4.15 Harmful Sexual Behaviour

1. Introduction

This procedure provides a clear, coordinated framework for professionals across Buckinghamshire to:

• Identify and respond to concerns about harmful sexual behaviour promptly and effectively.
• Ensure the safety and welfare of all children involved, including victims and those displaying HSB.
• Promote a consistent multi-agency approach, involving Children’s Social Care, Police, Youth Offending Service (YOS), Child and Adolescent Harmful Behaviour Services (CAHBS), education, and health.
• Support early intervention and therapeutic responses to reduce risk and prevent escalation.

2. Definitions

The term ‘harmful sexual behaviour’ describes a continuum of behaviours displayed by children and young people under 18, ranging from those considered ‘inappropriate’ at a particular age or developmental stage to ‘problematic’, ‘abusive’ and ‘violent’ behaviours (Hackett). The NSPCC uses the following definitions:

• Problematic sexual behaviour (PSB) is developmentally inappropriate or socially unexpected sexualised behaviour which does not have an overt element of victimisation or abuse.
• Harmful sexual behaviour (HSB) is developmentally inappropriate sexual behaviour displayed by children and young people which is harmful or abusive.
• Peer-on-peer sexual abuse is a form of HSB where sexual abuse takes place between children of a similar age or stage of development. Child-on-child sexual abuse is a form of HSB that takes place between children of any age or stage of development.

Problematic or harmful sexual behaviour can include:

• frequently and intentionally accessing age inappropriate sexual material online;
• using inappropriate language;
• undertaking mutual sexual activity they are not ready for with peers;
• sending and receiving illegal images;
• sexual interactions where there are significant power differences, lack of consent, or with force or threats;
• engaging in abusive or sexually violent sexual behaviour online or offline.

3. Overview

Research by the Centre of Expertise on Child Sexual Abuse shows that in pre-adolescent children, behaviour is more likely to be at the ‘inappropriate’ or ‘problematic’ end of the continuum. Most pre-adolescent children displaying harmful sexual behaviour have themselves been sexually abused or experienced other kinds of trauma or neglect.

Older children and young people displaying harmful sexual behaviour are mostly boys, many of whom have a history of adverse childhood experiences and family difficulties.

Most sexually abused children and young people do not go on to abuse others, and the majority of children and young people displaying harmful sexual behaviour do not commit sexual offences as adults. However, older adolescents who abuse younger children, and those whose sexual behaviours involve violence, are at greater risk of further sexual offending.

The limited research into technology assisted harmful sexual behaviour suggests that boys who engage ‘only’ in watching images of child sexual abuse online have far less troubled histories than those who commit other sexual offences. There may sometimes be a link between viewing online pornography and subsequent harmful sexual behaviours.

There is limited published research on effective interventions, particularly at the ‘problematic’ end of the continuum, although there is a general consensus that interventions need to be holistic, child-focused and involve parents/carers.

Professionals working with children need knowledge and skills to respond to harmful sexual behaviour, and to create organisational contexts which maximise safety from abuse. Prevention education should take a long-term, ‘whole school’ approach to healthy relationships, and involve children and young people in development and delivery. Broader public health approaches which challenge gender inequality and patriarchal values and attitudes are also required.

The Harmful Sexual Behaviour (HSB) Framework and Audit: An Evidence-informed Operational Framework for Children and Young People Displaying Harmful Sexual Behaviours (Hackett, Branigan, and Holmes, NSPCC) covers the essential elements of developing and delivering an integrated and effective HSB service for children, young people and their families:

• a continuum of responses to children and young people displaying HSB;
• prevention, identification and early assessment;
• effective assessment and referral pathways;
• interventions;
• workforce development.

4. Hackett’s Sexualised Behaviour Continuum

Hackett’s continuum presents sexualised behaviour as a range from ‘normal’ to ‘inappropriate’, ‘problematic’, ‘abusive’ and ‘violent’ (Hackett, Children, Young People and Sexual Violence, in Barter and Berridge Children Behaving Badly? Exploring Peer Violence Between Children and Young People, Wiley). See Continuum Guide (NSPCC)

See the Understanding Sexualised Behaviour in Children (NSPCC) for further information.

Diagram of the Hackett Continuum.

4.1 Developmentally typical (green) behaviours

The NSPCC use the term ‘developmentally typical’ to describe behaviours that are green on the continuum –  these green behaviours might also be termed ‘healthy’, ‘normal’ or ‘developmentally expected’.

Green sexual behaviour:

• is developmentally expected and socially acceptable;
• is consensual, mutual and reciprocal;
• involves shared decision making.

4.2 Problematic (amber) behaviours

The NSPCC use ‘problematic sexual behaviour’ (PSB) as an umbrella term for all amber behaviours. On the Hackett continuum, amber behaviours are described as ‘inappropriate’ or ‘problematic’.

Inappropriate behaviour

inappropriate behaviour includes:

• single instances of developmentally inappropriate sexual behaviour;
• behaviour that is socially acceptable within a peer group but would be considered inappropriate outside that group;
• generally consensual and reciprocal;
• may involve an inappropriate context for behaviour that would otherwise be considered normal.

Problematic behaviour

Problematic behaviour includes:

• developmentally unusual and socially unexpected behaviour;
• may be compulsive;
• consent may be unclear and the behaviour may not be reciprocal;
• may involve an imbalance of power;
• does not have an overt element of victimisation.

4.3 Harmful (red) behaviours

Red sexualised behaviours are harmful to the child who displays them, as well as the people the behaviour is displayed towards. The NSPCC refer to all red sexual behaviours as ‘harmful sexual behaviour’ (HSB). Hackett divides these into ‘abusive’ and ‘violent’ behaviours.

Abusive behaviour

Abusive behaviour includes:

• intrusive behaviour;
• may involve a misuse of power;
• may have an element of victimisation;
• may use coercion and force;
• may include elements of expressive violence;
• informed consent has not been given (or the victim was not able to consent freely).

Violent behaviour

Violent behaviour includes:

• physically violent sexual abuse;
• highly intrusive;
• may involve instrumental violence which is physiologically and/or sexually arousing to the perpetrator;
• may involve sadism.

5. Children and Young People who Display Harmful Sexual Behaviour

An understanding of how children develop sexually can help practitioners recognise which sexual behaviours are developmentally typical and identify if a child is displaying behaviour that is problematic or harmful.

Sexual Development and Behaviour in Children (NSPCC) contains information about the stages of typical sexual development and behaviour for different age groups.

5.1 Pre-adolescent children

While the behaviour of some pre-adolescent children may be ‘problematic’, it is seldom intentionally abusive. Many pre-adolescent children displaying harmful sexual behaviour have been sexually abused or exposed to developmentally inappropriate sexual experiences, such as seeing pornography. Their behaviour may be a way of communicating what has happened to them or an indirect response to other factors in their lives, including other forms of trauma and neglect.

5.2 Adolescents

The early teens are the peak time for the occurrence of harmful sexual behaviour. The vast majority of adolescents who display such behaviour are male, but it is rare for research or practice to focus on the significance of gender.

Most research has been conducted with criminal justice or ‘clinical’ populations and has repeatedly found that boys who have committed a sexual offence, or have been referred to specialist services because of concerns about their behaviour, generally have other major difficulties in their lives; these include experience of physical or sexual abuse or neglect, witnessing domestic violence, or having parents with mental health or substance abuse issues. Adverse childhood experiences tend to be more strongly linked to antisocial behaviour in males than in females.

Adolescents displaying abusive or violent sexual behaviour are, like their peers whose offending behaviour is non-sexual, likely to have low self-esteem, poor social skills and difficulties with anger, depression and peer relationships.

When harmful sexual behaviour involves siblings, it may occur within a context of family violence and neglect. Compared with other intra-familial abuse, it may occur more often and over longer periods, and be more likely to involve intrusive and penetrative acts.

It is increasingly recognised that some forms of sexual harassment and abusive behaviours between adolescents are so commonplace in schools and colleges that some young people may regard them as ‘normal’. Higher levels of general antisocial behaviour tend to be shown by adolescents who behave in sexually harmful ways towards their peers, compared with those whose harmful sexual behaviour targets younger children.

5.3 Children with learning disabilities or autism

Children and young people with learning disabilities are more vulnerable both to being sexual abused and to displaying inappropriate or problematic sexual behaviour; in one large UK study, 38% of under-18s referred to specialist services because of harmful sexual behaviour were assessed as having a learning disability. However, it is likely that the high level of adult supervision of children and young people with learning disabilities means that their sexual behaviour is more likely to be observed and problematised.

Reasons why some children and young people with learning disabilities may be more likely to display harmful sexual behaviour include having less understanding that some sexual behaviours are not acceptable, and fewer opportunities to establish acceptable sexual relationships; receiving less sex education; struggling with social skills; and relating more easily to children younger than themselves.

While research suggests that individuals with autism spectrum disorders are not at increased risk of offending generally, a proportion of harmful sexual behaviours in individuals with autism may result from specific difficulties in understanding what other people may be thinking or feeling.

5.4 Girls and young women

Most research into harmful sexual behaviour is based on male populations or includes only small numbers of girls. However, studies have found that girls and young women displaying abusive sexual behaviour are likely to have experienced more victimisation (including intra-familial sexual abuse, other forms of abuse and frequent exposure to family violence) than boys. Two UK studies found that, compared to boys, girls who sexually harmed had typically experienced more chronic and extensive maltreatment in childhood, had been sexually abused at an earlier age and were more likely to have been abused by more than one person.

Harmful sexual behaviour tends to be identified at a younger age in girls than in boys, and tends to involve younger victims. It is relatively rare for girls’ abusive sexual behaviour to involve the use of physical force. Girls displaying harmful sexual behaviour are less likely than boys to be charged with an offence, in part because they and their victims tend to be younger – but, like boys who display harmful sexual behaviour, they often have difficulties in school and relatively high levels of learning difficulties.

Girls’ Talk (Barnado’s) is a resource pack for practitioners supporting girls who have displayed harmful sexual behaviour to develop healthy sexual relationships.

6. Responding to an Incident

All incidents of harmful sexual behaviour require an immediate and appropriate response. Practitioners becoming aware of incidents of harmful sexual behaviour must act appropriately to support and protect both children who have displayed the behaviour and those who have been impacted by the behaviour. Practitioners should discuss with their safeguarding lead whether a referral to children’s social care should be made (see Referrals chapter) Where a child is in immediate danger or a possible criminal offence has been committed, the police must be notified. Where there is an imminent risk of serious harm, steps may be need to ensure the child’s immediate protection (see Immediate Protection chapter).

Keeping Children Safe in Education part Five: Child on Child Sexual Violence and Sexual Harassment (Department for Education) sets out specific guidance for educational establishments. Locally, CABS (Child and Adolescent Harmful Behaviour Service) can support children and young people in Oxfordshire and Buckinghamshire about whom there are concerns in relation to harmful sexual behaviour (HSB).

7. Assessment

For information on assessments, see Assessments chapter. Specific considerations will apply in cases of harmful sexual behaviour. In all cases it is important to undertake an holistic assessment which gives as clear a view as possible about the child or young person’s sexual behaviours and the degree to which, for a child of that age, they should be considered healthy, inappropriate, problematic or abusive.

Harmful Sexual Behaviour among Children and Young People (NICE) distinguishes between early help assessments and more specific HSB risk and needs assessments.

The NICE guidance states that an ‘early help’ assessment is warranted when a child’s sexual behaviours are indicated at the level of ‘inappropriate’ on the continuum. NICE suggests that a designated lead practitioner acts as a single point of contact for the child and family, coordinates early help and develops a care plan to deliver agreed actions. A NICE early help assessment would take into account the child or young person’s development status, gender identity and any neurodevelopmental or learning disabilities. The purpose of the assessment is to ascertain whether the child’s needs can be met by universal services or whether a referral for a more specialist HSB risk and needs assessment is necessary.  Early help may help to prevent escalation of sexual violence.

For children and young people whose sexual behaviours are more indicative of abusive and violent categories on the continuum model, a more specific assessment of risk and need is likely to be required. NICE recommends that professionals responsible for risk assessments should use age-appropriate assessment tools, taking into account the child or young person’s age, neurodevelopmental disabilities, learning disabilities and gender identity.  Whichever tool is used, effective assessment practice should include holistic, child-focussed, multi-agency assessments that examine the needs met by the behaviour, any underlying reasons or triggers, and protective factors and strengths that can be used to manage or reduce HSB.

It is vital to assess parental capacity to protect their children, the ability to manage a safety plan, and their capability to meet the needs of their children while considering the wider demands on the family.

8. Interventions

Interventions are required to deal with a highly diverse group of children and young people and their families. Interventions should be tailored to the specific needs of the child and family, rather than applied routinely to all. Research suggests that a tiered approach to intervention is most appropriate, which distinguishes children and young people whose needs can be met through parental monitoring, through those who need limited psycho educative support, from those who would benefit from more specialist intervention services and placements.

Effective support should target presenting sexual behaviour problems as well as broader issues in the child or young person’s early experience (unresolved trauma, experiences of abuse, family issues). Resilience models aim to mobilise the child or young person’s strengths and reduce the risk of repeat harmful sexual behaviour by helping them develop positive relationships and pro-social ambitions.