In discussing definitional issues, the author supports a new category of "sexual arousal disorder of childhood." This description would allow the child's need for specialist assessment and treatment services to be addressed at an early point, so as to prevent patterns of sexual offending. A review of theoretical issues concludes that there is no single theoretical approach that can span the whole range of issues that arise in clinical work with young sex offenders. An assessment model for adolescent sex offenders involves a semistructured approach for discussing difficult, embarrassing, and dangerous behavior with juveniles. It involves the use of a pictorial representation of the thoughts, feelings, and fantasies, as well as the actions of the offender (Vizard et al. 1996). This has proven helpful in the assessment of risk and treatability. The themes that have stemmed from group and individual work with juvenile sex offenders suggest that their sense of rejection by adults also stems from a real rejection of their treatment needs by professionals in the field. Two clinical vignettes are appended.