A View from All Sides
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About Problematic Sexual Behaviors (PSB)
What are Problematic Sexual Behaviors (PSB)?
From the time they are babies, children develop sexually, just as they do physically, cognitively, and emotionally. They also exhibit sexual behaviors, and as they grow, children’s sexual behaviors evolve. Children’s sexual behaviors fall on a spectrum, ranging between healthy, concerning, and problematic.
The term “problematic sexual behaviors” is a recent one. You might hear people use other phrases to describe behavior or conduct that may fall into this category, such as “juvenile sex offense,” “sexual misconduct,” or “sexual reactivity.”
Definition of Problematic Sexual Behaviors
Problematic sexual behaviors, also referred to as PSB, are behaviors initiated by children that:
- Involve sexual body parts (i.e., genitals, anus, buttocks, and/or breasts);
- Happen outside of children’s expected developmental trajectory;
- Cause harm to themselves or others; and
- Do not respond to typical caregiving strategies.
When PSB involve two or more children, the National Child Traumatic Stress Network explains that PSB can often have one or more of the following characteristics:
- Involve threats, force, or aggression
- Involve children of different ages or abilities
- Are associated with strong emotional reactions in a child — such as anger or anxiety
- Interfere with typical childhood interests and activities
PSB encompass a very wide array of behaviors, such as when children:
- Repeatedly touch their genitals to the point of needing medical attention
- Repeatedly rub their genitals against a classmate without their consent
- Pressure their significant other to engage in sexual activity
- Publicly masturbate
- Engage in sexual acts with a sibling
- Sexually assault their peers or teacher
- Post sexually explicit videos of themselves or others online
- View images or videos of children engaging in sexual activity
“PSB” is not a clinical diagnosis. However, PSB present behavioral health challenges that children can overcome with the right supports. Children who engage in PSB often present with co-occurring disorders, such as Post-Traumatic Stress Disorder (PTSD), anxiety, depression, or oppositional defiant disorder.1
What do we know about the scope of PSB?
Problematic sexual behaviors (PSB) are prevalent. Studies show that between 35% and 71% of sexual assaults on children are committed by other children.1 Because of this, addressing PSB when they occur is an important part of preventing child sexual abuse.
While we don’t know the proportion of children who engage in PSB, different data snapshots show that, every year, thousands of children engage in PSB in Massachusetts:
- Over 9% of high school students report being a victim of sexual dating violence in 2021. This represents approximately 26,000 students.2
- At least 56 students were disciplined for sexual assault and 526 were disciplined for sexual harassment during the 2023-2024 school year. 3
- According to Massachusetts Children’s Alliance (MACA), MA had 1,500 PSB cases in 2024.
Why Do Children Engage in PSB?
For children, problematic sexual behaviors (PSB) are not always related to sexual stimulation. Often, children who exhibit PSB do so out of curiosity, anxiety, lack of accurate information about their bodies, as part of self-calming or attention-seeking strategies, or imitation. Imitation may stem from exposure to mature adult sexual behaviors.
Additionally, research shows that many of these behaviors can come from trauma. A majority of children with PSB have experienced physical, sexual, and/or emotional abuse. Many others have been exposed to domestic or community violence.4 Other risk factors include inadequate family boundaries around sexuality and nudity, as well as early exposure to pornography.5 PSB can present in various ways, each of which may require a distinct approach to addressing the behavior.
Common Misconceptions about PSB
To best support children engaging in PSB, it is important to understand what science tells us PSB are and what they are not. The table below addresses common questions with evidence-based answers.
When a family member or professional working with a child learns a child in their care has engaged in, or is currently engaging in, PSB, it can be confusing and stressful. But help is available! There are highly effective services and treatment options available in Massachusetts.
Together with the Massachusetts Office of the Child Advocate, the Children’s Trust created this comprehensive guide to help you navigate our state systems with confidence and determine what your next steps should be.
Learn more about how to respond to PSB with this tailored guidance for parents/caregivers and professionals
Sources
1 Early studies examining reports to law enforcement found that “juveniles account for more than one-third (35.6 percent) of those known to police to have committed sex offenses against minors” See: Finkelhor, D., Ormrod, R., and Chaffin, M. (2009, December). Juveniles Who Commit Sex Offenses Against Minors. Office of Juvenile Justice and Delinquency Prevention Bulletin. https://www.ojp.gov/pdffiles1/ojjdp/227763.pdf. A recent survey of a nationally representative sample of 13,052 children ages 0-17 years found that “the majority of offenses were at the hands of other juveniles (76.7% for males and 70.1% for females).” See: Gewirtz-Meydan, A. and Finkelhor, D. (2019). Sexual abuse and assault in a large national sample of children and adolescents. Child Maltreatment, 1(12). https://doi.org/10.1177/1077559519873975
2 Massachusetts Department of Elementary and Secondary Education and Department of Public Health. (2021). Health and risk behaviors of Massachusetts youth. https://www.mass.gov/doc/health-and-risk-behaviors-of-massachusetts-youth-2021/download
3 Massachusetts Department of Elementary and Secondary Education. 2023-24 Student Discipline Data Report. https://profiles.doe.mass.edu/statereport/ssdr.aspx
4 Children who harm other children by engaging in PSB are often victims of abuse themselves. Research shows that between 20% and 48% of children with PSB have experienced sexual abuse and that between 32% and 48% of children exhibiting PSB have experienced physical abuse. Studies have also highlighted that PSB is more common in children exposed to domestic violence. Allen, B. (2017). Children with sexual behavior problems: Clinical characteristics and relationship to child maltreatment. Child Psychiatry and Human Development 48, 189–199. https://doi.org/10.1007/s10578-016-0633-8; Silovsky, J., Niec, L., Bard, D., & Hecht, D. (2007). Treatment for preschool children with interpersonal sexual behavior problems: A pilot study. Journal of Clinical Child & Adolescent Psychology, 36(3), 378–391. https://doi.org/10.1080/15374410701444330 ; Bonner, B. L., Walker, C. E., & Berliner, L. (1999). Children with sexual behavior problems: Assessment and treatment – final report. Grant No. 90-CA-1469. U. S. Department of Health and Human Services, National Clearinghouse on Child Abuse and Neglect; Silovsky, J. F., & Niec, L. (2002). Characteristics of young children with sexual behavior problems: A pilot study. Child Maltreatment, 7(3), 187–197. https://psycnet.apa.org/doi/10.1177/1077559502007003002 ; Friedrich, W. N., Davies, W., Feher, E., & Wright, J. (2003). Sexual behavior problems in preteen children. Annals of the New York Academy of Sciences, 989, 95–104. https://doi.org/10.1111/j.1749-6632.2003.tb07296.x ; Mesman, G., Harper, S., Edge, N., Brandt, T. and Pemberton, J. (2019, May). Problematic sexual behavior in children. Journal of Pediatric Health Care, 33(3), 323-331. https://doi.org/10.1016/j.pedhc.2018.11.002.
6 Allen, B. (2017). Children with sexual behavior problems: Clinical characteristics and relationship to child maltreatment. Child Psy-chiatry and Human Development, 48, 189–199. https://doi.org/10.1007/s10578-016-0633-8 ; Silovsky, J., Niec, L., Bard, D., & Hecht, D. (2007). Treatment for preschool children with interpersonal sexual behavior problems: A pilot study. Journal of Clinical Child & Adolescent Psychology, 36(3), 378–391. https://doi.org/10.1080/15374410701444330 ; Bonner, B. L., Walker, C. E., & Berliner, L. (1999). Children with sexual behavior problems: Assessment and treatment – final report. Grant No. 90-CA-1469. U. S. Department of Health and Human Services, National Clearinghouse on Child Abuse and Neglect.
7National Center on Sexual Behavior of Youth. (2003, July). NCSBY fact sheet: Children with sexual behavior problems: Common misconceptions vs. current findings. https://www.ncsby.org/sites/default/files/2022-08/NCSBY%20-%20CSBP%20Common%20Misconceptions%20vs%20Current%20Findings_0.pdf
8 Harris, M., Lanni, D. and Svendsen, S. (2023) A conceptual analysis of system responses to the issue of problematic sexual behaviors in children and recommendations for future work in Children’s Advocacy Center multidisciplinary teams. Frontiers in Psychiatry 14. https://doi.org/10.3389/fpsyt.2023.1266463
9A meta-analysis of 158 studies from the past four decades including 30,396 adolescent perpetrators found that sexual recidivism rates for juvenile sex offenders have been, compared to general juvenile recidivism rates, consistently low (7–9%). See: Lucier, P., McCuish, E., and Frechette, J. (2023, January). A meta-analysis of trends in general, sexual, and violent recidivism among youth with histories of sex offending. Trauma, Violence, & Abuse, 25(1), 54-72. https://doi.org/10.1177/15248380221137653 ; Kelley, A., Shawler, P., Shields, J. and Silovski, J. (2019, April). A qualitative investigation of policy for youth with problematic sexual behavior. Journal of community psychology, 47(6), 1347–1363. https://doi.org/10.1002/jcop.22187 ; Caldwell M. F. (2010). Study characteristics and recidivism base rates in juvenile sex offender recidivism. International journal of offender therapy and comparative criminology, 54(2), 197–212. https://doi.org/10.1177/0306624X08330016
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