Scoping Review of the Definitions Used to Describe and Understand Harmful Sexual Behaviors in Children and Young People

Abstract

There is a growing body of evidence that adolescents, and other children, are responsible for a significant proportion of sexual abuse against children. However, there are substantial differences in how this phenomenon is defined and conceptualized between and within sectors. This scoping review explored the current definitions of harmful sexual behaviors (HSB), and other similar terms, used across a range of stakeholder groups. In all, 141 papers were reviewed from both empirical and gray literature sources, including key policy and practice documents. Included papers needed to list a clear definition for the behavior of interest. There was disagreement and inconsistency across the included papers in their conceptualization of harmful, abusive, or problematic sexual behavior (PSB) in children and adolescents. Although the term HSB has been adopted as an umbrella term or continuum in many policy, practice, and research settings, there is a large variance in behaviors, treatment needs, etiology, and harms present across different types of sexual behavior. Relying solely on one term to describe a wide range of sexual behaviors in children and young people may limit the understanding of this issue and imply similarities between groups that are not present. We suggest that clearly defined subsets of HSB, such as sexual abuse, technology-assisted HSB, and PSB, may give more context to the behavior of concern and may be helpful in informing further research, prevention, and best practice approaches.

Keywords

sexual abuse sexual assault prevention of child abuse offenders youth violence

Recent findings from the nationally representative Australian Child Maltreatment Study revealed that more than one in four Australians have experienced child sexual abuse (CSA) (Mathews et al., 2023). To date, much of the research, policy, and service provision has focused on adults perpetrating sexual harm toward children; however, multiple studies have shown that a significant proportion of sexual abuse has been inflicted by other children and young people in a variety of settings (Gewirtz-Meydan & Finkelhor, 2020). Nevertheless, there is general disagreement and inconsistency about the nature and conceptual framework of this problem. Young people who sexually harmed others previously seemed similar to their adult counterparts, but more recent research has highlighted the unique differences and characteristics of young people engaging in sexual offending behaviors when compared to adults (Barra et al., 2018). Similarly, there has been little attention to whether there are differences from the perspective of victims in the experiences of sexual harm from adults compared to peers. Ever-changing societal norms about sexuality and what is considered developmentally appropriate and socially accepted, particularly for adolescents, continue to create uncertainty and disagreement about this phenomenon. Definitions are largely influenced by legal, social, and familial factors. Terms such as “developmentally appropriate” are also not easily defined or understood, particularly cross-culturally.

The broad term harmful sexual behavior (HSB) has been generally accepted across services and policymakers, particularly in Australia, New Zealand, and the United Kingdom. The term was designed to capture a range of sexual behaviors and experiences, including sexual offending, and it focuses on the behavior of concern rather than labeling the child or young person (Hackett et al., 2019). With the understanding of this phenomenon being in its relative infancy, further work is needed to generate knowledge and understanding about sexual harm inflicted by children and young people and its impacts. A shared conceptual understanding and definition of HSB would allow researchers, policymakers, legislators, service providers, and communities to understand, respond to, and prevent HSB.

Objectives

This scoping review aims to understand the currently used definitions of HSB and how this phenomenon is described and understood. Researchers, practitioners, and policymakers have used multiple terms to describe sexual behaviors in children and young people. These include the following: problematic sexual behavior (PSB), reactive sexual behavior, sexual offending, HSB, sibling abuse, and peer-to-peer abuse. This scoping review aims to determine how these other terms fit within an overall definition of HSB, and CSA more broadly. The focus of this review was on children and young people (under 18 years) engaging in HSB toward other children, young people, and adults. Harm perpetrated by adults is beyond the scope of the present review.

Method

For this scoping review, we used the five stages outlined by Arskey and O’Malley (2005): formulating a research question, identifying relevant papers through a systematic search of the evidence, screening the papers in line with inclusion and exclusion criteria, extracting data from the papers, and synthesizing findings using content analysis. This approach does not require the critical appraisal of papers but allows for the inclusion of both empirical studies and a broad range of gray literature including policy and practice documents. Due to the objectives of the scoping review, we also included research not published in scholarly peer-reviewed journals. We focused specifically on gray literature from Australia and the United Kingdom due to the term HSB being generally accepted across research, services, and policy in these jurisdictions.

The research questions that informed the scoping review were as follows:

How is HSB currently defined and described?

Are the terms “peer-to-peer abuse,” “sibling abuse,” etc., used to describe subsets of HSB?

2.1. Are the terms used differently, depending on whether the focus is on the behaviors, the person engaging in the behavior, or the person subjected to the behavior?

2.2. How do/does the definition(s) fit within the concepts of CSA and adolescent sexuality more broadly?

2.3. Does the research literature distinguish between HSB and adult-perpetrated CSA?

3. Are the current definitions in use for HSB applied consistently across cultures, sectors, and stakeholder groups (education, psychology, policy, legal, and specialist sexual abuse services)?

Before we started the review, we registered a protocol via the Open Science Framework (OSF) (https://osf.io/qwc73/). OSF allows for the registration of protocols for scoping reviews.

Eligibility Criteria

Inclusion Criteria

We screened only papers written in English, including both qualitative and quantitative studies of any design, as well as policy and practice documents such as government reports. To be eligible, papers could include the examination or discussion of victims, adult survivors, and children and young people who had engaged in HSB. Papers may have used other terms such as problem sexual behavior, sexual offending, or sibling sexual abuse. No limit was placed on the date of publication. We included papers only if they clearly defined sexual harm instigated by children and young people.

Exclusion Criteria

We excluded any studies only about harm perpetrated by adults. We excluded any sources that did not include a definition for HSB (or other similar term).

Search Strategy and Information Sources

Our systematic search strategy involved search terms to cover two concepts (see Table 1). We chose the first set of terms to focus search results on papers about children and young people. The second set of terms was designed to capture papers focused on HSB.

Table 1.

Search Terms.

A. Child and Young People	B. HSB
Child* OR “young person” OR “adolescen” OR student OR teenage*	“harmful sexual* behavio” OR HSB OR “problem sexual* behavio” OR PSB OR “reactive sexual behavio” OR “juvenile sex offend” OR “adolescent sex offend” OR “sibling abuse” OR “peer* abuse” OR “sex* harm* behavio” OR “sex reactive behavio*”

Note. HSB = harmful sexual behaviors.

Six electronic databases were searched in May 2022: PsycINFO, MEDLINE, SocINDEX, Web of Science, ERIC, and Campbell Systematic Reviews. We selected these databases to gain a broad range of sources that would be covered in a range of settings and disciplines, including psychology, criminology, law, education, and social sciences. We employed the same search strategy for each database using the search terms set out in Table 1.

We also searched for gray literature from websites of key Australian and United Kingdom agencies, where there has been considerable policy and research focus on the problem of harmful sexual behavior (HSB) including Australian Institute of Family Studies, Australian Institute of Criminology, Australian Centre for Child Protection, Australian Government Royal Commission into Institutional Responses to CSA, Parenting Research Centre, Australia’s National Office of Child Safety, and the UK’s National Society for the Prevention of Cruelty to Children (NSPCC).

Results

Search Results

After systematic and targeted searching, we identified 1,478 papers for screening. All were double-blind screened by two independent reviewers in Rayyan (an online tool used to aid in the screening of studies for reviews). Any disagreements were resolved through discussion. A total of 141 papers were included for data extraction. Supplementary materials provide an overview of the included papers. Data extraction was completed by the first author in an Excel spreadsheet. A modified PRISMA flowchart is shown in Figure 1.

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Chart.

Definitions

Definitions for Sexual Offending Behaviors

A large proportion (N = 59, over 40%) of the included papers included definitions for sexual offending behaviors. Terms used included juvenile sex offender, adolescent sex offender, sexual offending, illegal sexual behavior, and sexual abuse. The included papers did not use a consistent definition to describe this type of sexual behavior. Several of the excluded papers were also of this group but provided no definition, possibly due to the definition being seen as self-explanatory, as describing a legal-based definition of those under the age of the majority who have committed sexual offenses.

Defining sexual offending behaviors was generally limited to post-pubescent age groups, “those who commit such acts while between the age of puberty (12-14) and the age of the majority (18-20)” (Aljazireh, 1993, p. 423). This was largely reflective of the legislation for the relevant jurisdiction such as the age of criminal responsibility. Some papers extended the age of adolescence beyond 18 to reflect the developmental stage of those under the age of 21. For example, McKibbin et al. (2017) referenced Australian policy and research for their definition of children being zero to 12 years and young people being between the ages of 13 and 21 (McKibbin et al., 2017).

Gerardin and Thibaut (2004) defined sexual offending in adolescence as “youth who commits any sexual act with a person of any age against the victim’s will, or in an aggressive, exploitative, or threatening manner” (p. 79). Whereas other definitions simply focused on the illegal nature of the sexual behavior, rather than providing other descriptors (Bunston, 2000). Sexual offenses included both coercive and non-consensual acts and included both “hands-on” and “hands-off” offenses.

Although there were differences between included papers on the definitions used, largely the definitions for these terms included themes such as force, coercion, illegal behaviors, and non-consensual acts (Barbaree & Marshall, 2006; Bourke & Donohue, 1996; Dwyer & Boyd, 2009). Some also included themes of violence and aggression (Gerardin & Thibaut, 2004; Perry & Orchard, 1992).

Early definitions of sexual offending were largely influenced by Finkelhor’s (1986) definition of CSA (referenced in Craig et al., 2010), where an important feature was there being at least a 5-year age gap between perpetrator and victim. For example, Ryan and Colleagues’ (1987) definition of CSA perpetrated by an adolescent included the necessity of a 5-year age difference, as well as acts perpetrated against the victim’s will (referenced in Hastings et al., 1997). More recent definitions have removed the need for an age gap, noting that sexual harm can occur between children and young people of any age. Preference for understanding imbalances of power and use of force, coercion, or intimidation were more common in recent definitions.

Some authors theorized that it is possible to differentiate between adolescents who engage in sexual offending behaviors by the severity of their behaviors. Authors of several papers cited Aylwin and Colleagues’ (2000) definition that included six levels of severity increasing in the intrusiveness of sexual contact and levels of violence and force present. None of the included papers examined these severity groups but it was referenced as being used to assess treatment needs alongside a range of other risk assessment tools (Aebi et al., 2011; Barra et al., 2018). Some included papers that used groups or typologies to distinguish between different types of sexual offending behaviors based on the victim’s age or the relationship between the adolescent and the victim. For example, Craig and Colleagues (2010) drew on O’Brien’s (1991) four groups based on the relationship between the adolescent and the victim: (a) sibling incest, (b) child molester non-family, (c) non-child offender, and (d) mixed offender. In addition, differences between adolescents who sexually offended younger children with those who offended against same-aged peers or adults were explored (Keelan & Fremouw, 2013; Kjellgren et al., 2006). Across the included papers, it was clear that adolescents who engage in sexually offending behaviors are a heterogeneous group. Victim age, relationship, and the use of force were noted as important considerations for assessing treatment needs (Jensen et al., 2020; Lillard et al., 2020; Ryan & Otonichar, 2016; Ueda, 2017).

Definitions for PSB

A smaller proportion (N = 43, approximately 30%) of included papers examined PSBs in children under 12 years old (CEASE, 2016; El-Murr, 2017). Papers using this term often differentiated between the types of sexual behavior and developmental needs between pre- and post-pubescent children. This conceptual understanding may have been influenced by biological factors, such as the onset of puberty, social factors (such as social expectations and norms around sexuality and relationships), and legal influences (such as the age of criminal responsibility). Terms such as sexually reactive children, sexually acting out, and sexual behaviors of concern were also used. The themes identified were developmentally inappropriate behaviors, behaviors that involve secrecy and/or feelings of confusion and embarrassment, behaviors non-responsive to adult intervention, and behaviors that may be potentially harmful (Blomfield, 2018; Pelech et al., 2021; Pithers et al., 1998; Shawler et al. 2018; Silovsky et al., 2019).

One frequently referenced definition, developed by Chaffin et al. (2008), defined PSBs as:

children ages 12 and younger who initiate behaviors involving sexual body parts (i.e., genital, anus, buttocks, breasts) that are developmentally inappropriate, occurs at a greater frequency or at an earlier age than would be developmentally or culturally expected, become a preoccupation and/or reoccur after adult intervention, or are potentially harmful to themselves or others (use of force, coercion, or intimidation, cause physical injury or emotional distress, appear to be interfering with social development, involve children of substantially different ages). (p. 200)

However, Gray and Colleagues (1997, p. 271) noted that PSB may be “equivalent to criminal violation if performed by an adult,” noting that PSB may include quite serious and harmful sexual acts, even in pre-pubescent children. Imbalance in power and control were noted as important factors to consider in distinguishing between normal and PSB, regardless of the age group in consideration (Crisci et al., 1998; Offermann et al., 2008). For example, sexual behaviors that targeted a more vulnerable child were distressing, did not stop following parental intervention, or were persistent may be identified as problematic (Blomfield, 2018). Johnson’s (1991) early work in distinguishing between groups based on the nature of the sexual behavior, and Pithers et al.’s (1998) five considerations for problem sexual behavior in children informed several of the included papers in this area.

Definitions for HSB

HSB was the term most used in papers published by research from Australia and the United Kingdom and made up about 30% of the included papers (N = 44). This was likely influenced by Simon Hackett’s work for the NSPCC in the United Kingdom and the Australian Government’s Royal Commission into Institutional Responses to CSA adopting HSB as the term to describe harmful or abusive sexual behavior in children and young people (Australian Government, 2017; Hackett, 2014). Hackett’s (2014) definition and continuum of HSB was among one of the most frequently referenced:

sexual behaviours expressed by children and young people under the age of 18 years old that are developmentally inappropriate, may be harmful towards self or others, or be abusive towards another child, young person, or adult. (Hackett et al., 2019, derived from Hackett, 2014, p. 13)

In his continuum, Hackett (2011, 2014) distinguished between normal, inappropriate, problematic, abusive, and violent sexual behavior. In papers referencing Hackett’s (2014) definition and continuum (or similar variations), it was clear that the term HSB was designed to capture a large variety of sexual behaviors ranging from sexually abusive and violent behaviors such as rape, as well as potentially problematic or inappropriate behaviors in children and young people.

Although Hackett’s (2011, 2014) continuum and definition have been well-accepted and referenced across research, practice, and policy, there is still general disagreement about the understanding of “developmentally appropriate.” Other definitions for HSB focused instead on the imbalance of power and lack of consent while also indicating the harm caused to victims. For example, Calder and Colleagues (2001, p. 5) defined HSB as “any form of sexual activity with another individual, that they have powers over by virtue of age, emotional maturity, gender, physical strength, intellect, and where the victim in this relationship has suffered sexual exploitation and betrayal of trust” (referenced in Gibson, 2014). Hunter (2011) noted lack of consent (defined in their book as significant age differences or behavior that is manipulative or coercive) as the important factor in conceptualizing HSB.

The term “sexually abusive behaviors” was also used and generally referred to behaviors in adolescence, “sexually abusive behaviour applies to children and young people aged 10-17, defined by criminal law to be minors who have reached the minimum age of criminal responsibility” (El-Murr, 2017, p. 5). Overlaps in terms and themes were present—particularly relating to coercion, use of force, imbalance of power, lack of consent, intimidation, and aggression or violence—and were similar to the language used to describe sexual offending behaviors (ATSA, 2006; McCuish & Lussier, 2017). It was clear that this subset of behaviors could cause physical and emotional harm (Hackett et al., 2016). In more recent papers, terms such as sexually abusive behaviors were preferred compared to juvenile or adolescent sexual offending, largely to label the behavior of concern rather than labeling the young person (El-Murr, 2017). In some papers, these behaviors were linked with a broader understanding of CSA (Banks, 2014; Lane & Ryan, 2010; Malvaso et al., 2020; Righthand & Welch, 2004).

Types or Subsets of HSB

Important types of sexual behavior were noted in some of the included papers. These included sibling sexual abuse, PSB across childhood and adolescence, and technology-assisted HSB. Unique definitions were presented in the papers for these and key findings pointed to distinct characteristics as compared to the broader conceptualization of HSB. We have also considered whether the perspective taken by the paper was on the child or young person instigating the sexual harm, on the person harmed, or both.

Victimization

One defining feature of the included papers was that most (approximately 97%) focused on the child or young person engaging in harmful, abusive, or problem sexual behavior. Very few (N = 4, less than 3%) included papers mentioned in their definition the child, young person, or adult who had been harmed or victimized. Of the included papers that focused entirely or in part on the victim-survivor, the chosen definitions were more commonly aimed at a broader definition of sexual abuse. For example, Kloppen and Colleagues (2016) referenced Butchart and Colleagues’ (2006, p. 19) definition of CSA that had a particular focus on the victim:

the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared, or else that violates the laws or social taboos of society. Children can be sexually abused by both adults and other children who are by virtue of their age or stage of development—in a position of responsibility, trust, or power over the victim.

In their study of educators’ understanding of sexual behaviors in children and adolescents, Ey and McInnes (2018) referenced Johnson’s (1988, p. 219) definition that considered children or young people to be perpetrators of sexual abuse when they:

(1) act in a sexual way with another child, (2) use force or coercion in order to obtain the participation of the other child or the victim was too young to realise they were being violated and did not resist the sexual behavior, or it was an offense such as exhibitionism, and (3) there was an age differential of at least two years, and (4) there was a pattern of sexually overt behavior in their history.

Themes of imbalance of power and the use of force or coercion were also present in Calder’s (1999, p. 2) definition of “child-on-child sexual abuse,” as children engaging in:

any form of sexual activity with another individual, that they have powers over by virtue of age, emotional maturity, gender, physical strength, intellect and where the victim in this relationship has suffered a sexual exploitation. (referenced in Yates, 2018)

Nearly all included papers noted that although the harms of sexual offenses (and other harmful or abusive sexual behaviors) committed by children and young people are comparable to those perpetrated by adults (Aljazireh, 1993; Bereiter & Mullen, 2012), young people are developmentally distinct and should be treated as a separate group from adult perpetrators of CSA (Barra et al., 2018). Davidson (1987) also noted an important distinction between sexual offending behaviors, or what they termed “sexually assaultive behavior,” and experimentation, innocent “sex-play,” and non-forcible sexual acts between non-related adolescents of a similar developmental stage.

PSB

It was clear from the included papers that separating pre-pubescent children from adolescents is important. PSBs in any age group were defined by some of the included papers as those that do not victimize others but may cause emotional distress or social rejection (Hackett et al., 2016; Meiksans & Bromfield, 2017). Many of the included papers acknowledged that these behaviors could result in physical, emotional, and social harms but the developmental differences and differences in types of behaviors between pre- and post-pubescent children were noteworthy and important.

With the introduction of Hackett’s definition of HSB (2014), the term PSB was included in their continuum of sexual behavior among children regardless of age. This acknowledged that young children (12 and under) may still engage in harmful and even abusive sexual behaviors and were not limited to the “problematic category” of sexual behavior. Similarly, this change also acknowledged that sexual behaviors in adolescents were not limited to just “normal” or “abusive” categories either.

Sibling Sexual Abuse

Publications on sibling sexual abuse, sibling incest, or other similar terms, specifically noted the harmful and abusive sexual behaviors that can be present in sibling relationships, even pre-puberty. Some included papers still pointed to age gaps in their definitions, “sexual behavior that is clearly exploitative in nature (i.e., where there is a significant age difference or where force, violence, or intimidation is employed)” (O’Brien, 1991, p. 75), or familial sexual abuse or intrafamilial sexual assault occurs when the age difference between siblings is greater than 5 years (Finkelhor, 1979; Craig et al., 2010). In these papers, they were more likely to use terms such as abuse and exploitation, suggesting that age gaps played a part in differentiating between sexual behaviors that were normal or problematic and those that were abusive or exploitative. Other papers noted that abusive or exploitative sexual behaviors may occur regardless of age gaps, with themes of imbalances of power and the use of force present. Since our search was conducted, a study by Marmor and Tener (2022) found unique typologies in cases of sibling sexual abuse. They concluded that it is important to consider different dynamics of sexual behavior.

Technology-Assisted HSB

Many of the definitions throughout the included papers were limited to contact sexual behaviors (involving touch or penetration) or non-contact behaviors such as exhibitionism and voyeurism but did not typically consider the use of technology. In fact, only three of the included papers specifically referenced technology in their definition (Armstrong, 2021; Lewis, 2018; McKibbin & Humphreys, 2019). Armstrong (2021, p. 3) provided a simple definition, “sexualised behavior carried out with the use of technology.” Lewis (2018) referenced Hollis and Belton’s (2017) definition of technology-assisted harmful sexual behavior as “one or more children engaging in sexual discussion or acts—using the internet and/or any image-creating/sharing or communication device—which is considered inappropriate and/or harmful given their age or stage of development” (p. 8). In a study examining the perceptions of Australian out-of-home care workers, McKibbin and Humphreys (2019) included technology as a consideration of how children and young people may experience sexual exploitation by referencing Beckett and Colleagues (2017) definition:

a form of child abuse that occurs when an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants and/or (b) for the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual and does not always involve physical contact, as it can also occur through the use of technology. (p. 7)

Key Findings

Across the included studies, regardless of the terminology used, it was clear that HSB is a significant issue facing families, schools, and our criminal justice and child protection systems (Baker et al., 2001; Banks, 2014; Draugedalen, 2021; Ey & McInnes, 2018; Firmin, 2020; Lloyd, 2019; McInnes & Ey, 2020; McKibbin et al., 2022; Waters et al., 2021; Yates, 2018). Definitions were applied inconsistently across stakeholder groups, and the use of terminology was different depending on whether the focus was on the victim-survivor, or the child or young people causing the harm. There were clear subsets identified, but these were also defined inconsistently across the literature. Across the included papers, there was a clear distinction between (a) normal sexual development (Davidson, 1987), (b) sexual behaviors that are harmful or abusive, and (c) adult-perpetrated CSA.

Trauma and other adverse childhood events were consistently identified in the histories of those presenting with HSB, PSB, and sexual offending behaviors, regardless of the severity of the behavior, the setting, or the age group of interest. Experiences such as sexual abuse victimization, experiences of alternative care (out-of-home care), harsh or neglectful parenting practices, exposure to violence, parental arrest, and socioeconomic disadvantage were identified across several papers (Aljazireh, 1993; Blomfield, 2018; Delago et al., 2020; Felizzi, 2015; Gray et al., 1997; Hawkes, 2011; Lévesque et al., 2010; Szanto et al., 2012).

Although many researchers identified trauma and adversity in the history of children and young people presenting with HSBs, it was apparent that they are a heterogeneous group (Bourke & Donohue, 1996; Johnson, 2002). Early intervention was key, with youths exhibiting PSBs in early childhood having a higher re-offense rate than those who first exhibited HSBs in middle childhood or adolescence (Grossi et al., 2012). Parental involvement, social supports, adequate risk assessment, sex education, and involving young people in the development of safety plans were identified as key to intervention (Apsche & Ward, 2003; Barra et al., 2018; Bastos et al., 2021; Clionsky & N’Zi, 2019; Gibson, 2014; Marriage et al., 2017; McKibbin, 2017; Prisco, 2015; Shawler et al., 2018; Stith & Bischof, 1996).

Discussion

The purpose of our scoping review was to better understand the definitions used in existing research, policy, and practice for HSB in children and young people. It was clear that how HSBs are interpreted and defined is inconsistent and has been influenced by time and cultural values. This has made comparison between studies challenging and likely means that we do not have an accurate assessment of the prevalence, nature, etiology, or treatment needs for this population. It is important to note that the present review is limited to definitions and conceptual understandings present in the included papers. Several excluded papers included an examination of key concepts but failed to include a specific definition of the sexual behavior of interest. As well as the international peer-reviewed literature search, we supplemented this with a particular focus on gray literature from agencies in Australia, New Zealand, and the United Kingdom given their similar approach to terminology. Therefore, findings are particularly relevant to these jurisdictions. Further exploration is needed for this concept in other contexts, including in non-Western cultures.

Hackett’s (2011, 2014) continuum and definition of HSB were commonly cited across a range of stakeholder groups including policy, practice, education, out-of-home care, and child welfare. Consideration of the developmental context in differentiating between normal, problematic, and harmful or abusive sexual behavior, and the subsequent harms that can be caused was highlighted throughout his work (Hackett, 2014; Hackett et al., 2016, 2019). Although Hackett (2014) suggested HSB as a broad umbrella term for a range of sexual behaviors in children and young people, he noted that there is merit in using different terminology to describe subsets of the proposed continuum. In the adult-perpetrated sexual abuse literature, there is precedence for using distinct terms to describe different types of sexual harm and abuse. For example, there are distinctions made between workplace sexual harassment, rape, and sexual abuse in the context of interpersonal relationships. This approach creates clarity and allows for research and practice that addresses the unique needs of each type of sexual behavior.

We suggest that sexual abuse, sexual offending behavior, problem sexual behavior, sibling sexual abuse, and technology-assisted HSB are examples of important types of HSBs in children and young people. There were key differences identified relating to etiology and treatment needs depending on the relationship between the victim and instigating young person (e.g., victims that are siblings, peers, or other), victim age, use of force, and type of sexual behavior (Aylwin et al., 2000; Butz & Spaccarelli, 1999; Craig et al., 2010; Jensen et al., 2020; Keelan & Fremouv, 2013; Kjellgren et al., 2006; Lillard et al., 2020; Marriage et al., 2017; Ueda, 2017). For example, adolescents who had offended younger children were found to be more likely to have experienced trauma earlier in life, have multiple victims, have lower self-esteem, have more internalizing behavior problems, and be indiscriminate of relationship to and gender of the victim, compared to those who had offended against peers or adults (Jensen et al., 2020; Lillard et al., 2020; Ueda, 2017). Adolescents who used force, including verbally and physically coercive sexual behaviors, were more likely to display misogynistic fantasies, sexual compulsivity, and hypermasculinity, compared to those who did not use force as part of their sexual offending behaviors (Johnson & Knight, 2000). Furthermore, an analysis of Australian cases of problem sexual behavior in children revealed five distinct groups (sexually aggressive, non-symptomatic, highly traumatized, rule breaker, and abuse reactive) based on underlying factors that contributed to the sexual behaviors, rather than the nature of the sexual behavior itself. These factors included maltreatment history, diagnosis, and aggression (Pithers et al., 1998). These findings support the notion that using a wide range of terminology to conceptualize subtypes of this phenomenon is important as it informs best practice and prevention.

Most of the included papers had a clear focus on the child or young person exhibiting the behavior. Importantly, of those that included a focus on victim-survivors, it was more likely that the chosen definition would reflect a broader conceptualization of CSA. This reflected an important distinction in understanding of this phenomenon based on the perspective taken. Perhaps a focus on victim-survivors lends itself to an understanding of the abusive nature of certain types of HSB and the comparable impacts these behaviors have to adult-perpetrated sexual abuse, thus using terms such as sexual abuse. However, in cases involving children and young people, there is not always a clear distinction between perpetrator and victim. Similarly, key findings from workers’ perceptions in Australia found that children and young people often did not identify themselves as victims in cases of child sexual exploitation (McKibbin & Humphreys, 2019). These findings highlight key issues in conceptualizing sexual harm inflicted by children and young people, particularly in the digital world.

Although not an included paper in this review, Mathews and Collin-Vézina’s (2017) conceptual model of CSA suggests four factors that must be present in order for an act or experience to be conceptualized as CSA the victim must be a child either developmentally or considered by the law or society norms; true consent must be absent; the acts must be sexual; and the acts must constitute abuse. Relationships where there is an imbalance of power, a position of inequality, and exploitation of vulnerability may constitute abuse. In their conceptual model of CSA, the age difference between victim and perpetrator, and harm were not preconditions to an act being considered sexually abusive, noting that both adolescents and adults may perpetrate CSA (Mathews & Collin-Vézina, 2017).

There was a consensus that although certain types of HSB are clearly abusive in nature to victim-survivors, how children and young people who engage in these behaviors are described is important. More recent publications were largely in favor of terms labeling the behavior rather than labeling the child or young person. For example, labels such as “adolescent sex offender” are inappropriate and stigmatizing. Reducing the stigma associated with labeling a child or young person as an “offender” while also acknowledging the harm caused and the serious nature of the behaviors is important and should be reflected in the terminology used (Barry & Harris, 2019; Blomfield, 2018; El-Murr, 2017; Hackett, 2014).

Critical Findings

A large majority of the papers in our review relied on samples from correctional, criminal justice, or child protection settings. It is likely that this approach represents only the most serious end of sexual offending behaviors in adolescence, only one subset of this phenomenon. With papers focusing on strict legal definitions for sexual offending behaviors, a large proportion of both victims and instigating children and young people are undetected (Gewirtz-Meydan & Finkelhor, 2020), and victims are less likely to identify themselves as having been harmed (McKibbin & Humphreys, 2019), many children and young people are less likely to receive intervention or participate in empirical research. Most papers were also based on English-speaking populations, with few including consideration of diverse groups. These issues highlight a significant gap in the research base and understanding of a broad range of HSB subtypes in children and young people.

Implications for Practice, Policy, and Research

Clear and operational definitions for important subsets of HSB across sectors would allow for clarity in conceptualizing and preventing this issue. Clearly defined terms are also essential for service providers, parents and carers, and other professionals to be better equipped to identify problems, harmful, or abusive sexual behaviors, respond appropriately, and prevent further harm. Relying solely on one term to describe a range of sexual behaviors present in children and young people limits our understanding of the different developmental pathways and treatment needs, and implies similarities between groups that are not present. Research is also needed on diverse groups presenting with different subsets of this phenomenon in different settings. It is not clear if current findings are generalizable across cultures or settings (i.e., outside of criminal justice or child protection settings).

Findings point to key factors that contribute to risk, particularly child maltreatment and adversity (Aljazireh, 1993; Blomfield, 2018; Delago et al., 2020; Felizzi, 2015; Gray et al., 1997; Hawkes et al., 2000; Lévesque et al., 2010; Szanto et al., 2019). These factors can be targeted from a broad public health approach model. Parents, teachers, and other youth-serving organizations are key targets for prevention. This can include parenting supports to target harsh parenting practices and reduce the risk of child abuse and neglect, socioeconomic and social supports, training and education for teachers and other workers, and adequate sex education. Parental involvement and assessment are pivotal in improving outcomes (Clinosky & N’Zi, 2019; Kloppen et al., 2016; Kulesz & Wyse, 2007). We need flexibility in our approaches to this issue. This allows for responses and interventions that target the individual needs of the child or young person, and result in better outcomes. This might include family-based interventions, such as Multi-Systemic Therapy (MST-HSB), where insecure attachment, poor parental monitoring and supervision, and abuse and neglect have played a role (Fonagy et al., 2015; Pourliakas et al., 2016).

We suggest that although HSB may be a useful umbrella term adopted by researchers, policymakers, and practitioners alike, it is important to also acknowledge the large variance in behaviors, treatment needs, etiology, and harms present across the subtypes of HSB. Using terms such as CSA may be appropriate in the context of working with victim-survivors of HSB, giving acknowledgment to the comparable harms and impacts as with adult-perpetrated CSA. Using terms for other subsets of HSB such as sexual abuse, sibling sexual abuse, technology-assisted HSB, sexually abusive behavior, and problem sexual behavior gives more context to the behavior of concern and may be helpful for informing further research, prevention, and best practice approaches.

Supplemental Material

sj-docx-1-tva-10.1177_15248380231218294 – Supplemental material for Scoping Review of the Definitions Used to Describe and Understand Harmful Sexual Behaviors in Children and Young People

Supplemental material, sj-docx-1-tva-10.1177_15248380231218294 for Scoping Review of the Definitions Used to Describe and Understand Harmful Sexual Behaviors in Children and Young People by Gabrielle R. Hunt, Daryl J. Higgins, Megan L. Willis and Lottie Harris in Trauma, Violence, & Abuse

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Gabrielle Hunt

Daryl Higgins

Lottie Harris

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Gabrielle Hunt, is a registered psychologist and is undertaking a Doctor of Philosophy as part of the Australian Child Maltreatment Study. Gabby’s research focus is on organizational risk factors for child maltreatment in faith-based settings and implementing evidence-based prevention. Her research and ongoing work is informed by her experience as a psychologist working with survivors of child sexual abuse as well as young people engaging in harmful sexual behaviors.

Professor Daryl Higgins, is the Director of the Institute of Child Protection Studies. His research focuses on public health approaches to protecting children, and child-safe organizational strategies. A registered psychologist, Prof Higgins has been researching child abuse impacts and prevention, family violence, and family functioning for nearly 30 years. Throughout his career, he has published numerous articles, papers, and reports that have made a significant impact on policy related to child maltreatment, both in Australia and internationally.

Megan Willis, PhD, is a senior lecturer in the School of Behavioral and Health Sciences at the Australian Catholic University. Her current research interests include identifying risk factors for intimate partner violence perpetration and victimization, and understanding the effects of child maltreatment on mental health outcomes.

Lottie Harris, is a doctoral student and a research assistant with the Institute of Child Protection Studies, Australian Catholic University. Lottie’s study is part of the Australian Child Maltreatment Study, the first Australian study of the prevalence of child maltreatment. Lottie’s research focus is on the health impacts of child multi-type maltreatment, and the subsequent best-practice interventions for children and young people in out-of-home care. This research is expanding on Lottie’s professional experience in child welfare, which includes both policy and research and direct practice in the homelessness and out-of-home care sectors within NSW.

References

* Aebi

Plattner

Steinhausen

H. C.

Bessler

. (2011). Predicting sexual and nonsexual recidivism in a consecutive sample of juveniles convicted of sexual offences. Sexual Abuse: A Journal of Research and Treatment, 23(4), 456–473. https://doi.org/10.1177/1079063210384634

* Alemagno

S. A.

Stephens

Shaffer-King

Teasdale

. (2009). Prescription drug abuse among adolescent arrestees: Correlates and implications. Journal of Correctional Health Care: The Official Journal of the National Commission on Correctional Health Care, 15(1), 35–81. https://doi.org/10.1177/1078345808326620

* Alexy

E. M.

Burgess

A. W.

Prentky

R. A

. (2009). Pornography use as a risk marker for an aggressive pattern of behavior among sexually reactive children and adolescents. Journal of the American Psychiatric Nurses Association, 14(6), 442–453. https://doi.org/10.1177/1078390308327137

* Aljazireh

. (1993). Historical, environmental, and behavioral correlates of sexual offending by male adolescents: A critical review. Behavioral Sciences and the Law, 11(4), 423–440. https://doi.org/10.1002/bsl.2370110409

* Anderson

Parkinson

. (2018). Balancing justice and welfare needs in family group conferences for children with harmful sexual behavior: The HSB-FGC framework. Journal of Child Sexual Abuse, 27(5), 490–509. https://doi.org/10.1080/10538712.2018.1477217

* Andrade

J. T.

Vincent

G. M.

Saleh

F. M

. (2006). Juvenile sex offenders: A complex population. Journal of Forensic Sciences, 51(1), 163–167. https://doi.org/10.1111/j.1556-4029.2005.00010.x

* Apsche

J. A.

Ward

S. R

. (2003). Mode deactivation therapy and cognitive behavioral therapy: A description of treatment results for adolescents with personality beliefs, sexual offending and aggressive behaviors. The Behavior Analyst Today, 3(4), 460–470. https://doi.org/10.1037/h0100003

* Armstrong

L. M

. (2021). Is restorative justice an effective approach in responding to children and young people who sexually harm? Laws, 10(4), 86. https://doi.org/10.3390/laws10040086

Arskey

O’Malley

(2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616

10.

Association for the Treatment of Sexual Abusers (ATSA). (2006). Report of the Task Force on Children with Sexual Behavior Problems. Beaverton, OR.

11.

* Australian Government. (2017). Final report, Volume 10: Children with Harmful Sexual Behaviors. Royal Commission into Institutional Responses to Child Sexual Abuse.

12.

Aylwin

A. S.

Clelland

S. R.

Kirkby

Reddon

J. R.

Studer

L. H.

Johnston

(2000). Sexual offense severity and victim gender preference: A comparison of adolescent and adult sex offenders. International Journal of Law and Psychiatry, 23, 113–124. https://doi.org/10.1016/s0160-2527(99)00038-2

13.

* Baker

A. J.

Schneiderman

Parker

. (2001). A survey of problematic sexualized behaviors of children in the New York City Child Welfare System: Estimates of problem, impact on services, and need for training. Journal of Child Sexual Abuse, 10(4), 67–80. https://doi.org/10.1300/j070v10n04_05

14.

* Banks

. (2014). Sexually harmful behavior in adolescents in a context of gender and intellectual disability: Implications for child psychologists. Educational and Child Psychology, 31(3), 9–21. https://doi.org/10.53841/bpsecp.2014.31.3.9

15.

* Barbaree

H. E.

Marshall

W. L

. (2006). The juvenile sex offender (2nd ed.). Guilford Press.

16.

* Barra

Bessler

Landolt

M. A.

Aebi

. (2018). Testing the validity of criminal risk assessment tools in sexually abusive youth. Psychological Assessment, 30(11), 1430–1443. https://doi.org/10.1037/pas0000590

17.

* Barry

Harris

. (2019). The children’s programme: A description of a group and family intervention for children engaging in problematic and harmful sexual behavior and their parents/carers. Journal of Sexual Aggression, 25(2), 193–206. https://doi.org/10.1080/13552600.2019.1589002

18.

* Bastos

K. R. P.

Eusébio

A. M. L.

Pereira

K. N. D. A.

Silva

T. O. S. D.

Costa

L. F

. (2021). Characteristics of adolescent sexual offenders and their victims: A study of judicial processes. Saúde e Sociedade, 30, 1– 13. https://doi.org/10.1590/s0104-12902021181112

19.

* Becker

J. V.

Johnson

B. R

. (2001). Treating juvenile sex offenders. In Ashford

J. B.

Sales

B. D.

Reid

W. H.

(Eds.), Treating adult and juvenile offenders with special needs (pp. 273–289). American Psychological Association.

20.

Beckett

Holmes

Walker

(2017). Child sexual exploitation. Definition and guide for professionals: Extended test. https://www.beds.ac.uk/media/86735/uob-rip-cse-guidancefeb2017.pdf

21.

* Bereiter

Mullen

. (2012). Treating juvenile sex offenders. In Handbook of juvenile forensic psychology and psychiatry (pp. 385–404). Boston, MA: Springer

22.

* Blokland

van Wijk

A. P

. (2008). Criminal careers of Dutch adolescent sex offenders: A criminological perspective. In Smith

M. J.

(Eds.), Childhood sexual abuse: Issues and challenges (pp. 203–219). Nova Publishers.

23.

* Blomfield

J. C

. (2018). Understanding and responding to problem sexual behaviors in children. Australian Journal of General Practice, 47(6), 366–369. https://doi.org/10.31128/ajgp-02-18-4490

24.

* Bourke

M. L.

Donohue

. (1996). Assessment and treatment of juvenile sex offenders: An empirical review. Journal of Child Sexual Abuse, 5(1), 47–70. https://doi.org/10.1300/J070v05n01_03

25.

* Bromberg

D. S.

O’Donohue

W. T

. (2013). Handbook of child and adolescent sexuality: Developmental and forensic psychology. Academic Press.

26.

* Bunston

. (2000). Working with adolescents and children who have committed sex offences. Australian and New Zealand Journal of Family Therapy, 21(1), 1–7. https://doi.org/10.1002/j.1467-8438.2000.tb00403.x

27.

* Burke

D. M

. (2001). Empathy in sexually offending and nonoffending adolescent males. Journal of Interpersonal Violence, 16(3), 222–233. https://doi.org/10.1177/088626001016003003

28.

Butchart

Harvey

H. P.

Mian

Fürniss

(2006). Preventing child maltreatment: A guide to taking action and generating evidence. World Health Organization and the International Society for Prevention of Child Abuse and Neglect.

29.

* Butz

Spaccarelli

. (1999). Use of physical force as an offense characteristic in subtyping juvenile sexual offenders. Sexual Abuse: A Journal of Research and Treatment, 11(3), 217–232. https://doi.org/10.1177/107906329901100305

30.

Calder

M. C.

(1999). Working with young people who sexually abuse. Russell House Publishing.

31.

Calder

Hanks

Epps

K. J.

Morrison

Henniker

(2001). Juveniles and children who sexually abuse (2nd ed.). Russell House.

32.

* Cashwell

C. S.

Caruso

M. E

. (1997). Adolescent sex offenders: Identification and intervention strategies. Journal of Mental Health Counselling, 19(4), 336–348.

33.

CEASE. (2016). Standards of practice for problem sexual behaviors and sexually abusive behavior treatment programs. CEASE.

34.

Chaffin

Berliner

Block

Cavanagh-Johnson

Friedrich

W. N.

Louis

D. G.

Lyon

T. D.

Page

I. J.

Prescott

D. S.

Silovsky

J. F.

Madden

(2008). Report of the ATSA Task Force on children with SBP. Child Maltreatment, 13, 199−218. https://doi.org/10.1177/1077559507306718

35.

* Clionsky

L. N.

N’Zi

A. M

. (2019). Addressing sexual acting out behaviors with adolescents on the Autism Spectrum. Adolescent Psychiatry, 9(2), 129–134. https://doi.org/10.2174/2210676609666190730091304

36.

* Craig

William

L. R.

Browne

K. D

. (2010). Assessment and treatment of sexual offenders with intellectual disabilities: A handbook. John Wiley & Sons Ltd.

37.

* Cranbourne-Rosser

Campbell

Pilkington

Carthy

. (2020). The role of presence when working with children and young people demonstrating harmful sexual behavior. Counselling and Psychotherapy Research, 20(4), 580–590. https://doi.org/10.1002/capr.12338

38.

Crisci

Lay

Lowenstein

(1998). Paper dolls and paper airplanes: Therapeutic exercises for sexually traumatised children. Indianapolis, IN: Kidsrights.

39.

* Davidson

H. A

. (1987). Improving the legal response to juvenile sex offenders. Children’s Legal Rights Journal, 8(4), 15–20.

40.

* De Crisce

. (2013). Sexual addiction and hypersexual behaviors in adolescents. Clinical handbook of adolescent addiction (pp. 362–376).

41.

* DeLago

Schroeder

C. M.

Cooper

Deblinger

Dudek

Finkel

M. A

. (2020). Children who engaged in interpersonal problematic sexual behaviors. Child Abuse and Neglect, 105, 104260. https://doi.org/10.1016/j.chiabu.2019.104260

42.

* Draugedalen

. (2021). Teachers’ responses to harmful sexual behavior in primary school–findings from a digital survey among primary school teachers. Journal of Sexual Aggression, 27(2), 233–246. https://doi.org/10.1080/13552600.2020.1773552

43.

* Draugedalen

Kleive

Grov

. (2021). Preventing harmful sexual behavior in primary schools: Barriers and solutions. Child Abuse and Neglect, 121, 105295. https://doi.org/10.1016/j.chiabu.2021.105295

44.

* Dwyer

R. G.

Boyd

M. S

. (2009). Sex education for male adolescent sex offenders in a group setting led by general psychiatry residents: A literature review and example in practice. American Journal of Sexuality Education, 4(3–4), 208–224. https://doi.org/10.1080/15546120903408925

45.

* Elkovitch

Latzman

R. D.

Hansen

D. J.

Flood

M. F

. (2009). Understanding child sexual behavior problems: A developmental psychopathology framework. Clinical Psychology Review, 29(7), 586–598. https://doi.org/10.1016/j.cpr.2009.06.006

46.

* El-Murr

. (2017). Problem sexual behaviors and sexually abusive behaviors in Australian children and young people (CFCA Paper No. 46). https://aifs.gov.au/sites/default/files/publication-documents/46_problem_sexual_behaviors_0.pdf

47.

* Ey

L. A.

McInnes

(2018). Educators’ observations of children’s display of problematic sexual behaviors in educational settings. Journal of Child Sexual Abuse, 27(1), 88–105. https://doi.org/10.1080/10538712.2017.1349855

48.

* Felizzi

M. V

. (2015). Family or caregiver instability, parental attachment, and the relationship to juvenile sex offending. Journal of Child Sexual Abuse, 24(6), 641–658. https://doi.org/10.1080/10538712.2015.1057668

49.

Finkelhor

(1979). Sexually victimized children and their families. Dissertation Abstracts International Section A: Humanities and Social Science, 39(11-A), 7006–7007.

50.

Finkelhor

(1986). Abusers: Special topics. In Finkelhor

Araji

Baron

Browne

Peters

S. D.

Wyatt

E. G.

(Eds.), A sourcebook on child sexual abuse (pp. 89–142). SAGE.

51.

* Firmin

. (2020). School rules of (sexual) engagement: Government, staff and student contributions to the norms of peer sexual-abuse in seven UK schools. Journal of Sexual Aggression, 26(3), 289–301. https://doi.org/10.1080/13552600.2019.1618934

52.

* Fonagy

Butler

Baruch

Byford

Seto

M. C.

Wason

Wells

Greisbach

Ellison

Simes

. (2015). Evaluation of multisystemic therapy pilot services in Services for Teens Engaging in Problem Sexual Behavior (STEPS-B): Study protocol for a randomised controlled trial. Trials, 16, 1–19. https://doi.org/10.1186/s13063-015-1017-2

53.

* Gerardin

Thibaut

. (2004). Epidemiology and treatment of juvenile sexual offending. Pediatric Drugs, 6, 79–91. https://doi.org/10.2165/00148581-200406020-00002

54.

Gewirtz-Meydan

Finkelhor

(2020). Sexual abuse and assault in a large national sample of children and adolescents. Child Maltreatment, 25(2), 203–214. https://doi.org/10.177/1077559519873975

55.

* Gibson

. (2014). Narrative practice and the signs of safety approach: Engaging adolescents in building rigorous safety plans. Child Care in Practice, 20(1), 64–80. https://doi.org/10.1080/13575279.2013.799455

56.

* Grant

. (2000). The historical development of treatment for adolescent sex offenders. Trends and issues in crime and criminal justice (145). Australian Institute of Criminology. https://www.aic.gov.au/publications/tandi/tandi145

57.

* Gray

Busconi

Houchens

Pithers

W. D

. (1997). Children with sexual behavior problems and their caregivers: Demographics, functioning, and clinical patterns. Sexual Abuse: A Journal of Research and Treatment, 9, 267–290. https://doi.org/10.1177/107906329700900402

58.

* Grossi

L. M.

Brereton

Lee

A. F.

Schuler

Prentky

R. A

. (2017). Sexual reoffense trajectories with youths in the child welfare system. Child Abuse and Neglect, 68, 81–95. https://doi.org/10.1016/j.chiabu.2017.03.024

59.

* Grossi

L. M.

Lee

A. F.

Schuler

Ryan

J. L.

Prentky

R. A

. (2016). Sexualized behaviors in cohorts of children in the child welfare system. Child Abuse and Neglect, 52, 49–61. https://doi.org/10.1016/j.chiabu.2015.12.014

60.

Hackett

(2011). Children and young people with harmful sexual behaviors. In Barter

Berridge

(Eds.), Children behaving badly? Peer violence between children and young people (pp. 121–135). John Wiley & Sons.

61.

* Hackett

. (2014). Children and young people with harmful sexual behaviors. Research in Practice. https://tce.researchinpractice.org.uk/wp-content/uploads/2020/05/children_and_young_people_with_harmful_sexual_behaviors_research_review_2014.pdf

62.

Hackett

Branigan

Holmes

(2019). An evidence-informed framework for children and young people displaying harmful sexual behaviors. National Society for the Prevention of Cruelty to Children (NSPCC). https://learning.nspcc.org.uk/research-resources/2019/harmful-sexual-behavior-framework

63.

Hackett

Holmes

Branigan

(2016). Harmful sexual behavior framework: An evidence informed operational framework for children and young people displaying harmful sexual behavior. NSPCC.

64.

* Hall

D. K.

Mathews

Pearce

. (2002). Sexual behavior problems in sexually abused children: A preliminary typology. Child Abuse and Neglect, 26(3), 289–312. https://doi.org/10.1016/s0145-2134(01)00326-x

65.

* Hallett

Deerfield

Hudson

. (2019). The same but different? Exploring the links between gender, trauma, sexual exploitation and harmful sexual behaviors. Child Abuse Review, 28(6), 442–454. https://doi.org/10.1002/car.2591

66.

* Hastings

Anderson

S. J.

Hemphill

. (1997). Comparisons of daily stress, coping, problem behavior, and cognitive distortions in adolescent sexual offenders and conduct-disordered youth. Sexual Abuse, 9(1), 29–42. https://doi.org/10.1177/107906329700900103

67.

* Hatton

V. A.

Duff

. (2019). Delivering an intervention to a young person minimising his harmful sexual behavior–a practice case study. Journal of Sexual Aggression, 25(2), 207–222. https://doi.org/10.1080/13552600.2018.1551499

68.

* Hawkes

. (2011). Description of a UK study of onset of sexually harmful behavior before the age of ten years in boys referred to a specialist assessment and treatment service. Child Abuse Review, 20(2), 82–101. https://doi.org/10.1002/car.1133

69.

Hollis

Belton

(2017). Children and young people that engage in technology assisted harmful sexual behavior: A study of their behaviors, backgrounds and characteristics. https://www.nspcc.org.uk/globalassets/documents/research-reports/exploring-technology-assisted-harmful-sexual-behavior.pdf

70.

* Horton

C. B

. (1996). Children who molest other children: The school psychologist’s response to the sexually aggressive child. School Psychology Review, 25(4), 540–557. https://doi.org/10.1080/02796015.1996.12085843

71.

* Hunter

J. A

. (2011). Help for adolescent males with sexual behavior problems: A cognitive-behavioral treatment program, Therapist guide. Oxford University Press.

72.

* Jenkins

C. S.

Grimm

J. R.

Shier

E. K.

van Dooren

Ciesar

E. R.

Reid-Quiñones

. (2020). Preliminary findings of problematic sexual behavior: Cognitive-behavioral therapy for adolescents in an outpatient treatment setting. Child Abuse and Neglect, 105, 104428. https://doi.org/10.1016/j.chiabu.2020.104428

73.

* Jensen

Smid

S. C.

Bøe

. (2020). Characteristics of adolescent boys who have displayed harmful sexual behavior (HSB) against children of younger or equal age. BMC Psychology, 8(1), 1–13. https://doi.org/10.1186/s40359-020-00490-6

74.

* Johnson

G. M.

Knight

R. A

. (2000). Developmental antecedents of sexual coercion in juvenile sexual offenders. Sexual Abuse: A Journal of Research and Treatment, 12(3), 165–178. https://doi.org/10.1177/107906320001200301

75.

Johnson

T. C.

(1988). Child perpetrators-children who molest other children: Preliminary findings. Child Abuse & Neglect, 12(2), 219–229. https://doi.org/10.1016/0145-2134(88)90030-0

76.

Johnson

T. C.

(1991, August/September, 8–15). Understanding the sexual behaviors of young children (SIECUS Report). Sex Ed for Social Change (SIECUS).

77.

* Johnson

T. C

. (2002). Some considerations about sexual abuse and children with sexual behavior problems. Journal of Trauma & Dissociation, 3(4), 83–105. https://doi.org/10.1300/j229v03n04_05

78.

* Keelan

C. M.

Fremouw

W. J

. (2013). Child versus peer/adult offenders: A critical review of the juvenile sex offender literature. Aggression and Violent Behavior, 18(6), 732–744. https://doi.org/10.1016/j.avb.2013.07.026

79.

* Keogh

. (2018). The internal world of the juvenile sex offender: Through a glass darkly then face to face. Routledge.

80.

* King-Hill

. (2021). Assessing sexual behaviors in children and young people: A realistic evaluation of the Brook Traffic Light Tool. Child Abuse Review, 30(1), 16–31. https://doi.org/10.1002/car.2664

81.

* Kjellgren

Wassberg

Carlberg

Långström

Göran Svedin

. (2006). Adolescent sexual offenders: A total survey of referrals to social services in Sweden and subgroup characteristics. Sexual Abuse, 18(4), 357–372. https://doi.org/10.1177/107906320601800404

82.

* Kloppen

Haugland

Svedin

C. G.

Mæhle

Breivik

. (2016). Prevalence of child sexual abuse in the Nordic countries: A literature review. Journal of Child Sexual Abuse, 25(1), 37–55. https://doi.org/10.1080/10538712.2015.1108944

83.

* Kraemer

B. D.

Salisbury

S. B.

Spielman

C. R

. (1998). Pretreatment variables associated with treatment failure in a residential juvenile sex-offender program. Criminal Justice and Behavior, 25(2), 190–202. https://doi.org/10.1177/0093854898025002003

84.

* Kulesz

K. M.

Wyse

W. J

. (2007). Sexually abused children: Symptomatology and incidence of problematic sexual behaviors. Journal of Evidence-Based Social Work, 4(1–2), 27–46. https://doi.org/10.1300/J394v04n01_03

85.

* Lakey

J. F

. (1995). The profile and treatment of male adolescent sex offenders. International Journal of Adolescence and Youth, 6(1), 67–74. https://doi.org/10.1080/02673843.1995.9747780

86.

* Lane

Ryan

. (2010). Habituated patterns: The sexual abuse cycle. In Ryan

Leversee

T. F.

Lane

(Eds.), Juvenile sexual offending (pp. 116–146). John Wiley & Sons.

87.

* Leroux

E. J.

Clow

K. A.

Motayne

Seto

M. C

. (2020). The association of childhood sexual abuse with non-paraphilic and paraphilic sexual behaviors among adolescents who have sexually offended. The Journal of Sex Research, 57(9), 1189–1201. https://doi.org/10.1080/00224499.2020.1749821

88.

Lévesque

Bigras

Pauzé

(2010). Externalising problems and problem sexual behaviors: Same etiology? Aggressive Behavior, 36(6), 358–370. https://doi.org/10.1002/ab.20362

89.

* Lewis

D. O.

Shankok

S. S.

Pincus

J. H

. (1979). Juvenile male sexual assaulters. American Journal of Psychiatry, 136(9), 1194–1196. https://doi.org/10.1176/ajp.136.9.1194

90.

* Lewis

. (2018). Literature review on children and young people demonstrating technology-assisted harmful sexual behavior. Aggression and Violent Behavior, 40, 1–11. https://doi.org/10.1016/j.avb.2018.02.011

91.

* Lillard

C. M.

Cooper-Lehki

Fremouw

W. J.

DiSciullo

V. A

. (2020). Differences in psychosexual development among child, peer, and mixed juvenile sex offenders. Journal of Forensic Sciences, 65(2), 526–534. https://doi.org/10.1111/1556-4029.14194

92.

* Lloyd

. (2019). Response and interventions into harmful sexual behavior in schools. Child Abuse and Neglect, 94, 104037. https://doi.org/10.1016/j.chiabu.2019.104037

93.

* Lloyd

Walker

Firmin

. (2020). Keeping children safe? Advancing social care assessments to address harmful sexual behavior in schools. Child & Family Social Work, 25(4), 751–760. https://doi.org/10.1111/cfs.12751

94.

* Louis

D. G

. (2016). Playful cognitive-behavioral therapy for children with sexual behavior problems. In Drewes

A. A.

Schaefer

C. E.

(Eds.), Play therapy in middle childhood (pp. 99–113). American Psychological Association.

95.

* Malovic

Murphy

Coulton

. (2020). Finding the right assessment measures for young people with intellectual disabilities who display harmful sexual behavior. Journal of Applied Research in Intellectual Disabilities, 33(1), 101–110. https://doi.org/10.1111/jar.12299

96.

* Malvaso

C. G.

Proeve

Delfabbro

Cale

. (2020). Characteristics of children with problem sexual behavior and adolescent perpetrators of sexual abuse: A systematic review. Journal of Sexual Aggression, 26(1), 36–61. https://doi.org/10.1080/13552600.2019.1651914

97.

* Mangold

Tindell

C. N.

Williams

Kuhn

S. K.

Duffy

M. J.

Gabel

King

A. R

. (2021). Perceptions of children’s age-appropriate and problematic sexual behaviors among adults living in the United States. American Journal of Sexuality Education, 16(4), 501–517. https://doi.org/10.1080/15546128.2021.1934212

98.

* Margari

Lecce

P. A.

Craig

Lafortezza

Lisi

Pinto

Stallone

Pierri

Pisani

Zagaria

Margari

Grattagliano

. (2015). Juvenile sex offenders: Personality profile, coping styles and parental care. Psychiatry Research, 229(1–2), 82–88. https://doi.org/10.1080/15546128.2021.1934212

99.

* Margolin

. (1984). A treatment model for the adolescent sex offender. Journal of Offender Counselling Services Rehabilitation, 8(1–2), 1–12. https://doi.org/10.1300/j264v08n01_02

100.

Marmor

Tener

(2022). “I don’t fit into any category”: Adult perspectives on the dynamics of past sexual acts between siblings in Jewish Othodox society. Acta Psychologica, 228, 103645. https://doi.org/10.1016/j.actpsy.2022.103645

101.

* Marriage

N. D.

Blackley

A. S.

Panagiotaros

Seklaoui

S. A.

van den Bergh

Hawkins

. (2017). Assessing parental understanding of sexualized behavior in children and adolescents. Child Abuse and Neglect, 72, 196–205. https://doi.org/10.1016/j.chiabu.2017.08.009

102.

Mathews

Collin-Vézina

(2017). Child sexual abuse: Toward a conceptual model. Trauma, Violence and Abuse, 20(2). https://doi.org/10.1177/152483801773872

103.

Mathews

Pacella

Scott

J. G.

Finkelhor

Meinck

Higgins

D. J.

Erskine

H. E.

Thomas

H. J.

Lawrence

D. M.

Haslam

D. M.

Malacova

Dunne

M. P.

(2023). The prevalence of child maltreatment in Australia: Findings from a national survey. Medical Journal of Australia, 218(S6), S13–S18. https://doi.org/10.5694/mja2.51873

104.

* McCuish

E. C.

Lussier

. (2017). Unfinished stories: From juvenile sex offenders to juvenile sex offending through a developmental life course perspective. Aggression and Violent Behavior, 37, 71–82. https://doi.org/10.1016/j.avb.2017.09.004

105.

McInnes

L. A.

(2020). Responding to problematic sexual behaviours of primary school children: Supporting care and education staff. Sex Education, 20(1), 75–89. https://doi.org/10.1080/14681811.2019.1621827

106.

* McKibbin

. (2017). Preventing harmful sexual behavior and child sexual exploitation for children & young people living in residential care: A scoping review in the Australian context. Children and Youth Services Review, 82, 373–382. https://doi.org/10.1016/j.childyouth.2017.10.008

107.

* McKibbin

Humphreys

. (2019). The perceptions of Australian workers about caring for sexually exploited children in residential care. Child Abuse Review, 28(6), 418–430. https://doi.org/10.1002/car.2564

108.

* McKibbin

Humphreys

. (2021). Frontline workers’ response to harmful sexual behavior: Building blocks for promising practice. Trauma, Violence, & Abuse, 24(2), 597–612. https://doi.org/10.1177/15248380211036077

109.

* McKibbin

Halfpenny

Humphreys

. (2022). Respecting sexual safety: A program to prevent sexual exploitation and harmful sexual behavior in out-of-home care. Australian Social Work, 75(1), 111–121. https://doi.org/10.1080/0312407x.2019.1597910

110.

* McKibbin

Humphreys

Hamilton

. (2017). “Talking about child sexual abuse would have helped me”: Young people who sexually abused reflect on preventing harmful sexual behavior. Child Abuse and Neglect, 70, 210–221. https://doi.org/10.1016/j.chiabu.2017.06.017

111.

* Meiksans

Bromfield

L. A

. (2017). A continuum of responses for harmful sexual behaviors: An issues paper for Commissioner for Children and Young People Western Australia. Australian Centre for Child Protection. https://apo.org.au/sites/default/files/resource-files/2017-12/apo-nid172636.pdf

112.

* Mesman

G. R.

Harper

S. L.

Edge

N. A.

Brandt

T. W.

Pemberton

J. L

. (2019). Problematic sexual behavior in children. Journal of Paediatric Health Care, 33(3), 323–331. https://doi.org/10.1016/j.pedhc.2018.11.002

113.

* Messerschmidt

J. W

. (2011). The struggle for heterofeminine recognition: Bullying, embodiment, and reactive sexual offending by adolescent girls. Feminist Criminology, 6(3), 203–233. https://doi.org/10.1177/1557085111408062

114.

* Miccio-Fonseca

L. C

. (2014). Comparative differences in the psychological histories of sex offenders, victims, and their families. In Coleman

E. J.

Dwyer

(Eds.), Sex offender treatment (pp. 71–84). Routledge.

115.

* Morrill

Bachman

. (2013). Confronting the gender myth: An exploration of variance in male versus female experience with sibling abuse. Journal of Interpersonal Violence, 28(8), 1693–1708. https://doi.org/10.1177/0886260512468324

116.

* National Centre on Child Abuse and Neglect. (1991). Family violence: An overview. U.S. Department of Education. https://files.eric.ed.gov/fulltext/ED333319.pdf

117.

* O’Brien

M. J

. (1991). Taking sibling incest seriously. In Patton

M. Q.

(Eds.), Family sexual abuse: Frontline research and evaluation (pp. 75–92). SAGE.

118.

* Offermann

B. J.

Johnson

Johnson-Brooks

S. T.

Belcher

H. M

. (2008). Get SMART: Effective treatment for sexually abused children with problematic sexual behavior. Journal of Child & Adolescent Trauma, 1(3), 179–191. https://doi.org/10.1080/19361520802313445

119.

* Okami

. (1992). “Child perpetrators of sexual abuse”: The emergence of a problematic deviant category. Journal of Sex Research, 29(1), 109–130. https://doi.org/10.1080/00224499209551637

120.

* Oliver

L. L.

Nagayama Hall

G. C.

Neuhaus

S. M

. (1993). A comparison of the personality and background characteristics of adolescent sex offenders and other adolescent offenders. Criminal Justice and Behavior, 20(4), 359–370. https://doi.org/10.1177/0093854893020004004

121.

* Openshaw

D. K.

Graves

R. B.

Ericksen

S. L.

Lowry

Durso

D. D.

Agee

Todd

Jones

K. E.

Scherzinger

. (1993). Youthful sexual offenders: A comprehensive bibliography of scholarly references, 1970–1992. Family Relations, 42(2), 222–226. https://doi.org/10.2307/585458

122.

* Pelech

Tickle

Wilde

. (2021). Professionals’ experiences of working with children and young people with harmful sexual behavior: A systematic review using meta-ethnographic synthesis. Journal of Sexual Aggression, 27(2), 264–284. https://doi.org/10.1080/13552600.2020.1846801

123.

Perry

G. P.

Orchard

(1992). Assessment and treatment of adolescent sex offenders. Professional Resource Press, Australia.

124.

* Pithers

W. D.

Gray

Busconi

Houchens

. (1998). Children with sexual behavior problems: Identifica-tion of five distinct child types and related treatment considerations. Child Maltreatment, 3(4), 384–406. https://doi.org/10.1177/1077559598003004010

125.

* Pitre

Daignault

Tourigny

. (2021). Children with sexual behavior problems: Differences observed following cognitive behavior therapy. Sexologies, 30(4), 242–259. https://doi.org/10.1016/j.sexol.2021.04.001

126.

* Pourliakas

McDonald

Macvean

Shackleton

Clayton

Palmieri

Michaux

. (2016). Review of approaches to prevent and respond to problem sexual behavior in children and young people in out-of-home care. Report prepared by the Parenting Research Centre on behalf of the New South Wales Government Department of Family and Community Services.

127.

* Prisco

. (2015). Parental involvement in juvenile sex offender treatment: Requiring a role as informed supervisor. Family Court Review, 53(3), 487–503. https://doi.org/10.1111/fcre.12169

128.

* Pritchard

Graham

Ikin

Penney

Kovacs

Mercer

Edwards

Jones

Mace

F. C

. (2011). Managing sexually harmful behavior in a residential special school. British Journal of Learning Disabilities, 40(4), 302–309. https://doi.org/10.1111/j.1468-3156.2011.00712.x

129.

* Rasmussen

L. A

. (2000). The trauma outcome process: An integrated model for guiding clinical practice with children with sexually abusive behavior problems. Journal of Child Sexual Abuse, 8(4), 3–33. https://doi.org/10.1300/j070v08n04_02

130.

* Rasmussen

L. A.

Dibble

. (1989). The Utah report on juvenile sex offenders. The Utah Task Force of the Utah Network on Juveniles Offending Sexually (NOJOS). https://www.ojp.gov/pdffiles1/Digitization/152452NCJRS.pdf

131.

* Ricks

J. M.

DiClemente

R. J.

Gullotta

T. P.

Plant

R. W.

Evans

M. A

. (2015). Adolescent sex offenders. In Gullotta

T. P.

Plant

R. W.

Evans

M. A.

(Eds.), Handbook of Adolescent Behavioral Problems (pp. 577–593). Springer.

132.

* Righthand

Welch

. (2004). Characteristics of youth who sexually offend. Journal of Child Sexual Abuse, 13(3–4), 15–32. https://doi.org/10.1300/j070v13n03_02

133.

* Runyon

M. K.

Kenny

M. C.

Berry

E. J.

Deblinger

Brown

E. J

. (2006). Etiology and surveillance in child maltreatment. In Lutzker

J. R.

(Eds.), Preventing violence: Research and evidence-based intervention strategies (pp. 23–47). American Psychological Association.

134.

* Russell

Harvey

. (2016). Working with adolescents who display sexually harmful behavior. Journal of Children’s Services, 11(3), 191–203. https://doi.org/10.1108/jcs-07-2015-0022

135.

* Ryan

E. P.

Murrie

D. C.

Hunter

J. A

. (2012). Juvenile sex offenders: A guide to evaluation and treatment for mental health professionals. Oxford University Press.

136.

* Ryan

E. P.

Otonichar

J. M

. (2016). Juvenile sex offenders. Current Psychiatry Reports, 18, 1–10. https://doi.org/10.1007/s11920-016-0706-1

137.

Ryan

Lane

Davis

Isaac

(1987). Juvenile sex offenders: Development and correction. Child Abuse & Neglect, 11, 385–395. https://doi.org/10.1016/0145-2134(87)90012-3

138.

* Scavo

Buchanan

B. D

. (1989). Group therapy for male adolescent sex offenders: A model for residential treatment. Residential Treatment for Children & Youth, 7(2), 59–74. https://doi.org/10.1300/j007v07n02_06

139.

* Schmidt

S. R.

Bonner

B. L.

Chaffin

. (2011). Understanding and treating adolescents with illegal sexual behavior. In Goodyear-Brown

(Eds.), Handbook of child sexual abuse: Identification, assessment, and treatment (pp. 469–485). John Wiley & Sons.

140.

* Schnitzer

Terry

Joscelyne

. (2020). Adolescent sex offenders with autism spectrum conditions: Currently used treatment approaches and their impact. The Journal of Forensic Psychiatry & Psychology, 31(1), 17–40. https://doi.org/10.1080/14789949.2019.1659388

141.

* Shaw

J. A.

Antia

D. K

. (2010). Sexually aggressive youth. In Benedek

E. P.

Ash

Scott

C. L.

(Eds.), Principles and practice of child and adolescent forensic mental health (pp. 389–401). American Psychiatric Publishing, Inc.

142.

* Shawler

P. M.

Bard

M. E.

Taylor

E. K.

Wilsie

Funderburk

Silovsky

J. F

. (2018). Parent-child interaction therapy and young children with problematic sexual behavior: A conceptual overview and treatment considerations. Children and Youth Services Review, 84, 206–214. https://doi.org/10.1016/j.childyouth.2017.12.006

143.

* Shawler

Silvis

V. G.

Taylor

E. K.

Shields

Beasley

Silovsky

J. F

. (2020). Early identification of youth with problematic sexual behavior: A qualitative study. Child Abuse and Neglect, 105, 104317. https://doi.org/10.1016/j.chiabu.2019.104317

144.

* Silovsky

J. F.

Niec

. (2002). Characteristics of young children with sexual behavior problems: A pilot study. Child Maltreatment, 7(3), 187–197. https://doi.org/10.1177/1077559502007003002

145.

*Silovsky

J. F.

Hunter

M. D.

Taylor

E. K

. (2019). Impact of early intervention for youth with problematic sexual behaviors and their caregivers. Journal of Sexual Aggression, 25(1), 4–15. https://doi.org/10.1080/13552600.2018.1507487

146.

* Silovsky

J. F.

Letourneau

E. J.

Bonner

B. L

. (2020). Introduction to CAN special issue: Children with problem sexual behavior. Child Abuse and Neglect, 105, 104508. https://doi.org/10.1016/j.chiabu.2020.104508

147.

* Silovsky

J. F.

Swisher

L. M.

Widdifield

Turner

V. L.

Bromberg

D. S.

O’Donohue

W. T

. (2013). Children with sexual behavior problems. In Bromberg

D. S.

O’Donohue

W. T.

(Eds.), Handbook of child and adolescent sexuality (pp. 497–518). Elsevier Inc.

148.

* Slemaker

Mundey

Taylor

E. K.

Beasley

L. O.

Silovsky

J. F

. (2021). Barriers to accessing treatment services: Child victims of youths with problematic sexual behavior. International Journal of Environmental Research and Public Health, 18(10), 5302. https://doi.org/10.3390/ijerph18105302

149.

* Smith

T. J.

Lindsey

R. A.

Bohora

Silovsky

J. F

. (2019). Predictors of intrusive sexual behaviors in preschool-aged children. The Journal of Sex Research, 56(2), 229–238. https://doi.org/10.1080/00224499.2018.1447639

150.

* Sneddon

Grimshaw

D. G.

Livingstone

Macdonald

. (2020). Cognitive-behavioral therapy (CBT) interventions for young people aged 10 to 18 with harmful sexual behavior. Cochrane Database of Systematic Reviews, 6(6), CD009829. https://doi.org/10.1002/14651858.cd009829.pub2

151.

* Sperry

D. M.

Gilbert

B. O

. (2005). Child peer sexual abuse: Preliminary data on outcomes and disclosure experiences. Child Abuse and Neglect, 29(8), 889–904. https://doi.org/10.1016/j.chiabu.2004.12.011

152.

* Stith

S. M.

Bischof

G. H

. (1996). Communication patterns in families of adolescent sex offenders. In Cahn

D. D.

Lloyd

S. A.

(Eds.), Family violence from a communication perspective (pp. 108–126). SAGE.

153.

* Szanto

Lyons

J. S.

Kisiel

. (2012). Childhood trauma experience and the expression of problematic sexual behavior in children and adolescents in state custody. Residential Treatment for Children & Youth, 29(3), 231–249. https://doi.org/10.1080/0886571x.2012.702519

154.

* Taylor

E. K.

Slemaker

Silovsky

J. F

. (2020). Professionals’ perceptions of electronic and online sexual behaviors of youth in their community. Children and Youth Services Review, 111, 104831. https://doi.org/10.1016/j.childyouth.2020.104831

155.

* Taylor

E. K.

Tener

Silovsky

J. F.

Newman

. (2021). Comparison of children’s advocacy centre responses to harmful sexual behavior among siblings: An international perspective. Child Abuse & Neglect, 122, 105371. https://doi.org/10.1016/j.chiabu.2021.105371

156.

* Tener

Sigad

L. I.

Katz

Shimron

Harel

Greenblum

Shemesh

Zabib

Y. Z

. (2022). “Maybe I imagined it, maybe it really was all just childish play”: Complexity and ambiguity in survivors’ perceptions of harmful preadolescent sexual behavior. Child Abuse and Neglect, 123, 105368. https://doi.org/10.1016/j.chiabu.2021.105368

157.

* Thibaut

Bradford

J. M.

Briken

De La Barra

Häßler

Cosyns

. (2016). The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the treatment of adolescent sexual offenders with paraphilic disorders. The World Journal of Biological Psychiatry, 17(1), 2–38. https://doi.org/10.3109/15622975.2015.1085598

158.

* Ueda

. (2017). Developmental risk factors of juvenile sex offenders by victim age: An implication for specialised treatment programs. Aggression and Violent Behavior, 37, 122–128. https://doi.org/10.1016/j.avb.2017.09.006

159.

* Valdivia-Salas

Jiménez

T. I.

Lombas

A. S.

López-Crespo

. (2021). School violence towards peers and teen dating violence: The mediating role of personal distress. International Journal of Environmental Research and Public Health, 18(1), 310. https://doi.org/10.3390/ijerph18010310

160.

* van Eys

P. P

. (1997). Group treatment for prepubescent boys with sexually aggressive behavior: Clinical considerations and proposed treatment techniques. Cognitive and Behavioral Practice, 4(2), 349–382. https://doi.org/10.1016/s1077-7229(97)80007-7

161.

* Waters

Anstey

Clouston

Sydor

. (2021). Exploring teachers’ lived experiences of child-on-child harmful sexual behavior at school: An interpretative phenomenological analysis. Journal of Sexual Aggression, 27(2), 219–232. https://doi.org/10.1080/13552600.2021.1896810

162.

* Webster

G. P.

Butcher

. (2012). The assessment of problem sexual behaviors amongst children: A human rights centred approach. Sexual Abuse in Australia and New Zealand, 4(1), 22–32. https://doi.org/10.3316/informit.657454000079339

163.

* Wiehe

V. R

. (1997). Sibling abuse: Hidden physical, emotional, and sexual trauma. SAGE.

164.

* Yates

. (2018). “Siblings as better together”: Social worker decision making in cases involving sibling sexual behavior. British Journal of Social Work, 48(1), 176–194. https://doi.org/10.1093/bjsw/bcx018

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.06 MB