About Harmful or Problematic Sexual Behaviors (PSB)

What are Harmful or 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 and concerning.

arrow graphic showing healthy, concerning, harmful boxes

Definition of Harmful or Problematic Sexual Behaviors

Harmful or Problematic Sexual Behaviors (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 these behaviors involve two or more children, the National Child Traumatic Stress Network explains that these behaviors 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

These sexual behaviors encompass an array, including 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

These behaviors are not a clinical diagnosis. However, they can present health challenges that children can overcome with the right supports. Children who engage in these behaviors 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 Harmful or Problematic Sexual Behaviors (PSB)

Harmful sexual behaviors are prevalent. Studies show that between 35% and 71% of sexual assaults on children are committed by other children.² Because of this, addressing these behaviors when they occur is an important part of preventing child sexual abuse.

While we don’t know the proportion of children who engage in these behaviors, 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.³

At least 56 students were disciplined for sexual assault and 526 were disciplined for sexual harassment during the 2023-2024 school year.⁴

Children’s Advocacy Centers report 1,500 cases involving PSB in 2024.

Why Do Children Engage in Harmful or Problematic Sexual Behaviors (PSB)

For children, certain sexual behaviors are not always related to sexual stimulation. Often, children who exhibit these sexual behaviors 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. Many children who exhibit these sexual behaviors have experienced physical, sexual, and/or emotional abuse. Many others have been exposed to domestic or community violence^.5 Other risk factors include inadequate family boundaries around sexuality and nudity, as well as early exposure to pornography.⁶ These behaviors can present in various ways, each of which may require a distinct approach to addressing the behavior.

Common Misconceptions about Harmful or Problematic Sexual Behaviors (PSB)

To best support children engaging in sexual behaviors, it is important to understand what science tells us these behaviors are and what they are not. The table below addresses common questions with evidence-based answers.

Do all children who display harmful sexual behaviors have a history of sexual abuse?

Not necessarily. It is true that 20-48% of children who exhibit harmful sexual behaviors have experienced sexual abuse. But there are many other adverse and/or traumatic experiences that can cause them. Other common root causes include experiencing physical abuse, neglect, family challenges (e.g., intimate partner violence, parental mental illness), and community violence.⁷

Do girls exhibit harmful sexual behaviors?

Yes. Children of all gender identities engage in harmful sexual behaviors. Some parents and professionals struggle to recognize that girls can engage in harmful sexual behaviors. This can sometimes lead to caregivers being less likely to report these behaviors in girls as compared to boys. In fact, studies found that girls make up a third of school-age children engaged and upwards of 65% of preschool children with these behaviors.⁸

Do children who have experienced sexual abuse sometimes display sexualized behaviors toward other children?

Not typically. Research shows that 95% of children who have experienced sexual abuse do not go on to display harmful sexual behaviors.⁹

Is there evidence that children who exhibit harmful sexual behaviors are more likely to engage in sexual offending in adulthood?

No. With appropriate supports, most children engaging in these behaviors do not go on to commit sexual offenses in the future.¹⁰ Additionally, most adult sexual offenders do not report that their behaviors began in childhood. Research has not documented a relationship between childhood harmful sexual behavior and adult sexual offending.¹¹

When a family member or professional working with a child learns a child in their care has engaged in, or is currently engaging in, harmful sexual behaviors, 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.

Not sure if a child’s sexual behavior is concerning?

Learn more about how to respond to concerning sexual behaviors with this tailored guidance for parents/caregivers and professionals

Sources

¹ Allen, B. (2022, September). Etiological perspectives on problematic sexual behavior of preteen children: Implications for treatment. Clinical Child and Family Psychology Review, 26, 50-64. https://doi.org/10.1007/s10567-022-00412-5

² 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

³ 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

⁴ Massachusetts Department of Elementary and Secondary Education. 2023-24 Student Discipline Data Report. https://profiles.doe.mass.edu/statereport/ssdr.aspx

⁵Children 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 PSB-CY: Clinical Assessment and Treatment Overview Course Series. Course 1: Clinical Assessment of Children and Youth with Problematic Sexual Behavior”. https://www.ncsby.org/sites/default/files/Problematic%20Sexual%20Behavior%20-Protective%20Factors%20and%20Vulnerabilities%20(1).pdf. Adapted from: 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(1), 95-104. Retrieved from: https://doi.org/10.1111/j.1749-6632.2003.tb07296.x.

⁷ 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.

⁸National 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

⁹Harris, 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

¹⁰A 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

¹¹Silovsky, J. F. & Bonner, B. L. (July, 2003). NCSBY Fact Sheet: Children with Sexual Behavior Problems: Common Misconceptions vs. Current Findings. National Center on Sexual Behavior of Youth https://www.ncsby.org/sites/default/files/2022-08/NCSBY%20-%20CSBP%20Common%20Misconceptions%20vs%20Current%20Findings_0.pdf

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