with (e.g., a neighbor seen many times but never officially met, a classmate attending the same school and/or class, but has never conversed). McCann and Lussier’s (2008) meta-analysis (18 studies, N = 3189) reported youth who sexually abused strangers had higher rates of sexual recidivism, as did other studies (Carpentier and Proulx 2011; Långström 2002). A dated study of male adolescent “mentally retarded and non–retarded sex offenders” (researchers’ term) reported “most adolescents in both groups had offended previously and most knew their victims, however, this was less often the case for the mentally retarded than non-retarded offenders” (Gilby et al. 1989, p. 545).

Studies on adjudicated male adolescent sex offenders show wide disparity in defining “stranger” (i.e., no standardized definition). Finkelhor et al.’s (2009) study of NIBRS sample of sex crimes committed by youth and adults against minors reported 63.2% of the youth sexually abused acquaintances, and 25% abused family members; only 2.5% sexually abused strangers. Carpentier and Proulx (2011) found 4.5% sexually abused strangers (defined as “a previously unknown victim” [p. 444]). Dissimilarly, a Singapore study of male adolescent sex offenders reported 51.3% sexually abused strangers, defined as opposite of “acquaintance”, which were “[i.e., friends, family members, and relatives]” (Chu and Thomas 2010, p. 221). Including non-related individuals known to the family as “strangers” may result in inflated percentage, as they may be individuals in the environment who have close relationships with youth and their families (e.g., neighbors, church members). Conversely, large percentage of strangers in Chu and Thomas’ study may mirror cultural factors. Overly crowded society (e.g., Singapore) is fertile ground for impersonal interactions and emotional detachment, possibly contributing to more youth sexually abusing strangers.

Limited research exists on youth who commit sex crimes connected to the Internet and social media (e.g., sexting, videotaping sex acts, pornography). Such youth are “camouflaged” (Miccio-Fonseca and Rasmussen 2018); that is, they are present, but often not identified. Likewise, no studies have attempted to identify and/or examine youth involved in sex trafficking. Victims’ accounts in sex trafficking research consistently report violent and sexually violent behaviors by their perpetrators, some of whom are juveniles (Polaris Project 2015). Empirical data on Very High Risk youth extracted from first cross validation of MEGA♪ (Miccio-Fonseca 2013a, 2016a) provide a hypothesized template of the characteristics of juvenile sex traffickers, both males (Miccio-Fonseca 2017c) and females (Miccio-Fonseca 2017e).

Evolving Paradigms in Risk Assessment Tools

Risk assessment tools for sexually abusive individuals experienced an evolution over the past two decades, now categorized in three ways: (a) unstructured clinical judgment (UCJ), (b) actuarial methods, and (c) structured professional judgment (SPJ). UCJ (subjective) method is exclusively based on assessor’s impression of the offender’s individual recidivism risk. Actuarial is a structured method, characterized by empirically established (statistically weighted) risk and/or protective factors producing calibrated risk categories grounded on given algorithms. SPJ is based on the assessor’s individual (subjective) weighting factors (which are not statistically weighted for the age and gender of the individual being assessed) coupled with clinical impression based on the comprehensive consideration of an individual’s developmental, personal, and criminal characteristics (Barra et al. 2018). Research has shown evaluator’s SPJ clinical judgment of the findings of the risk assessment, is no better than chance in predicting recidivism (Elkovitch et al. 2008).

Widely known contemporary risk assessment tools are designed for male sexually abusive adolescents, assessing only three levels of risk (i.e., Low, Moderate, and High). Juvenile Sexual Offender Assessment Protocol (J-SOAP-II - Prentky et al. 2000; Prentky and Righthand 2003) is an empirically guided structured professional judgment tool, without normative data. Prentky and Righthand (2003) recommend that “the J-SOAP-II be scored by two independent clinicians who then compare and discuss their scores. The agreed-upon scores should be used” (p. 9). Risk scores are thus subjective estimates. Independent studies of J-SOAP-II report inconsistent predictive validity (Hempel et al. 2013), causing professionals to express caution about using it in forensic settings (Fanniff and Letourneau 2012).

JSORRAT-II, is an empirical actuarial tool, primarily for youth adjudicated in the Juvenile Court system, focusing “exclusively on static risk indicators” (Ralston et al. 2016, p. 536). JSORRAT-II has had inconsistent predictive validity in validation studies (Epperson and Ralston 2015) and two independent studies of youth in residential programs (Rasmussen 2017; Viljoen et al. 2008), both of which found JSORRAT-II was not predictive. Viljoen et al. (2012) meta-analysis of sexually abusive male adolescents (33 studies, N = 6196) found no differences in predictive validity when comparing J-SOAP-II, JSORRAT-II, and two other tools.

In the past decade, the field of risk assessment for sexually abusive youth has evidenced evolutionary development from reliance on structured professional judgment (e.g., J-SOAP-II) to scientifically constructed tools with cut-off scores (e.g., JSORRAT-II and MEGA♪) (Miccio-Fonseca and Rasmussen 2018). MEGA♪ is a conceptually designed empirical actuarial risk assessment tool applicable to all types of youth and (i.e., male, female, and transgender-female, ages 4 to 19, including youth with low intellectual functioning of borderline or below average, adjudicated and non-adjudicated). MEGA♪ has normative data, empirically established, statistically weighted cut-off scores (calibrated risk levels grounded on given algorithms) according to age and gender. Risk levels are definitive, meaning it can be used with confidence when making forensic recommendations. MEGA♪ is a proprietary tool, similar to other scientifically anchored measures (e.g., MIDSA), generating a comprehensive report idiosyncratic to the youth.

MEGA♪‘s Risk Scale and Protective Scale provide baseline assessment of static and dynamic risk and protective variables; repeated administrations (i.e., every 6 months) evaluate changes in risk level and protective factors. Clinical scales, Estrangement Scale and Historic Correlative Scale, provide valuable instructive information for supervision, treatment, case management, and monitoring. Definitive scores in risk levels, with associated probabilities of for recidivism, put MEGA♪ within the category of actuarial tools, more specifically, what Harris and Hanson (2010) describe as a “third generation” actuarial tool. MEGA♪ illustrates their contention that “third-generation risk assessment tools contain empirically validated factors that are intended to be clinically useful, i.e. factors that guide interventions and measure change” (p. 298).

Initial crossvalidation study (N = 1056) Miccio-Fonseca 2013a, 2016a) affirmed validation findings (N = 1184) (Miccio-Fonseca 2009, 2010) and demonstrated prognostic utility. Over a two-year follow-up, Risk Scale demonstrated significant predictive validity for 334 youth assessed at baseline (Time 1), and a minimum of 6 months later (Time 2); AUC = .71 [95% CI = .62–.80], Std. Error = .048; p < .001 (Miccio-Fonseca 2013a). Statistical probabilities of re-offense rate and risk levels were: Low Risk = 2.4%, Moderate Risk = 6.3%, High Risk = 12.2%, and Very High Risk = 20% (Miccio-Fonseca 2013b). Predictive validity was further demonstrated in two later crossvalidation studies (2014–2016 - N = 543 (Miccio-Fonseca 2016b), and 1987–20171 (Miccio-Fonseca 2017a, b)).

Two subsequent major studies were completed (1979–2017). MEGA♪Combined Cross Validation Studies (N = 2717– Miccio-Fonseca 2017a, d) examined several predictive validity variables for youth ages 13–19 (n = 2322), one defined as a sexually related probation or parole violation; 420 (who did not have this variable at Time 1) were followed; 32 (7.6%) recidivated (AUC = .71 [95% CI = .62–.80], Std. Error = .046, p < .000). Second predictive validity variable was defined as a sexually related probation or parole violation at Time 2, regardless of Time 1; 459 were followed; 60 (13.1%) recidivated (AUC = .77 [95% CI = .71–.83], Std. Error = .031, p < .000). Third predictive validity variable was defined as sexually abusive behaviors (i.e., oral, anal, vaginal, direct skin-to-skin contact, or penetration) reported at Time 2 by all age groups. For 4–12 years (n = 395), 39 were available for follow-up. Recidivism rate was 17.9% (n = 7) (AUC = .88 [95% CI = 0.73–1.00], Std. Error = .075, p = .002). Ages 13–15 years (n = 1152), 59 youth were followed; there were 17 recidivists (28.8%); predictive variable was non-significant for this age group. For 16–19 (n = 1170), 26 were followed; 7 recidivated (26.9%); (AUC = .76 [95% CI = 0.57–.95], Std. Error = .096, p = .04).

MEGA♪Combined Samples Studies (N = 3901 Miccio-Fonseca 2017a, d), the second major study, examined the fourth risk level (Very High) in detail. Very High Risk represents highly dangerous youth who engage in extremely violent, and lethal sexual crimes (e.g., kidnapping, rape at knifepoint, torture, strangulation, stabbing, and murder). Presented are comparisons on risk levels according to age and gender from MEGA♪Combined Samples Studies (N = 3901). Correspondingly provided are descriptive statistics on variables related to coercive characteristics on Very High Risk youth reported from MEGA♪Combined Cross Validation Studies (N = 2717). Implications for identifying and assessing youth who are sexually violent, and/or predatory sexually violent are described.

Methods

Sample

The MEGA♪Combined Cross Validation Studies, consisted of 2717 youth. The second major study, MEGA♪Combined Samples Studies consisted of 3901 youth. Participants in both major studies were adjudicated and non-adjudicated youth, ages 4--19 years (i.e., males, females, and transgender-females, including youth with low level of intellectual functioning of borderline or low average) (Miccio-Fonseca 2017a, d).

MEGA♪Combined Cross Validation Studies sample consisted of 2501 males (92.1%), 204 females (7.5%), and 12 transgender-females (.4%). There were three age groups; 4–12 (n = 395 [14.5%]); 13–15 (n = 1152 [42.4%]); 16–19 (n = 1170 [43.1%]); and 19.2% (n = 522) were youth with low intellectual functioning. Sample was ethnically diverse: 28.8% Caucasian; 8.8% African-American; 39.9% Hispanic; 1.5% Native American; 12.9% Asian American; and 8% Other, and included 19% who were bilingual.

MEGA♪Combined Samples Studies consisted of the validation study and three cross validations. Total overall sample (N = 3901) was 3480 males (89.2%), 409 females (10.5%), and 12 (.3%) transgender-females, in three different age groups: 4–12 (n = 592 [15.2%]); 13–15 (n = 1578 [40.4%]); and 16–19 (n = 1731 [44.4%]). There were 746 (19.1%) youth with low intellectual functioning (672 males, 69 females, and 5 transgender-females).

Samples in all MEGA♪ studies were from different parts of the globe, affording diversity in age, gender and ethnicity: USA (i.e., Arizona, California, Florida, Hawaii, Kentucky, Louisiana, New Mexico, Nevada, and Oregon), and international (i.e., Canada, England, Ireland, Scotland, Israel, and Australia). Sites included outpatient child assessment centers, residential facility for adjudicated sexually abusive youth, residential facility for non-adjudicated youth, youth in correctional custody and/or psychiatric facilities, and youth in foster homes (Miccio-Fonseca 2009, 2010, 2013a, 2016a, b, 2017a, b, d).

Procedure

In all MEGA♪ studies, youth were included if: (a) seen at selected facilities at intake, and/or (b) attending the program at 6 months and available for follow-up. Study sites were recruited via professional consultations and various professional conferences. MEGA♪ was completed by licensed mental health professionals and non-clinical professionals (e.g., child welfare workers, probation officers, group home or residential staff) having at least 2 years of experience working with sexually abusive youth. The principal investigator (author) trained individuals at each site to do the MEGA♪ risk assessments. The MEGA♪ 75-item questionnaire is to be completed after a comprehensive review of the case file. Although a clinical interview is not required to complete MEGA♪, it is encouraged.

Findings

The MEGA♪Combined Samples Studies, male and female youth were in all four risk levels (i.e., Low, Moderate, High, and Very High) and included all age groups (i.e., 4–12, 13–15, and 16–19). Most (62%) of the 3901 youth were in Low (28.3% [n = 1104]) or Moderate (34% [n = 1328]) risk levels; 24.7% (n = 962) were assessed at High risk level; and 13% (n = 507) Very High Risk level.

MEGA♪Combined Samples Studies report descriptive findings on 3480 males (89.2%). Most males were in Low and Moderate risk levels (i.e., Low = 26.7% [n = 927] and Moderate = 33.8% [n = 1176]); 25.4% (n = 886) were High Risk levels; and 14.1% (n = 491) were Very High Risk. There were 409 females (10.5%) in the total sample, in all age groups, and all risk levels (i.e., Low, Moderate, High, and Very High). Most females were Low (42.8% [n = 175]), or Moderate (36.2% [n = 148); 17.1% (n = 70) were High, and only 3.9% (n = 16) were Very High Risk.

None of the MEGA♪ studies set out to study transgender youth, or youth that were low intellectual functioning, specifically. In the process of data collection from various data points, they inadvertently became part of the data pool.

The percentage of the transgender-female youth in the overall sample (.3%, n = 12) is comparable to the incidence of transgender adolescents ages 13 to 17 in the US population, estimated by Herman et al. (2017) as 0.7% (approximately 150,000 youth). Transgender-female youth were in all three age groups, distributed in the Low, Moderate, and High risk levels; none were in the Very High Risk level.

Risk levels are reported according to age group. In the total sample of 592 youth ages 4 to 12, risk levels were: Low Risk = 40.5% (n = 240); ModerateRisk = 36.8% (n = 218), High Risk = 19.3% (n = 114); and Very High Risk = 3.4% (n = 20). There were 1578 youth in 13–15 age group; risk levels were: Low Risk = 26.4% (n = 417); Moderate Risk = 34.9% (n = 551); High Risk = 24.8% (n = 391); and Very High Risk = 13.9% (n = 219). For 16–19 (n = 1731), risk levels were: Low Risk = 25.8% (n = 447); Moderate Risk = 32.3% (n = 559); High Risk = 26.4% (n = 457); Very High Risk = 15.5% (n = 268).

Youth in the samples were identified as low intellectual functioning if the item “lower level of intellectual functioning” was checked. Given the research sites that participated, it is reasonable to think that youth identified in MEGA♪ studies as having low intellectual functioning were likely of borderline or below average intellectual functioning; many would have been eligible for or require (or already receiving) services related to special needs. Youth with low intellectual functioning in MEGA♪Combined Samples Studies (19.1% [n = 746]) were in all four levels of risk: Low Risk = 11.3% (n = 84); Moderate Risk = 36.2% (n = 270), High Risk = 33.3% (n = 249), and Very High Risk = 19.2% (n = 143).

Discussion

The MEGA♪ risk assessment tool has been under development the past three decades, scientifically anchored on clinical data on approximately 400 families (Miccio-Fonseca 1996, 2000, 2001). MEGA♪ was introduced at the 2006 ATSA conference in Chicago, IL, and sites recruited for validation studies. Validation findings were presented at the 2009 ATSA conference in Dallas, TX, sites again recruited for participation in subsequent cross-validation studies. The two major MEGA♪ combined sample studies are a culmination of more than a decade of validation research on the MEGA♪ risk assessment tool, beginning with the validation study (N = 1184 – Miccio-Fonseca 2009, 2010). First cross-validation study (N = 1056) ascertained four risk levels (calibrated), with cut-off scores according to age and gender, (Miccio-Fonseca 2013a, 2016a). MEGA♪ was then released for use (2013). In multiple cross-validation studies (Miccio-Fonseca 2016b, 2017a, b, d), MEGA♪ steadily demonstrated good predictive validity on multiple predictive variables. The tool is therefore generalizable for assessing a broad age range of youth with coarse sexual improprieties and sexually abusive behaviors.

Assessment tools with cut-off scores and calibrated risk levels (like MEGA♪) are definitive, anchored in scientific data. They differ significantly from the pioneering method of structured professional judgment tools (e.g., J-SOAP-II) that rely on clinical guess-estimates, therefore less decisive and exact in ascertaining the risk level. Establishing a fourth level of risk makes MEGA♪ uniquely different from other risk assessment tools (e.g., J-SOAP-II and JSORRAT-II), which only have three risk levels. In the MEGA♪, Risk Scale-Very High implies risk is likely at very critical levels, requiring immediate intervention; the operational definition reflects this. The youth may present a danger to self and/or others, possibly to lethality levels (i.e., sexually violent, and predatory sexually violent behaviors). Sexually abusive behaviors are apt to incrementally progress, becoming significantly more troubling over time. An expected finding was the small number of youth in Very High Risk level (13%), consistent with Miccio-Fonseca and Rasmussen’s (2009, 2014) nomenclature.

Gender and Age Comparisons

MEGA♪Combined Samples Studies confirmed previous findings of validation (Miccio-Fonseca 2009, 2010) and first cross-validation (Miccio-Fonseca 2013a, 2016a) studies. Male youth were significantly higher risk than females for coarse sexual improprieties and/or sexually abusive behaviors. Three times more males (14.1% [n = 491]) were Very High Risk than females; 16 (3.9%) consistent with studies of sexually violent youth evidencing sexually violent behaviors and predatory sexually violent behaviors are rare for females (Långström and Grann 2000; Långström 2002). Findings unequivocally demonstrate need for distinctive risk measures according to gender.

This is the first risk assessment study reporting findings on transgender-female sexually abusive youth. Transgender refers to a broad spectrum of people “who transiently or persistently identify with a gender different from their natal gender” (DSM-5, American Psychiatric Association [APA] 2013, p. 451). A transgender-female youth is one whose birth sex is male, but cognizes herself to be female, and desires to live as a female. Correspondingly, a transgender male, whose birth sex is female, cognizes himself to be male, and desires to live his life as a male. Today’s Zeitgeist evidences greater acceptance of sexual minorities, and gender identities, increasing their visibility in society, whereby policies and procedures are changing to accommodate our citizens. Transgender-female youth were not found in Very High Risk level; the small size of the transgender-females (n = 12) prevents any definitive conclusions.

Unexpectedly, young children ages 4–12 (males and females) were in Very High Risk group (i.e., 3.4%). Finding youth under age 12 in Very High Risk level is most unusual, speaking to the need for early identification and immediate interventions. The finding however, is consistent with findings in Finkelhor et al.’s (2009) study of NIBRS data showing that children under 12 identified by police do engage in serious sex offenses. The children under 12 committed more sodomy, and sexual assault with object than adolescents (i.e., for sodomy: 15.4% [children under 12] vs. 11.9% [adolescents], and for sexual assault with object: 7.2% [children under 12] versus 4.2% [adolescents]). Administrators and clinicians treating sexually abusive children under age 12 need to design developmentally sensitive interventions. Therapeutic work may include sex education and early interventions to address intimacy deficits in these children and their families, thereby increasing their understanding of human sexual development and improving their ability to relate empathically and non-aggressively with others (Miccio-Fonseca 2014, 2018, 2019).

Characteristics of Very High Risk Youth

Coercive behaviors

Very High Risk youth engage in severe coercive behaviors not typically seen in majority of sexually abusive youth. MEGA♪Combined Cross Validation Studies (N = 2717), consisting of three cross validation studies (N = 1056 [2008–2012]; N = 543 [2012–2016]; N = 1118 [1987–2017]), report extensive descriptive findings on a small number of youth engaging in very aggressive sexually assaultive behaviors (Miccio-Fonseca 2017c, e). In the sample, 2.5% used a weapon; for each age group: 4–12 (1.3%, n = 5); 13–15 (2.2%, n = 25); and 16–19 (3.2%, n = 37). Gender comparisons found 2.5% for both males and females, and no transgender-female youth.

More males (8%) than females (5%) used combined coercive elements of threats of force, and/or lethal consequences and/or bodily harm and/or use of a weapon. History of removing a victim from the premises was reported by all age groups: 4–12 (.5%, only 2 of 395), 13–15 (1.6%), 16–19 (2.5%). Almost a quarter (24.9%) of total sample (N = 2717) sexually abused a stranger and/or casual acquaintance (26% males, 11.2% females, 25% transgender-female). Likewise, 25% had more than two victims of sexual abuse (27% males, 10% females, 50% transgender-female). Females were the least likely to sexually abuse strangers, or to have multiple victims.

Descriptive statistics from MEGA♪Combined Cross Validation Studies regarding age disparity of victims are informative of youth at Very High Risk (including those who are sexually violent and/or predatory sexually violent). Having adult victims is atypical, surprisingly present in all age groups: 4–12 (6%), 13–15 (6%), 16–19 (9%). Few had both child and adult victims of sexual abuse: 4–12 (4.5%), 13–15 (3.6%), 16–19 (4.7%). Transgender-females had more victims and were more varied in their sexual behaviors (i.e., 17% had both children and adult victims, compared to 4% males, and considerably less so for females −1%).

Neuropsychological Risk Factors

The MEGA♪Combined Cross Validation Studies (N = 2717) evidence need for risk assessment tools to incorporate neuropsychological factors for all risk levels consistent with literature reviews of other authors (Blasingame 2018; Karsten and Dempsey 2018). Over half (53%) of overall sample had problems with attention and/or concentration (58% transgender-females, 55% females, 53% males). Almost half (44%) were in Special Education; most were males (46%), followed by transgender-females (33%), and females (26%). Nearly a third (31%) reported having learning disabilities (42% transgender-females, 31% males, 25% females). Findings revealed a significant number have notable neuropsychological risk factors likely impacting educational performance.

Risk assessment tools need to be sensitive to youth with low intellectual functioning. In MEGA♪Combined Samples Studies, 19% were low intellectual functioning of borderline or low average, and in all levels of risk. A notable percentage (19.2%) were Very High Risk, evidencing a small number youth with low intellectual functioning engage in very serious sex offenses that can be lethal. A review of the extant literature on this population found some youth were predatory (i.e., sexually abused strangers) (Gilby et al. 1989; Lane 1997), or had “more ingrained behaviour; more distortions supportive of entitlement and control-based strategies for coping” (Griffin and Vettor 2012, p. 67).

Although Very High Risk youth are rare, and infrequently seen, odds are that invariably over a long professional career, one will encounter these preternatural youth on their caseloads or in their agencies. It is then we see adjustments in policies and procedures to consider such cases presenting themselves in the future. Accommodating for judicial status and different levels of risk, treatment services need to be available and tailored for each type of sexually abusive youth (i.e., male, female, transgender, children under 12, and youth with low intellectual functioning).

Family Lovemap

Family Lovemap, is an empirically grounded polygonal conceptual paradigm of shared omnipresent “factors related to different aspects of a vinculum of familial relationships (i.e., courtship, marital/cohabitation history, reproductive history, separation/divorce, death/widowhood, sexual abuse, etc.)” (Miccio-Fonseca 2014, p. 3). Family Lovemap, is the psychological connective tissue of intimacy in relationships, ingredients of overall relationships (i.e., family, friends, lovers, community), likely directly related to protective factors (Miccio-Fonseca 2014, 2018, 2019). Family Lovemap Aggregate had the highest internal consistency of the seven non-scalable ecological aggregates providing the conceptual grounding of MEGA♪ (Miccio-Fonseca 2009, 2010).

Various risk factors associated with MEGA♪Family Lovemap Aggregate were examined in MEGA♪Combined Cross Validation Studies (N = 2717). A preponderance of the sample, 84.2%, experienced parental separation before age 16 years. Less than half reported exposure to domestic violence (45.5%) or being victims of physical abuse (43%). Family history of sexual abuse was reported by 41.7% of the total sample. Consistent with reviews of prior literature (e.g., Oliver and Holmes 2015; Miccio-Fonseca 2016a), more females (57.8%) were victims of sexual abuse, compared to males (37.8%) and transgender (50%). Remarkably, 60.2% of the sample reported being victims of maltreatment (i.e., neglect and emotional abuse) pointing to the importance of a more intensively comprehensive assessment of child maltreatment, which often may not receive the level of attention it needs in treatment plans and interventions.

Computer Technology and Sexually Abusive Behavior

Madigan et al.’s (2018) large meta-analysis of over 100,000 teens demonstrated that prevalence of sexting has increased, and becomes more prevalent at older ages, an example of how today’s computerized society is influencing norms related to sexual behaviors in youth. Annotated reports have revealed the darker sides of cyber space as it relates to sex and sexuality. Technological progress brings many advantages without many of the warning labels that are later discovered needed once engaged. It also ignites the human imagination on the varied uses of these advances, and not always towards the best intentions and/or outcomes. This includes new manifestations of various kinds of sexual abuse. For example, the invention of camera brought about still pictures of pornography. Movie cameras brought about further development in photography, from black and white photos to color. Pornography could now be displayed in both venues, still photos, or “in living color” with “close-ups shots”. Thus technological enhancements related to Internet and cyberspace reveals other forms (kinds) of sexual abuse, (i.e., revenge porn, marketing for human sex trafficking), which have an impact and relationship with social networking. Assessment of the youth’s use of the Internet is critical, particularly when assessing very high risk youth who may engage in these sexually abusive behaviors online.

Antisocial Behaviors

MEGA♪-Combined Cross Validation Studies provide information concerning the family and/or youth involved in illegal antisocial behaviors, as well as problematic but not illegal behaviors for youth (e.g., truancy, disruptive behavior in school). More than half of the sample in all age groups reported a family history of general criminal behavior or lifestyle (60% males, 56.3% females, 50% transgender-females). A small percentage reported family history of legal difficulties due to sexual habits (18.5% males, 21% females, 25% transgender-females). More than half were arrested or charged with a crime before age of 16 (63.5% males, 31.3% females, 50% transgender-females). A smaller percentage had two or more adjudications for non-sex related offenses (13% males, females 8%, transgender-females 8%), and/or two or more adjudications for a sex offense (14% males, 2% females, 25% transgender-females).

Very High Risk youth likely have early educational history of behavior difficulties progressing into enduring ongoing behavioral and disciplinary problems. They characteristically fail to adhere to rules and/or respect authority figures, with a long-standing history of not getting along with others, likely becoming isolated and perhaps shunned in some cases. These problems may extend into youth’s adult life (i.e., poor employment history, poor family interactions, and dysfunctional platonic and/or romantic relationships). Absence of pro-social support systems may be an ingredient for migrating to antisocial peers and/or activities (e.g., stealing, lying, fraud, assault with a deadly weapon, robbery, rape).

Rasmussen (2017) completed a 6-year longitudinal study, comparing the predictive validity of the JSORRAT-II and the MEGA♪ on 129 adjudicated adolescent males in a secure residential facility, where almost half (43%) were assessed Very High Risk on the MEGA♪. Findings showed that MEGA♪ was predictive; the JSORRAT-II was not. Rasmussen (2018) followed 120 of the 129 subjects for 12 years, 1 month to date (September 2006 –October 2018) (personal communication, L.A.L Rasmussen, October 1, 2018). Sexual recidivism was defined as a new arrest for a sex crime as an adult, and/or listing on a Sex Offender Registry. Preliminary findings report sexual recidivism rate (12.5%) over twice what Caldwell (2016) reports, “…the most appropriate estimated base rate for sexual recidivism over the full data set falls approximately between 3 and 10%, with a global average of approximately 5%.” (p. 6).

Subjects in Rasmussen’s (2018) sample were arrested for exceptionally egregious crimes, which included sexual (i.e., rape with unconscious victim, oral copulation by force or fear, rape by force or fear, Sodomy on Child Under 10, sex assault, sexual battery against spouse, pimping and human sex trafficking) and non-sexual offenses. A substantial percentage were arrested for violent non-sexual crimes, (i.e., homicide, attempted willful, deliberate, premeditated murder, robbery, assault and battery [with serious bodily injury], possession of weapons, possession and carrying a concealed [and loaded] firearm, fire setting). Preliminary data reported 10% who were currently, or had been in prison (personal communication, L.A.L. Rasmussen, November 2018). These preliminary data underscore need for risk assessment tools differentiating Very High Risk youth, suggesting risk may significantly increase over time, similar to research reports of adult sex offender recidivism (Przybyliski 2015).

Very High Risk are characteristically different from other sexually abusive youth in type and severity of crimes (i.e., use of weapons, lethal threats, luring and/or restraining victims, removing victim from premises). Although some have documented histories of behavioral problems, others can appear quite sociable, on the surface not seeming to have antisocial proclivities. Some have pro-social support systems (i.e., youth is a valuable player on a team, popular among peers, volunteers service, etc.). Others exhibit good academic performance, high achievers, have family support and involvement. A few sexually violent or predatory sexually violent youth are absent an antisocial history (i.e., no school behavior problems, no detentions, no parent/teacher conferences, no suspensions, no arrests, or history with law enforcement). As a group, Very High Risk youth are thus contradictory in their behavioral characteristics, challenging to assess. These atypical (and rare) youthful offenders engage in extraordinarily violent, sometimes lethal sexual crimes (e.g., kidnapping, human sex trafficking, rape at knifepoint, torture, strangulation, stabbing, and murder). These youth may also engage in sex related crimes little researched, but an emerging problem in our society (i.e., human sex trafficking). Juvenile sex traffickers provide an important role in the sex trafficking business (e.g., recruitment) and are both male (Miccio-Fonseca 2017c) and female (Miccio-Fonseca 2017e).

Conclusion

Dangerous cases rising to the level of Very High Risk (i.e., possibly to lethality) are usually not seen in outpatient facilities, but rather in juvenile court systems and detention centers (i.e., juvenile hall). Extreme sex crimes often trigger implementation and/or amendments of new public policy and interventions in managing sexual offenders (i.e., Sexually Violent Predatory petitions, registration as a sex offender, etc.). Professionals are better able to assess sexually abusive youth accurately by implementing measures created through the best scientifically evidence-based methods. Leaving the important task of risk assessment to tools that only provide guess-estimates does not advance precision or accuracy, likely inhibiting the ability to correctly discriminate risk levels and degree of dangerousness.

Risk assessment measures cannot ignore the advances and contributions of technology; these are interconnected to anthropological and sociological elements within the society at large and changing (sexual) behaviors (Madigan et al. 2018). Risk assessment tools need to incorporate these changes and be alerted to the manifestations of the different kinds of online sexual abuse (e.g., revenge porn, marketing for human sex trafficking). Cyber space appears to have its own interactive global society with anthropological-sociological and psychosocial cultural values connected to sex and sexuality.

MEGA♪ is scientifically anchored on sizable, diverse, representative samples (N = 2717 and N = 3901) affirming a fourth level of risk (Very High) designed to specifically identify these very dangerous youth. To date, MEGA♪ is the only measure for youth in the field of risk assessment to undergo such extensive study in its development and testing on large diverse representative samples. Accuracy of the risk assessment device utilized to assess the youth’s risk level is paramount. Risk assessment tools need to have a degree of psychometric sophistication (based on normative data, have definitive cut-off scores according to gender and age, and have accurately calibrated risk levels) to be attuned to identifying and assessing the anomalies amongst sexually abusive youth.

Compliance with Ethical Standards

Conflict of Interest

Author states there is no conflict of interest.

Footnotes

1

Erroneously published as 1979–2017 in the online version of Miccio-Fonseca (2018) Family Lovemap article for the Special Issueon Risk Assessment of Sexually Abusive Youth in the Journal of Child Sexual Abuse.

California Coalition on Sexual Offending provided a $2000 research award, which was used for the final statistical analysis of the cross-validation study.

Name of the tool is MEGA♪; copyrighted and registered by the author includes the musical note.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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