An overview of the current research literature on harmful sexual behaviour.Key points
The sexual development of all children takes place along a continuum as they grow older and develop. Social and cultural factors and experiences, including abuse and peer pressure, can influence a child’s sexual development and can alter their ideas about sexual relationships. These ideas can lead to a child showing or engaging in harmful sexual behaviour which can be damaging to any children involved.
If a child does start to behave in a worrying manner especially if they use sexual actions or language that they should not be familiar with, it is important to address that behaviour immediately. Harmful sexual behaviours can indicate problems in a child’s life and have a serious negative impact on any other children who are exposed to them.
Harmful sexual behaviour involves one or more children engaging in sexual discussions or acts that are inappropriate for their age or stage of development. These can range from using sexually explicit words and phrases to full penetrative sex with other children or adults (Rich, 2011).
When assessing if a child’s sexual behaviour is harmful, it is important to not only take their age into account but also their physical, intellectual and emotional development.
Sexual behaviour between children is considered harmful if it involves coercion or threats of violence or one of the children is much older than the other. Davies (2012) suggested that there is cause for concern if there is an age difference of more than two years or if one of the children is pre-pubertal and the other post-pubertal.
In addition, Rich (2011) and Yates et al (2012) both stated that a young child can abuse an older child if the older one is disempowered because of disability.
The number of children who display harmful sexual behaviour is not fully known because it can be difficult to recognise and often goes unreported.
Radford et al (2011) found that two thirds of the contact sexual abuse experienced by 0-17 year olds was committed by peers.
Vizard et al (2007) reported that 30% to 50% of sexual abuse is perpetrated by adolescents, the majority of whom are boys.
Abuse and neglect
Children and young people who develop harmful sexual behaviours have usually experienced abuse and neglect themselves.
Jones and Ramchandani (1999) stated that around 50% of children with harmful sexual behaviours had been sexually abused themselves. Yates (2012) found all the children in his study of children with harmful sexual behaviour had experienced physical, emotional or sexual abuse.
Vizard (2007) suggested that parental mental health or domestic violence may also have an impact but this has not been fully explored.
Hawkes (2008) showed that previous abuse and neglect means that some children are unable to develop normal responses to distress or arousal and are confused about what is normal and appropriate behaviour. Yates et al (2012) suggested that children who abused siblings had different motivations to those who abused children from outside the home and those who abused siblings were often motivated by jealousy and anger as opposed to sexual arousal.
Pullman and Seto (2012) have linked the behaviours of sexually abusive adolescents with those who display other criminal behaviours. They note that a child who is showing signs of criminality may move towards acts of harmful sexual behaviour if they have a history of sexual abuse themselves or have had early exposure to pornography or sexual abuse.
Rich (2011), used a framework that compares the backgrounds of sexually abusive children with young offenders. He found that children who develop harmful sexual behaviours are likely to:
Cultural aspects can also play a role in how children develop ideas about sexuality and sexual behaviour. The huge changes in social media and mobile phone technology over the last decade have led to a massive shift in many children’s ability to access and share sexual images and other sexual content.
Research carried out for the NSPCC into sexting among young people (Ringrose et al, 2012) found that the widespread use of sexual language and images among children and young people had influenced their behaviour. Children are being exposed to sexual ideas and concepts at a much younger age. This is reflected in their cultural practices of using sexual language, sharing sexual images and taking part in sexualised acts. The research showed that in many cases these images and acts were obtained through coercion or threats and that some girls felt there was pressure on them to participate in order to gain acceptance from their peers.
The research found that children and young people have become normalised to acts of sexual aggression and sexual exploitation and highlighted how intricately these have become embedded in their peer culture. The exchange of sexual images of girls is almost a form of currency among boys and the accumulation of pictures and sexualised messages is a means of building a reputation. The research indicated that because of these sexualised practices, children are entering adulthood with a skewed impression of what is appropriate sexual behaviour (Ringrose, 2012).
Durham (2006) explored how harmful sexual behaviour is closely linked to gender roles and the perception of masculinity. He also included aspects of homophobia and racism which act to reinforce misplaced aggression and ideas about male domination. These ideas are then reinforced through media images and mainstream pornography.
Erooga and Masson (2006) mentioned the importance of power as a factor in sexual abuse and built on the work of Finkelhor and Browne (1985) to explain how a child’s early powerlessness during their own abuse can lead to them needing to dominate others.
Victims of harmful sexual behaviour may not know that what has been done to them is wrong, especially if it is seen as normal among their peers (Ringrose et al, 2012).
This normalisation can lead to them in turn behaving like this towards others (Brown, 2011 ). For many the fear and intimidation that was used to coerce them into taking part in these sexual activities will have serious long term effects on their emotional and developmental well-being (Goodyear-Brown, 2012). Many of the effects of these abusive situations can lead to the same effects that are associated with sexual abuse by adults.
The perpetrators of harmful sexual behaviour may themselves be suffering from the effects of previous abuse and their behaviours may be part of their reaction to it. Providing therapeutic support to children displaying these behaviours can help increase their resilience to behaving in a way that can harm themselves or others (Hackett, 2006).
The importance of service provision
Studies in the US have shown that up to 30% of children with harmful sexual behaviour go on to commit sexual offences as adults if they do not receive any treatment. For those children who do receive treatment, however, the figure drops to between 5% and 14% (Rich, 2011).
Janes (2011) found that children who received therapeutic support were less likely to go on to commit abuse as an adult compared to children who received no support.
Approaches to treatment
The causes of harmful sexual behaviour are wide ranging and involve a variety of aspects from a child’s life. This means that treatment must take a holistic approach and not just attempt to change the child’s behaviour but must examine and treat any factors that could be causing the child to engage in harmful sexual behaviour (Hackett, 2006).
Helping children with harmful sexual behaviour should include elements of sexual offence specific work, but St. Amand, Bard and Silovsky (2008) warned that seeing a child only as an offender can do more harm than good.
Multisystemic therapy (MST)
Treatment for children and young people with harmful sexual behaviour was originally based on the same models used for adult offenders (Smallbone et al, 2008). Recent changes in thinking have drawn more comparisons between children with harmful sexual behaviours and youth offenders rather than adult sexual offenders (Beerhuizen and Brugman, 2012; Janes, 2011; Pullman and Seto, 2012).
This shift in thinking resulted in many programmes and services being based on multisystemic therapy (MST).
MST is based on the idea that negative outcomes, such as, harmful sexual behaviour are a result of the relationships that children have. These can include relationships with family, peers, school, the wider community or any services that they may have contact with.
MST uses outcome focused interventions to directly alter harmful or negative relationships to reduce the triggers that can cause harmful sexual behaviours (Smallbone et al, 2008; Henggeler et al, 2009).
In the UK, there are several centres of good practice that provide therapeutic support for harmful sexual behaviour in children.
The Greater Manchester Adolescent Project (GMAP), the Assessment, Intervention, Moving on (AIM) and the National Clinical Assessment and Treatment Service (NCATS) are all services that have developed good frameworks for assessing and treating children with harmful sexual behaviour (Brown, 2011).
In other parts of the UK, however, the provision of services is patchy.
Beerthuizen, M and Brugman, D. (2012) Sexually abusive youths' moral reasoning on sex. Journal of Sexual Aggression, 18(2): 123-135.
Brown, J., O'Donnell, T. and Erooga, M. (2011) Sexual abuse: a public health challenge. London: NSPCC.
Davies, J. (2012) Working with sexually harmful behaviour [Article]. Counselling Children and Young People, March 2012: 20-23.
Durham, A. (2006) Young men who have sexually abused: a case study guide. Chichester: Wiley.
Erooga, M. and Masson, H. (2006) Children and young people with sexually harmful or abusive behaviours: underpinning knowledge, principles, approaches and service provision. In: Erooga, M. and Masson, H. (eds.) Children and young people who sexually abuse others: current developments and practice responses. 2nd ed. London: Routledge.
Finkelhor, D. and Browne, A. (1985) The traumatic impact of child sexual abuse: a conceptualization (PDF). American Journal of Orthopsychiatry, 55(4): 530-541.
Goodyear-Brown, P. (ed.) (2012) Handbook of child sexual abuse: identification, assessment, and treatment. Hoboken, New Jersey: Wiley.
Hackett, S. (2006) Towards a resilience-based intervention model for young people with harmful sexual behaviours. In: Erooga, M. and Masson, H. (eds.) Children and young people who sexually abuse others: current developments and practice responses. 2nd ed. London: Routledge.
Hawkes, C. (2009) Sexually harmful behaviour in young children and the link to maltreatment in early childhood: conclusions from a UK study of boys referred to the National Clinical Assessment and Treatment Service (NCATS), a specialist service for sexually harmful behaviour (PDF). London: NSPCC.
Henggeler, S et al (2009) Mediators of change for multisystemic therapy with juvenile sexual offenders. Journal of Consulting and Clinical Psychlogy. 77(3). 451-462.
Janes, L. (2011) Children convicted of sexual offences: do lifelong labels really help? The Howard Journal of Criminal Justice, 50(2): 137-152.
Jones, D. and Ramchandani, P. (1999) Child sexual abuse: informing practice from research. Abingdon, Radcliffe Medical Press.
Pullman, L. and Seto, M.C. (2012) Assessment and treatment of adolescent sexual offenders: implications of recent research on generalist versus specialist explanations. Child Abuse and Neglect, 36(3): 203-209.
Radford, L. et al (2011) Child abuse and neglect in the UK today. London: NSPCC.
Rich, P. (2011) Understanding, assessing and rehabilitating juvenile sexual offenders. 2nd ed. New Jersey: Wiley.
Ringrose, J. (2012) A qualitative study of children, young people and 'sexting': a report prepared for the NSPCC. London: NSPCC.
Smallbone, S., Marshall, W. and Wortley, R. (2008) Preventing child sexual abuse: evidence, policy and practice. Cullompton, Devon: Willan Publishing.
St. Amand, A., Bard, D.E. and Silovsky, J.F. (2008) Meta-analysis of treatment for child sexual behavior problems: practice elements and outcomes. Child Maltreatment, Vol.13, Iss.2. pp 145--166.
Vizard, E. et al (2007) Children and adolescents who present with sexually abusive behaviour: a UK descriptive study (PDF). Journal of Forensic Psychiatry and Psychology, 18(1): 59-73.
Yates, P., Allardyce, S. and MacQueen, S. (2012) Children who display harmful sexual behaviour: assessing the risks of boys abusing at home, in the community or across both settings. Journal of Sexual Aggression, 18(1): 23-35.
News on harmful sexual behaviour
Keep up to date with the most recent developments on working with adult sex offenders pulled from CASPAR, the current awareness service for child protection policy, practice and research.
Practice resources and research on harmful sexual behaviour
A list of publications and online resources for professionals working with children.
The treatment of young people with harmful sexual behaviour: an evaluation of a manual based approach
A treatment programme for children and young people displaying harmful sexual behaviour using the Change for good manual.
National Clinical Assessment and Treatment Service (NCATS)
A national centre of expertise on children and young people who show harmful sexual behaviour.
Search the NSPCC Library Online for more research on harmful sexual behaviour in children and young people.