Case studies shape the developmental pathways and complex intervention experiences of adolescents involved in sexually harmful behavior in Indian settings. This chapter provides methodologically rigorous case narratives taken from qualitative interviews from participant research, and ethical case study designs that address issues of anonymity, confidentiality, and research ethics. Four case studies of composite cases that involve different developmental pathways—early-onset accumulation of risk factors, peer-influenced group offending, trauma-based behavior with cultural conflict, and rapid modernization with related identity conflicts—highlight the complexity of individual, family, community, and societal variables that affect adolescent sexual offending. Multidisciplinary intervention approaches with cognitive-behavioral therapy, trauma-informed care, involving families, and community-based rehabilitation are demonstrated to have outcomes. Cases point to tensions between accountability and possibilities for development, and the importance of protective factors and resilience, as well as critically important culturally sensitive and trauma-informed interventions. Analysis shows that good case management involves integrated coordination between mental health, child welfare, educational and justice systems with structural solutions such as poverty, discrimination, and lack of access to services and ongoing adherence to ethical safeguards that protect their dignity and confidentiality as participants.