Problematic Sexual Behaviors in Children & Youth (PSB-CY)

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As a psychotherapist specializing in problematic sexual behaviors, what was once relegated to either adults dealing with these issues and teenage sex offenders has now spread to a new category known in therapeutic communities as “problematic sexual behaviors in children and youth” (PSB-CY) as they may be too young to be criminalized yet their behaviors are serious enough where correction intervention and action needs to be taken.

Problematic sexual behaviors in children and youth can entail physical contact initiated by children and youth under the age of 18 that involve sexual body parts (genitals, anus, buttocks, or breasts) or non-physical behaviors impacting others such as voyeurism, sharing of pornography, and/or exhibitionism.  In both types of behaviors, the main criterion is that they deviate from normative sexual behavior and are developmentally inappropriate and/or potentially harmful.

The National Center on Sexual Exploitation estimates about 1/3 of all perpetrators are children under the age of 18, which means that child on child sexual abuse is a difficult reality that must be addressed.

This issue is garnering more public and clinical attention due to increased reports of younger children initiating the problematic sexual behavior (children 10 years or younger), many of whom would not be appropriately served if the judicial system labeled them as child sex offenders. 

So what is normal and what is problematic when it comes to sexual development in children?  The general answer depends on the behaviors, the age-appropriateness of the sexual acts, whether it was consensual, how it impacts others (i.e. causes distress), and if there’s a disparity between the victim and the child initiating the behaviors in terms of age, developmental ability, or size.

What parents need to remember is that first off, it is very normal for children to have sexual behaviors and related questions as sexual development begins in infancy.  As toddlers, they begin to articulate their curiosity with questions and behaviors related to their bodies, gender differences, and sexual functioning.  It’s normal for toddlers to be curious about sexuality and ask questions about gender, reproduction, and sexual functioning.

The American Association of Pediatrics lists these types of behaviors as normative for children birth-5 years old:

•      Showing their genitals to others

•      Standing too close

•      Trying to look at nude people

•      Masturbation

However you can see how according to the American Association of Pediatrics the following behaviors are considered very abnormal (i.e. fewer than 1.5% exhibit the following these sexual behaviors from birth-6 years old): 

•      Putting mouth on genitals

•      Asking self/others to engage in specific sex acts

•      Imitating intercourse

•      Inserting objects into the vagina or anus

•      touching animal genitals

Experts in this area prefer to categorize childhood sexual behaviors on a continuum based on the following 4 levels.

  1. Normative
  2. Cautionary/concerning
  3. Problematic
  4. Severe/harmful

Anything beyond normative should be explored and viewed more thoroughly.  

In terms of numbers, every 9 minutes Child Protective Services (CPS) substantiates, or finds evidence for, a claim of child sexual abuse.  The Rape, Abuse & Incest National Network (RAINN) gives these findings:

  • 82% of all victims under 18 are female
  • 66% of the childhood victims are 12-17 yrs. old
  • 34% under 12 years old

So why the increase?  This is due to the increase and earlier exposure of pornography among children, an increased awareness among health care professionals and other mandated reporters so past child-on-child sexual behaviors which may have been minimized in society are now taken seriously.  Also, mainstream media delivers much more sexualized messages and materials than in the past.

The American Academy of Pediatrics cites, “American media is thought to be the most sexually suggestive in the Western Hemisphere. The average American adolescent will view nearly 14,000 sexual references per year”.

When it comes to PSB-CY, experts have found early early adolescents between ages 12-14 are the peak of child offenders. (Source: This age-range experiences a lot of changes as puberty begins, and if they have a skewed view of sex, they may perpetrate against a younger or smaller child.

Past perceptions associated children with PSBs as dangerous, deviant, and perpetrators who must be sent away to protect the community or else they will become future sexual predators.  The reality is that most respond well to increased supervision and safety with family participation in evidence-based treatment. A small minority though due to more extensive trauma or psychiatric issues, requires more intensive supports.

Past reasoning for why a child would initiates PSB-CY was placed on the child being a victim of sexual abuse.  While that is one risk factor, it is incomplete as many non-abused children also engage in PSB.  Some are individual risk factors such as a child’s level of impulsiveness, ability to deal with anger, and respect boundaries.  Others can include attention deficit disorders, learning disabilities, and reactivity to other traumatic events.  Family risk factors include parental depression, substance abuse, domestic violence, and harsh parenting practices. The wider community can also provide either protective factors or add to the risk of PSB.  (Source: National Center on the Sexual Behavior of Youth)

Factors at Play in PSB-CY:

• Home Violence (Domestic Abuse)

• Physical or Sexual Abuse

• Behavioral issues (impulsivity, ADD, Oppositional defiant disorder)

• Developmental Disabilities

• Excessive exposure to adult sexual activity or pornography (home, media, internet)

• Parental depression, substance abuse, or frequent absences due to work

(Source: National Center on the Sexual Behavior of Youth)

Due to the various components that makes a child susceptible to PSB, the treatment is oftentimes also multi-layered to address the following: 

· Behavioral health counseling 

· Special Needs assessments and IEP

·  Child Protective Services

·  Domestic Abuse Counseling

·  Co-occurring behavioral disorders

· Law Enforcement and Judicial System (depending on age)

These statistics are not meant to scare or alarm you but to reflect the everyday realities we live in.  We as parents must engage our children throughout their developmental cycle (toddlers, teenagers, college-age students) so they’re not only well-informed about healthy sexual behaviors but also much more aware of when and how to speak up when the behaviors encroach on their boundaries.  

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