Professionals

This web site presents an overview of the latest research findings and best practices for professionals working with youth with PSB.

Your Guiding Principles

Situations involving problematic sexual behavior (PSB) of youth are complex and unique. That’s a central idea to keep in mind as we try to help you better understand PSB. You’re equipped with experience and expertise in your profession. This information is designed to build on your foundation with best practices to address PSB of youth.

On the surface, problematic sexual behavior of youth might resemble behaviors of adults who have committed sex crimes. But we caution you to not view youth behavior the same way. The origins, motives, and responses to intervention are distinct. Life circumstances and individual factors influence a youth’s path.

The National Center on the Sexual Behavior of Youth has developed Guiding Principles to set the standard of practice for professionals working with youth with problematic sexual behavior. These principles are designed to complement specific professional standards of practice.

Each youth’s behavior must be conceptualized with a developmental framework. Motivations and causal factors differ by developmental periods and generally have little in common with adults who commit sex offenses. Children’s social, emotional, language, and cognitive development and functioning should be considered in conceptualizing and responding to PSB of youth. A developmentally appropriate approach capitalizes on the malleability and responsivity of youth.

Effective response starts at the moment PSB of youth is identified. Once identified, best interdisciplinary practice streamlines pathways to establish safety of all children, conduct assessment, engage in recommended intervention, and implement community response.

Children and adolescents displaying problematic behavior are unique individuals. You must examine the individual youth and family’s needs, risks, vulnerabilities, strengths, and other characteristics that facilitate positive intervention responses. The best safety plans, placement, treatment, and community responses are objective and tailored to the situation.

“Juvenile sex offender,” “perpetrator,” and similar terms can lead to misconceptions, harsh decision-making, and discrimination. We recommend people-first language that labels behavior rather than the youth. Consider “children with problematic sexual behavior” or “adolescents with problematic or illegal sexual behavior.” Attention should be given to the labels used and the longevity of the information within documentation systems to avoid inappropriately stigmatizing and negatively impacting future decision making. Consider efforts to document the behavior in the context of the setting and time rather than labeling the child.

Family members, peers, and other community members have fundamental influences on youth’s growth, development, decision-making, and behavior. Effective interventions directly involve parents and caregivers. They establish safety and support the youth’s healthy development. Your goal is building social bonds, positive support, and peer groups. We want to promote healthy development.

PSB of youth can have a rippling impact on the other children involved, family members, and others in the social system. There is great complexity in situations when PSB of youth occur within a family. The needs of all family members should be considered. Decisions about supervision, safety planning, intervention, and placement are made with understanding of the needs, wishes, protective capacity, risks, vulnerabilities, and responsivity to interventions of all family members.

Promoting safety and addressing the needs of all the children, including child victims and siblings, are critical. Collaborative responses of law enforcement, child protective services, juvenile justice, attorneys, school personnel, health and behavioral health professionals, child advocates and others are better than multiple unilateral actions. Integrating the family’s voice is critical. Collaborative coordinated approaches improve outcomes for youth and families, and it promotes sounder policies and procedures.

High quality, holistic assessments use evidence-based practices and positively engage youth and their families. They examine case-specific needs, problems, and strengths. They define individual, family, and community targets for reducing risks and promoting healthy development. They reflect current functioning and circumstances. They include reassessments as the child develops. They integrate information from multiple sources. 

Targeted interventions are designed to eliminate problematic behaviors, reduce trauma impact, enhance well-being, and make family interactions healthier. Treatment is informed by assessment, matches the most urgent needs, and facilitates protective factors. Needs are often complex, but avoid tackling too much at once by requiring multiple services at the same time. Too many interventions at once can overwhelm families and be less effective. Prioritizing is key.

A continuum of care is needed that flexibly meets the needs of the youth with PSB, child victims, and family members. Interventions provided should be no more restrictive than what is needed for community safety and child well-being. Community and home-base interventions are generally safe and effective. They present opportunities for healthy and pro-social development. When out-of-home placements and more restrictive interventions are necessary for safety or behavioral health reasons, these placements should be as short in duration as possible. Transition and reintegration plans should start with admission while maximizing caregiver/family involvement.

Professionals have significant impact on the children, youth, and families. Relevant coursework, degrees, supervision and advanced training ensure professionals are qualified to work with youth and families. Professionals must have essential training in child and adolescent development and problematic and illegal sexual behavior of youth. Continuing education and training helps professionals stay current with empirical research on the PSB of youth, evidence-based practices and best policies. Professionals employ guidelines and ethical standards (such as, the Association of the Treatment and Prevention of Sexual Abuse Standards and Guidelines). Professionals recognize and practice within the scope of their profession and abilities.

Sound and effective public policies and practices are grounded in the best available research. Research is ever-evolving and thus, policies should respond accordingly. When new practices or policies are piloted or implemented, ongoing evaluation is needed to examine impact. Public policies found to be harmful should be rectified.

 

Note: We wish to acknowledge the contributions Dr. Sue Righthand and of the Oklahoma Workgroup on Problematic Sexual Behavior of Children to the updates of the guiding principles

 
Overview and Definitions

Sexual Development and Behavior

Humans are innately sexual beings, and sexual development begins in utero and continues throughout the lifespan. However, the expression of sexual behavior relies on social learning, as well as physiological and psychosocial reinforcement. It is important to acknowledge that context determines attitudes and beliefs regarding sexual behavior and what is considered appropriate. This variability is evident in diverse state laws, various perspectives, religion or a range of family beliefs. Consequently, parents or caregivers may not necessarily approve of sexual behavior that is considered normative or typical. When we use the term "normative sexual behavior," we refer to what is common or typical for a specific developmental age, rather than what a particular group or individual desires.

Overview

Normative Sexual Behaviors

Normative sexual behaviors are behaviors that involve parts of the body considered to be “private” or “sexual” (e.g., genitals, breasts, buttocks, etc.). These behaviors may be referred to as “sex play,” and are normally part of growing up for many children and adolescents. They are not considered to be harmful by most experts. For more information click here.

childhood sexual

Problematic Sexual Behaviors

Problematic Sexual Behaviors are deviations from normative or typical sexual behavior. They are child-initiated behaviors involving sexual body parts (i.e., genitals, anus, buttocks, or breasts) and are developmentally inappropriate and/or potentially harmful to themselves or others. Problematic sexual behaviors may involve behaviors that are entirely self-focused such as excessive masturbation, or behaviors that involve other children, such as touching other children’s genitals or sexual intercourse. Normative sexual behaviors may become problematic sexual behaviors when it increases in frequency and doesn’t respond to parenting strategies. Problematic sexual behaviors are a set of behaviors that are not normative, are considered unacceptable by society, and can cause impairment in functioning. For more information click here.

Why do children engage in sexual behaviors?

Professionals must consider the reasons why children engage in normative or problematic sexual behaviors. Although the term "sexual" is used, the intentions and motivations for these behaviors in children often are unrelated to sexual gratification. Rather, the behaviors may reflect curiosity, imitation, attention-seeking, anxiety, reenacting trauma, self-calming, loneliness, boredom, or anger. Problematic sexual behaviors are not always “caused” by having been sexually abused. Problematic sexual behavior may be related to other types of trauma, such as experiencing physical violence. Click here for more information about causes of problematic sexual behavior in children.

Adolescence is a time of life rapidly changing and evolving experiences with changes in physical, social, emotional, cognitive, and sexual development. Learning how to manage sexual arousal is an important milestone for many youth in puberty. As a result, when adolescents focus their sexual behavior on prepubescent children, do NOT assume their motivations reflect exclusive sexual arousal to young children—such interests are rare in teens. When teens engage prepubescent children in sexual behavior, such actions may be a response to a perceived opportunity rather than suggestive of problematic attraction to young children. Factors that contribute to a teen demonstrating problematic or harmful behavior are complex and vary.

Sex Play

Sex play between children, where behaviors and play activities are focused on body parts and functioning, is a normal part of child development. This play involves children exploring each other’s bodies and roles. It is natural for children to have curiosity about sexual behavior, their own and others’ bodies, and to show interest in sexual activities. Sex play is different from problematic sexual behavior. Sex play occurs between children of similar age, size, development, and abilities. Children typically know and play with each other regularly, such as siblings, other children in the family, neighbors, or friends, rather than among strangers. The children involved in sex play may be of the same or different sex. As children get older and more aware of the social rules, their sexual behavior, including sex play, becomes hidden and is generally not known to caregivers. Sexual play is periodic, by mutual agreement, and lighthearted. When any child is in distress or does not agree to the behavior, or when the sexual behavior becomes planned, frequent, or intrusive, there are causes for concern.

Normative Sexual Behavior

Normative Sex Knowledge and Behaviors by Age

Physical Development in children in the preschool years is a time of growth and developing competency in gross and fine motor coordination. Supervision and guidance for children in this age group is needed because their judgment and problem-solving skills are just beginning to be developed. They are constantly moving and learning through involvement in activities.

Sexual Knowledge

  • Children as young as 3 years of age can identify themselves. Initially, distinctions between sex are based on visual factors found in their culture, though by age 3 or 4 many are aware of genital differences. 
  • Preschool children's understanding of pregnancy and birth tends to be vague until about age 6.
  • Knowledge of adult sex behavior is most often limited to behaviors such as kissing and cuddling until about age 6 years when perhaps a quarter of children report knowledge of more explicit adult sexual behavior.

Sexual Behavior

Preschool children are curious in general and tend to actively learn about the world through listening, looking, touching, and imitating. Preschool children's general curiosity about the world manifests with questions as well as exploratory and imitative behaviors including sexual body parts. These sexual behaviors often occur in public and include:

  • Looking at others when they are undressing or nude
  • Intruding on others' physical boundaries (e.g., standing too close to others)
  • Showing private parts (e.g., being "silly" or not knowing rules about privacy)
  • Touching their own genitalia
  • Touching adults' breasts (particularly their female caregiver's)

Some children dress or play in ways culturally considered to be of the opposite sex--this is normal and not considered a sexual behavior. Children's touching of their own private parts is not the same behavior as what adults view as "masturbation."

They may touch their private parts if they itch or if they are exploring their own body. Young children seek experiences that are calming and pleasant, such as, they suck their thumb, they rub on soft blankets, and they periodically touch their private parts because it feels good.

There are several sex behaviors that are NOT normative in preschool children. These include intrusive, planned, or aggressive sex acts, putting their mouth on another child's sex parts, and pretending toys are having sex.

Physical Development

Girls often begin puberty earlier than boys and breast development can start as early as 7 or 8 years of age. Boys and girls progress through five stages of puberty but the onset and length of time in each stage varies. Early or delayed onset of puberty can have a significant impact on the social adjustment of youth.

Sexual Knowledge

Knowledge of pregnancy, birth, and adult sex activity expands greatly during the school-age period and may influence sexual behaviors. By age 10, most youth have a basic understanding of puberty, reproductive processes, and childbirth. The accuracy of children's knowledge depends on their exposure to correct informal and formal educational material.

Sexual Behavior

School-age children's sexual behaviors become more guided by societal rules.

  • Sexual behavior, including sex play, continues to occur throughout the school-age period. The behavior tends to be more concealed, and caregivers may not be aware of the children's behavior.
  • School-age children become increasingly more interested in media and are more likely to seek out television and pictures that include sexual behavior and nudity. (American Psychological Association report on the impact of media on the sexualization of girls.)
  • Self-touch and masturbatory behaviors occur among girls and boys equally, with an increase in frequency particularly among boys during this developmental period.
  • Modesty emerges during this developmental period, particularly with girls who often become shy and private about undressing and hygiene activities.
  • Sexual attraction to same age peers increases near the end of this developmental period with interactive behaviors typically beginning with playful teasing of others. Few children are involved in more explicit sex activities including sexual intercourse at the end of this developmental period (on average 6% of children under 13 years of age report sexual intercourse.

Adolescence may be conceptualized as a dramatic time of child development spanning the second ten years of life. Puberty and other significant physical, social, emotional, and intellectual changes, and sexual development, mark this ever fluctuating and sometimes emotionally unstable period of life. Significant brain development occurs during adolescence with rapid growth and related cognitive, social-emotional, and behavioral changes continuing until the early to mid-twenties.

Physical & Sex Development

During adolescence, pubertal development continues. For most youth, physical growth is complete by mid adolescence.

Adolescent sexual development includes not only physical changes, but the development of oneself as a sexual being. Adolescents are becoming increasingly aware of their sexual attractions and interests, including sexual orientation.

Young Adolescents

School children and young adolescents ages 9 to 13 may experience a substantial increase in sexual thoughts and feelings. One's first feelings of sexual attraction may occur as early as 9 to 12 years of age with onset of sexual fantasies occurring several months to one year later. This development may be followed by a "surge" of sexual interest and attractions. The physiological changes associated with puberty include increased levels of sex hormones further impact feelings of sexual arousal, attraction, and fantasies. Nocturnal emissions and the onset of menstruation are signs that the adolescent has reproductive capability.

Middle and Late Adolescence

By middle adolescence, which generally includes youth between 13 and 16 years, physical puberty may be almost complete. During this time sexual thoughts and feelings as well as sexual behavior expand further. In late adolescence, which typically includes 17 to 19 year olds, sexual thoughts, feelings, and activities may continue to significantly increase.

For example, youth may become involved in a relationship that includes sexual intimacy. Brain development does not cease at age 18 or 19 and significant social-emotional and intellectual growth relevant for healthy and pro-social behaviors can be expected to continue.

Developmental differences between young adolescents and older adolescents have been noted in brain growth, as well as in their social, emotional, and behavioral repertoires. Despite these overall patterns, it also is important to consider the tremendous variation in developmental milestones among teens.

Further, there may be "mismatches" in the rates of development across domains for individual youth. For example, a girl may begin puberty at 9 but not yet have developed the higher order cognitive skills necessary for managing social and sexual situations that may arise. Thus, age is not always the best indicator of social maturity and good judgment.

Differences between adolescents' cognitive and social functioning and those of adults are of great importance. When compared to adults, adolescents:

  • Are more impulsive.
  • Are more likely to take risks.
  • Have poorer judgment.
  • Are less able to consider the future consequences of their actions.

Adolescents may also be less capable of accurately identifying the emotions or intentions of others, resulting in misinterpretations that can contribute to inappropriate responses or behavior. For example, if a boy touches a girl's breast in the hall at school and she says, "Stop that!" but laughs as she says it, he may be unclear what she means.

Professionals must keep in mind that adolescents are trying to understand the rapid sexual development of their feelings and bodies. Adolescents may have advanced sexual knowledge and experience but may be well behind in abstract thinking and understanding the impact of their behaviors on others. As adolescents mature, they are able to understand and interpret their own sexual feelings and the emotions and behaviors of others.

Sexual Knowledge

The extent and accuracy of an adolescent's knowledge about sexual matters is determined by a variety of factors including parent-child relationship quality, family attitudes and knowledge, the availability of school-based sex education programs, Internet and publicly available written literature, and cultural factors.

  • Peers are a "go to" resource for most teens and, frequently, are a source of inaccurate and misleading information, such as overestimates of the degree to which others in the group are engaging in sexual activity.
  • Exposure to sexual and violent stereotypes, such as movies and music that depict girls and women as sex objects and portray manliness as associated with sexual conquests, may promote distorted attitudes about normal and healthy sexual behavior.
  • Open communication between adolescents and their parents/caregivers concerning sexuality and healthy sexual behavior is a key to facilitate the acquisition of accurate information. Early communication provided before the initiation of sexual behavior is important to lay the foundation for future dialogue.

The extent to which other information sources provide accurate and sufficient information varies considerably. Education and accurate information ensuring that sexual activities are consensual and consistent with relevant state laws may be limited or lacking.

Sexual Behavior

During early adolescence there is an increase in sexual behaviors which often involve self-exploration and masturbation. Some experimentation may involve opposite or same sex peers. While these behaviors often occur with mutual agreement, they may be motivated by self-interest more than reciprocal in nature. Sexual activity may be related to curiosity, opportunity, or sexual orientation. Sexual orientations are not considered sexual behavior problems.

The frequency of sexual activity increases in mid-adolescence. Many males begin masturbating to ejaculation between ages 13-15 years; the onset of masturbation in females is more gradual.

In contrast with early adolescence, mid adolescent sexual relationships may involve increased emotional intimacy and not be as self-focused. With late adolescents, the frequency of sexual activities increases.

Most sex is within dating or romantic relationships, but much occurs outside these relationships as well. Sex outside romantic relationships generally is more likely in boys and is associated with other risk factors, although casual sex among late adolescents and young adults ranging from kissing to sexual intercourse, such as "hooking up," has become more common.

In sum, throughout adolescence, sexual activities may include the following, with the more advanced behaviors more likely in older adolescents:

  • Sexually explicit conversations with peers
  • Obscenities and jokes within cultural norm
  • Sexual innuendo, flirting, and courtship
  • Interest in erotica; pornography use, and sexting*
  • Solitary masturbation
  • Hugging, kissing, holding hands
  • Making out, fondling*
  • Mutual masturbation*
  • Oral sex or intercourse with consenting partner*

Problematic Sexual Behavior

Problematic Sexual Behavior

There is no clear line that separates normative from problematic sexual behavior. Sexual behavior in childhood and adolescence falls on a continuum, from normative, to cautionary, to harmful.

childhood sexual

Problematic sexual behaviors include a wide range of behaviors:

  • Harmful or excessive self-touch or self-stimulation (such that it causes physical harm or damage, is excessive, and/or occurs in public despite interventions)
  • Non-intrusive and repetitive sexual behaviors (such as preoccupation with nudity, surreptitiously looking at others when they are naked, frequently showing private parts to others, preoccupation with pornography, especially child sexual abuse images or violent media, sexting, offensive sexualized language)
  • Sexual touching without permission or consent, such as poking, rubbing or squeezing
  • Sexual interactions with others (such as, digital-genital contact, oral-genital contact, sexual behavior that involve penetration) which are developmentally inappropriate or illegal
  • Distributing youth produced sexual images, such as through texting
  • Sexual contact with animals
  • Coercive or aggressive sexual contact or penetration

Guidelines for Identifying Problematic Sexual Behaviors

Professionals should be concerned when children's sexual acts or behaviors have one or more of the following characteristics:

  • Occur frequently or more frequently than expected
  • Take place between children of widely different ages or developmental stages (such as a 12-year-old who acts out with a 4-year-old, or a 15-year-old with a 10-year-old)
  • Occur between children of different capacity, for example, disparate physical size and strength or intellectual abilities or a position of authority
  • Are associated with strong, upset feelings, such as anger or anxiety/fear
  • Cause harm or potential harm (physical or emotional) to any child
  • Do not respond to typical parenting strategies (such as, instruction and supervision)
  • Involve coercion, force, or aggression, or threats thereof, of any kind

Problematic sexual behaviors are in contrast with normative sex play. Yet, some statistically normative sexual behaviors are considered problematic or even illegal due to familial, religious, cultural, or societal variations in attitudes regarding acceptable sexual behaviors in youth. Sometimes, sexual behaviors that do not involve others and occur in private, such as masturbation, may be concerning for some individuals or groups. However, sexual behaviors that do not involve others are not considered problematic, unless they are injurious, preoccupying, or interfere with other aspects of healthy development.

What do professionals need to know about sex laws?

Professionals are expected to know the laws and state statutes pertaining to sexual offenses and problematic sexual behavior. As professionals, it's important to not only know the laws, but also advocate for improved laws that address sexual behaviors in youth.

Professionals play an important role in informing parents and caregivers about the differences between normative, problematic, harmful, and illegal sexual behaviors in youth. Professionals should be able to distinguish legal from illegal sexual behavior, know what types of behavior constitute illegal behavior, and understand the laws pertaining to these behaviors.

Technology is advancing at a more rapid pace than laws are implemented and/or regulations are created. For example, many states do not have laws that adequately address youth produced sexual images resulting in charges that are very punitive and harsh given the action taken by the youth.

Many states are aware that current laws do not address this issue but have not created laws to address this concern. Given the technology available to youth, it is very important to discuss these issues with parents including giving them resources to implement parent controls and information about the types of electronic equipment that access the internet.

Laws differ across jurisdictions as to how old a youth must be before they may legally consent to sexual behaviors, for example, in most states the age of consent is 16, with some states youth as young as 14 may consent with another older youth.

For more information click here.

Professionals can help teens understand the laws and consequences when it comes to sexual behavior. Teens normally understand that some sexual behaviors can lead to trouble, but often they don't realize how much trouble. For example, teenagers may be aware that showing pornography to a 10-year-old would get them in trouble with parents or teachers but may not know that this behavior would result in delinquent charges, registration as a sexual offender, or even imprisonment.

Professionals, parents, and caregivers are responsible for knowing and conveying to children and adolescents' information on sexual development, sex education, healthy relationships, intimacy, consent, and the laws, including age of consent laws. Education can facilitate preventing problematic or illegal sexual behavior before it starts. Interventions for the youth, child victims, and their family can help the child victims heal and the youth with problematic and/or illegal sexual behaviors (including aggressive sexual behaviors) get on track for healthy and prosocial development.

Initial Considerations

What are some initial determinations in the case planning and clinical decision- process?

  • Are all the children who were involved in the sexual behavior currently safe and supported?
  • What actions are needed to create and maintain safety and support for the children and families?
  • Who is best to engage, inform, and support the family through the process including the assessment?
  • Given the results of the assessments, is community based intervention indicated for the youth with PSB and for the impacted children and siblings? If more intensive interventions are indicated, what is the least restrictive placement and treatment environment appropriate for the youth? How will the caregiver(s) be engaged in the services?
  • What approach to treatment would be best to address the priority service needs and build protective factors?
  • How can the case planning, services, and approach to the family be tailored to their needs?

Who is responsible for making decisions about the treatment and case planning?

  • Decision-making responsibilities will depend upon the professionals’ roles and responsibilities.
  • The child welfare and child protective service professionals are responsible for assessing and addressing child safety and protection from abuse. Law Enforcement and Juvenile justice professionals are charged with determining if a law has been broken and what pathway (e.g., adjudication, diversion, deferred prosecution) will facilitate public safety and youth rehabilitation. Health and behavioral health professionals assess for well-being, relevant vulnerabilities, risks, needs, and protective factors, facilitate safety planning, and recommend and provide therapeutic services to the children and families.
  • School personnel will assess, implement, and monitor safety plans and promote positive social-emotional well-being and academic progress of the students.
  • Best practices involve collaborative communication and efforts among all professionals and caregivers throughout the process.
Key Points
  1. Safety is the first priority in case planning and clinical decision making.
  2. Assessments drive family treatment and case planning and inform progress in services.
  3. Treatment planning and interventions ensure safety, address risk and protective factors, and other intervention needs using appropriate evidence based interventions.
  4. The case planning and clinical decision making process can vary for children and teens- professionals must be aware of these differences as they relate to safety, placement, and treatment plans.

Standards of Care

Professionals who respond to problematic sexual behavior of youth have the responsibility of making complex decisions that impact the lives of multiple community members. Youth with problematic sexual behaviors, impacted children, and family members are heterogeneous—straight forward simple rules of conduct do not apply. Professionals must consider key factors and apply appropriate responses based on scientific evidence. Professionals must seek agreement and collaboration among well-informed professionals in the field.

Guidelines and Standards of Care

Guidelines and Standards of Care for Professionals Working with Youth with Problematic Sexual Behavior

  • Recognize the importance of your work for promoting community and family safety.
  • Be aware of the potential for significant impact and life-altering consequences your practices may have on youth and their families.
  • Inform clients that professionals are mandated reporters of child abuse.
  • Ensure your clients are fully informed, in developmentally and cognitively appropriate language.
  • Inform clients of the limits and management of confidentiality when multiple agencies are involved.
  • Respond in a just manner, being careful to consider systemic and individual responses.
  • Conduct high quality initial evaluations and timely reassessments, and relevant, evidence based and supported interventions.
  • Continuously learn and grow in understanding of all areas of their background to provide a respectful and informed responsive approach.
  • Follow relevant practice guidelines and ethical standards (e.g., Association of the Treatment and Prevention of Sexual Abuse standards and guidelines, as well as those of their own professions).

Resources

  • In 2023, the Association of the Treatment and Prevention of Sexual Abuse Task Force on Children with Sexual Behavior Problems completed the update and 2nd addition of their report designed to guide professional practices with children ages 12 and under.  https://members.atsa.com/learn/Details/guidelines-children-with-sexual-behavior-problems-2nd-edition-194637 The 2023 ATSA report provides guidelines for treating children with sexual behavior problems. It focuses on person-first language, emphasizing the child's well-being over behavior. The report discusses various aspects including assessment, treatment approaches, and placement considerations, highlighting the importance of understanding each child's unique situation. It underscores the need for comprehensive, evidence-based practices, family involvement, and considers a broad range of contributing factors to effectively address and manage these behaviors, while ensuring the child's overall development and safety.  https://members.atsa.com/ap/CloudFile/Download/pgGxjO4p  Supplemental resources on topics such as Neurodevelopment and Children with PSB, Children’s Advocacy Centers and Problematic Sexual Behavior are  published and other topics are in development.
  • In 2017, the Association of the Treatment and Prevention of Sexual AbuseTask Force on Adolescents with Sexual Behavior Problems released professional practice standards for working with adolescents who engage in sexually abusive behavior. These standards were based on the current state of knowledge at the time and are consistent with those presented on NCSBY.org.

What qualifications are needed to work clinically with youth with problematic sexual behavior?

Clinicians should comply with generally accepted standards of practice in their mental health profession and follow the Professional Code of Ethics published by the Association for the Treatment of Sexual Abusers. Clinicians should:

  • Have appropriate training, experience, and continuing education.
  • Recognize their abilities and limitations.
  • Engage in consultation and teamwork.
  • Follow relevant professional guidelines and ethical standards.

Practitioners have an ethical obligation to become educated about relevant issues, seek out appropriate consultation, and coordinate care with other professionals involved whenever possible.

Clinicians must not have a conviction or a deferred judgment for any offense involving criminal, sexual or violent behavior or a felony that would bring into question the competence or integrity of the individual to provide sexual abuse specific treatment.

What are the ethical guidelines for professionals working with youth with problematic sexual behavior?

  • Professionals must be knowledgeable of their own profession’s ethical guidelines and standards of care as they relate to children and families, and specifically youth with problematic sexual behavior and youth involved in the courts.
  • Ethical guidelines require professionals to work within their areas of expertise, seek consultation when needed, and refer out if they are not adequately knowledgeable or proficient in a particular area. Professionals must always practice within the boundaries of their training and profession.
  • Some professions may not have ethical guidelines that directly address youth with problematic sexual behavior—in these cases, the Association for the Treatment and Prevention of Sexual Abuse guidelines for clinical professionals are a starting point for supporting ethical practices.

What training, experience and continuing education activities are important for working with youth with problematic sexual behavior?

  • Children and adolescents are not small adults. Professionals must have education and training in child and adolescent development. Relevant coursework, supervision and, especially, ongoing continuing education are important.
  • Professionals require specific training to develop core knowledge in child and teen problematic sexual behavior. Professionals must understand the heterogeneity among youth, their individual risks, strengths, and needs, and the context of the situation.
  • The nature and extent of this training needs to be commensurate with the type of activities and services provided.
  • Because laws and public policy influence decision making, professionals must be familiar with policies and laws that pertain to youth with problematic sexual behavior.
  • Professionals must recognize trauma and the potential impact on those involved and affected by the problematic sexual behavior.
  • Multidisciplinary teams help facilitate coordination of care and support professional decision making for youth and their families. Professionals must be aware of the roles and responsibilities of the other professionals involved in the response to youth problematic sexual behavior.

What are some specific areas of knowledge and expertise for professionals working with youth with problematic behavior?

Professionals must be able to answer the question, “Is the sexual behavior normative or problematic?” This requires knowledge of the following topics:

  • Range of sexual behavior exhibited by children and teens.
  • Relevant local laws.
  • Varying attitudes and beliefs.
  • Healthy sexual development in children and teens.
  • How to work with youth and their families.
  • How to establish communication and parenting skills that promote healthy development.

Professionals must be able to determine if the behavior is potentially illegal or problematic and what options are available.

A number of factors impact this determination.

  • State and federal laws vary dramatically for youth.
  • Relevant laws and public policies are included below.
  • The Federal Child Abuse Prevention and Treatment Act (CAPTA) (PL 111-320) provides federal guidelines for child abuse and neglect and child protection.
  • The Adam Walsh Child Protection and Safety Act of 2006 (PL-109-248) is the federal law that is designed to protect children from sexual exploitation, sexual abuse, and other sex offenses.
  • This Act strengthen penalties for crimes against children, makes it more difficult to reach children on the internet for sexual acts, requires background checks for adoptive and foster parents, and has expanded the national sex offender registry.
  • State laws are also relevant to address problematic sexual behavior of youth. These laws include ones pertaining to abused and neglected children, family court proceedings, children’s behavioral health programs, and sexual offender registration and community notification Professionals should collaboratively determine what response options fit with the characteristics of the case (e.g., deferred prosecution, types of charges, rehabilitation, and placement). The options that would be considered best in terms of standards of care may not be readily available in the community. Efforts towards systems change may need to be considered.
  • Professionals must keep in mind that most laws related to sexual offenses were developed to apply to adult sexual offenders. Many laws do not consider the differences in adult behaviors and child or youth with problematic or illegal sexual behaviors.
  • For example, some jurisdictions are considering legislation that would address “youth produced images” (also referred to as, “sexting”) separately from child pornography. Professionals must also be aware of the rates and risks of problematic sexual behavior including:
  • Low frequency of recurrent problematic or illegal sexual behavior overall.
  • Rates of nonsexual behavior problems are more likely than sexual ones.
  • Research-based risk and protective factors that may increase or decrease the likelihood of problematic sexual behaviors.
  • [Understanding PSB in Youth, Assessment (Coming Soon)]Professionals must be knowledgeable of evidence-based interventions and characteristics of best practices, including:
  • Evidence-based behavior management interventions.
  • Interventions should be family focused and match the interventions to fit the risk, needs, and responsivity of the youth with problematic sexual behavior.
  • Be developmentally appropriate for children or teens. See the Clinical Decision-Making and Intervention (Coming Soon) sections for more information about best practices and evidence-based practice. Professionals must be aware of the impact and response to trauma experienced by the youth with problematic sexual behavior, child victims, and families. Professionals must recognize trauma and intervene when appropriate. [www.nctsn.org]

Professionals must be knowledgeable about factors relevant for decision-making when considering placement following problematic sexual behavior including the steps for timely family reunification when out-of-home placement occurs.

Are there instances when specialized training is required?

Yes. Atypical sexual interests are rare among youth with problematic sexual behavior. Professionals working with teens with persistent, atypical sexual interests should stay abreast to the latest research and practices on how to address these concerns in a developmentally appropriate manner (do not utilize strategies solely designed for adults with pedophilia). 

What are the limitations of practice?

Professionals need to be cognizant of their capacity and competence, reaching for supervision and consultation particularly when reaching the boundaries of expertise. However, it can be difficult to know what we do not know. Continuous education, consultation and support is needed. In addition to the professional knowledge and skills described above, consultation and teamwork is important for helping professionals monitor decision making, the progress of families as they work toward reunification and resolution, the identification of risk and protective factors, and safety planning.

Public Policy

What key research findings are important for guiding public policies and agency practices?

  • Greater than one-third of sexual offenses against children are committed by other youth. Approximately one quarter of the child victims are related to the youth with illegal sexual behavior, and few victims are strangers to the youth Finkelhor, Ormrod, & Chaffin, 2009. Preventing sexual abuse in the first place will significantly reduce the number of child victims.
  • Decades of research indicate that sexual recidivism of youth is generally very low overall, typically ranging from 2-15%. In fact, a recent large meta-analytic study of adjudicated juveniles not in adult court found less than 3% recidivated with a sexual offense. Caldwell, 2016.
  • Due to the generally low recidivism rate, efforts at risk prediction leads to more false positives (labeling a youth as high risk, when they are not) than accurate predictions. Thus, ethical policies and practices should attend to reducing inadvertent harm caused.
  • Youth are quite distinct from adult sexual offenders in terms of etiology, context, impact, responsivity, and outcomes of the behavior. Adult sex offending policies and practices are not developmentally appropriate for youth with problematic or illegal sexual behavior.
  • Further, youth with problematic sexual behaviors are quite heterogeneous in terms of age (3-18 years of age), causes, risks and protective factors, severity and frequency of sexual behaviors, impact on the victims, family context, and responsivity to interventions [see examples here and Adolescents].
  • Effective treatment for youth with problematic and illegal sexual behavior exist.  Unfortunately, a limited number of youth have access to receive evidence-based treatment at the level of care needed (Dopp, Borduin, & Brown, 2015). Further, victims’ access to referral and to evidence-based care is limited, as is coordinated evidence-based care for the family in intrafamilial cases implemented.
  • Youth develop and mature and most frequently stop engaging in all types of offending. Research by Caldwell and colleagues have found reduced risk of violent recidivism even with youth who have psychopathic features (Caldwell, 2011; Caldwell, 2013; Caldwell, McCormick, & Umstead, 2007; Caldwell, McCormick, Wolfe, 2012; Caldwell, Skeem, Salekin, & Van Rybroek, 2006; Caldwell, & Van Rybroek, 2005; Caldwell, Vitacco, & Van Rybroek, 2006) holistic interventions that include the youth, family, and involved social system have the most evidence of effectiveness.
  • Juvenile registration and notification policies have not been found to improve public safety. Research has indicated that registration of juveniles does not improve recidivism, and instead has deleterious impacts on case processing (e.g., increased plea bargaining) and on child well-being (e.g., suicidal thoughts and behavior, harassment, mental health, and school problems) (e.g., Caldwell & Dickinson, 2009; Letourneau & Armstrong, 2008; Letourneau, Bandyopadhyay, Sinha, & Armstrong, 2009; Letourneau, Harris, Shields, Walfield, & Kahn, 2016).
  • Interventions that employ the Risk-Need-Responsivity Model of Assessment and Crime Prevention Through Human Services are associated with reductions in juvenile and adult recidivism, including sexual recidivism.

Child Welfare

All aspects of child welfare services should integrate a focus on well-being. Addressing child and family needs related to well-being critically reduces risks and increases safety and protective factors. This section provides information on protective factors, and youth and caregiver well-being.

When would Child Welfare respond to reports of children and adolescents with problematic sexual behaviors?

State Child Welfare agencies have statutory responsibility to respond to reports of children and adolescents exhibiting problematic sexual behaviors when such reports contain allegations of or suspicions of parental/caretaker abuse and/or neglect or when state laws or policies specifically assign responsibility for problematic sexual behaviors to the child welfare agency. Problematic sexual behavior in children and adolescents is behavior that involves private parts, behaviors that are unusual and concerning given the children’s age and developmental level and are potentially harmful to themselves and others. Each state has a unique set of laws and policies to address the responsibility to respond to youth with problematic sexual behaviors.

The following circumstances may result in the child welfare agency becoming aware of a youth's problematic sexual behaviors and initiating a response:

  • Suspicion or report of abuse or neglect of a child by an adult recently or currently in the home.
  • School report of problematic sexual behavior among children, occurring in the home or problematic sexual behavior occurring at school that causes concern for the safety of children in their home.
  • Situations in which a parent or caregiver has knowledge of the problematic sexual behavior of the child and/or adolescent and has failed to take any steps to stop it –
    • Encourages or allows the child and/or adolescent with the problematic sexual behaviors to babysit or otherwise have a caretaker role with the child victim or other vulnerable children.
    • Allows the child or adolescent with the problematic sexual behavior to have unsupervised contact with other vulnerable children.
  • The youth with problematic sexual behaviors and/or victim has identified specialized treatment needs about which the parents or caregivers have been informed, and services have not been sought and/or utilized
  • A child in foster care discloses that he or she is the victim of problematic sexual behavior of a youth residing in their home.

Some states, such as Missouri, require some level of response to every report of child-on-child sexual abuse. Other states require a response to all reports of sexual behavior between siblings. Still other states require some type of response to every report of suspected abuse and neglect.

Federal Definition of Child Abuse & Neglect

Federal legislation guides individual states by identifying a minimum set of acts or behaviors that define child abuse and neglect. The CAPTA Reauthorization Act of 2010 amended the Federal Child Abuse Prevention and Treatment Act (CAPTA) (42 U.S.C.A. § 5106g) to define child abuse and neglect as follows:

  • "Parents or caretakers must engage in any recent act or failure to act, resulting in death, serious physical or emotional harm, sexual abuse, or exploitation."
  • "Parents or caretakers must engage in an act or failure to act that presents an imminent risk of serious harm."

This definition of child abuse and neglect applies to parents and other caregivers. Generally, a "child" under this definition refers to someone younger than 18 years old or not an emancipated minor.

While CAPTA defines sexual abuse and special cases of neglect related to withholding or failing to provide medically indicated treatment, it does not provide specific definitions for other types of maltreatment, such as physical abuse, neglect, or emotional abuse. Although Federal legislation establishes minimum standards for states accepting CAPTA funding, each state determines its definitions of maltreatment within civil and criminal statutes.

State Definition of Child Abuse & Neglect

States define child maltreatment differently, while the Federal government establishes the minimum standards to be applied nationwide. Definitions of child abuse and neglect typically exist in two places within each State's statutory code:

  • Civil Statutes guide individuals mandated to identify, and report suspected child abuse and determine the grounds for intervention by State child protection agencies and civil courts. You can find your state's definitions by conducting a State Statues Search on the Information Gateway website.
  • Criminal Statutes outline the forms of child maltreatment that can lead to an offender's arrest and prosecution in criminal courts.

States generally recognize four significant types of maltreatment: neglect, physical abuse, sexual abuse, and emotional abuse or neglect.

Any person can actively report suspicions of child abuse or neglect and make reports anonymously. Most reports are made by individuals known as "mandatory reporters," who are required by State law to actively report suspicions of child abuse and neglect. CPS workers generally receive these reports and either screen them in or out.

What are the specific steps in a Child Welfare Response to problematic sexual behavior of youth?

Child Welfare staff are responsible for gathering and analyzing information from as many reliable sources as possible in order to answer key questions. These answers facilitate decision making and action planning for the response.

Intake Determinations:

  • Does the information, as reported, meet the statutory definition of child abuse and/or neglect?
  • Does the report meet the agency’s criteria for some level of response?

Assessment/Investigation

  • Has the occurrence of abuse and/or neglect been determined by the documentation of credible, verifiable evidence and /or a preponderance of the evidence?
  • Are all children safe?
  • What is the level of risk for future maltreatment?
  • What vulnerabilities, risk factors, protective factors and protective capacities have been identified?

Safety Planning

  • What actions are required to make and/or keep all children safe?

Case Planning and Treatment Planning

  • What actions are required to support the family’s active participation in intervention services to promote safety, healing, and family well-being?

Typically, child welfare systems actively take the following actions:

  • They investigate reports by receiving and investigating possible cases of child abuse and neglect.
  • They support families by providing prevention services to those who need assistance in protecting and caring for their children, aiming to prevent entry into foster care.
  • They arrange for temporary safe shelter, ensuring that children live with kin or foster families when it is unsafe for them to remain home.
  • They strive to return children to their families when safety conditions have improved or find alternative permanent arrangements, such as arranging for reunification, adoption, or establishing other permanent family connections for children leaving foster care.

What Happens When a Report Is Filed

A report is screened when sufficient information suggests the need for an investigation. A report may be screened out if there is insufficient information to follow up on or the reported situation does not meet the State's legal definition of abuse or neglect. In such cases, the CPS worker may actively refer the person reporting the incident to other community services or law enforcement for additional assistance.

CPS caseworkers actively respond within a few hours to a few days after entering a report, depending on the type of alleged maltreatment, the potential severity of the situation, and State law requirements. They actively engage in conversations with parents and other individuals in contact with the child, such as doctors, teachers, or child-care providers. They may also actively communicate with the child, either alone or in the presence of caregivers, based on the child's age and level of risk.

By the end of the investigation, CPS caseworkers typically make one of two findings—either unsubstantiated (unfounded) or substantiated (founded). These terms may vary from State to State.

  • An unsubstantiated finding indicates that the caseworker actively concludes there is insufficient evidence to determine that the child was abused or neglected or that the reported incident does not meet the legal definition of child abuse or neglect.
  • A substantiated finding typically indicates that the caseworker actively believes that an incident of child abuse or neglect has occurred, as defined by State law.

For more information on the Child Welfare system, visit the Child Welfare Information Gateway.

What other professionals are involved in cases of youth with problematic sexual behaviors?

Agencies such as Law Enforcement and Juvenile Justice may also have statutory responsibility for some situations involving problematic sexual behaviors. Given this parallel responsibility; shared assessment, decision making, and recommendations for intervention and response will support families best in their efforts to successfully manage the issue of problematic sexual behavior in their home.

Treatment interventions with children and adolescents with problematic sexual behaviors and their families often involves licensed treatment providers who have specialized knowledge and experience with this population.

A multidisciplinary, coordinated, community-based system guided by best-practice response by the professionals involved in the protection of children, is recommended. Coordinated interventions can facilitate family engagement in services and enhance the safety and well-being of the community. Shared goals include:

  • Keeping all involved children safe.
  • Assessing and responding to the treatment needs of the family.
  • Assisting youth with problematic sexual behaviors in learning appropriate, pro-social behaviors.
  • Supporting and enhancing positive family functioning and parent/caregiver monitoring.
  • Ensuring community safety.
  • Safeguarding the legal rights of the identified child or adolescent.

A Child Advocacy Center (CAC) can facilitate a multidisciplinary team (MDT) in a manner to reduce the impact of trauma on children and families. Because of its close relationships with professionals in the community who are involved in child protection, a CAC is often well equipped to coordinate the MDT response to youth with problematic sexual behaviors, their child victim and caregivers.