There are similarities in these cases when compared with retrospective studies and case reports of serial killers on the role of sexually sadistic fantasies and actual killings. The possibility of developing sexual paraphilias at a young age has been established, so the possibility of adolescents developing sadistic paraphilias can be presumed. This article focuses on how the sexually sadistic fantasy can eventually be acted out, possible motives for the act to be repeated multiple times, and the possibility of predicting the progression from fantasy to actual killing. The article also recommends methods for assessing and treating youngsters who express violent sexually sadistic killing fantasies to facilitate interventions to interrupt the progression to actual killing. Note references