Harmful sexual behaviour by children and young people: Expert Group report

Chapter 4: Theories About Causes of Harmful Sexual Behaviours

Theories about the causes of HSB are closely linked to the theories of prevention, which are discussed in Chapter 6.

International and UK Research, and Practice Evidence from the Expert Sub Groups

This section contains a brief overview of research evidence over the last few decades, along with information from the five sub groups who explored the following topics:

• Children and Young People with Intellectual Disabilities
• Intra-familial Behaviours
• Internet Pornography
• Involvement of Younger Children
• Peer on Peer Abuse
• Risk Assessments and Responses

Evidence across different countries and contexts consistently shows that sexual violence, as well as domestic abuse and other forms of gender-based violence, is primarily perpetrated by men and boys, most often against women and girls.^[37]

There has been much less research relative to children involved in HSB in early years, and overall much more research regarding adults who display HSB, and within adult male prison populations.

Research into the causes of HSB has emerged from a number of perspectives including psychological and social cultural dimensions. In addition to personal experiences from children and young people that have been considered by researchers seeking to understand why some children and young people become involved in HSB and others do not, feminist activists, research evidence, theory and practice developed over a number of decades understands that gendered forms of violence are intrinsically connected with historic and continuing inequalities in social structures and culture.

Gender inequality is seen by those identifying a gendered analysis as the key driver of forms of violence including HSB. At a structural level the nature, prevalence and impact of HSB is also shaped by intersecting inequalities, principally of class, race, disability and age.

Whilst gendered disparities in perpetration and experience of sexual violence are clearly shown in relevant data, there is often no wider discussion or analysis on how we understand the overrepresentation of boys and men as perpetrators of sexual offences, or its implications for prevention.

Those working with a gendered analysis understand the overrepresentation of boys and men as perpetrators in relation to gender inequality, with gendered roles and constructs shaped according to gender-unequal social structures. Historically and, in very general terms, men have been attributed a dominant position within patriarchal societies, and in many contexts have been afforded entitlement to sexual access to women. Correspondingly, women have been given very little sexual agency and have been subject to strict controls designed to protect patrilineal inheritance.

Modern society is complex and there has been much social change over the last century, but gendered socialisation along these lines continues^[38], and can be seen in modern day attitudes and values in relation to sexual relationships and sexual violence. The negative impacts of gender inequality fall disproportionately on girls and women, although it is also important to recognise the consequences of prescribed gender roles for boys and men. For example, social norms around masculinity can make it difficult for boys and men to express certain emotions such as vulnerability or to report when they have suffered HSB. That can have significant implications for their wellbeing and mental health. It also affects society's understanding of HSB by others.

Rather than understanding instances of sexual violence as 'deviant' and 'episodic', a gendered analysis approach suggests that they can be 'normative' and 'functional'^[39]; normative because they reflect and convey patriarchal values in terms of men's power, control and sexual entitlement, and functional because the violence serves to maintain those structures of power. In addition, this approach also credits context in shaping and enabling violence against women in that such behaviours are seen in contexts where, for example, male violence is tolerated, excused or naturalised, or perpetrators are not held accountable and victims are blamed, resulting in violence being fostered.

Recent research explores the gendered nature of expectations, attitudes and practices relating to sexual behaviour. For example, a report commissioned for the Office of the Children's Commissioner of England and Wales highlighted gendered patterns in attitudes towards sexual consent, with young men facing pressures to gain 'man points' through having sex (with girls), and facing a loss of status and position if, for example, they respected a girl's decision not to have sex. By contrast, young women faced blame and scrutinisation of their actions if they experienced sexual exploitation and/or violence, "with revealing clothing, drinking alcohol, visiting a man's house or sending sexualised pictures all seen as evidence that they were responsible for what happened to them afterwards."^[40]

A study of attitudes and practices relating to anal sex in young people's heterosexual relationships identified that such practices were often understood to be painful and risky particularly for women and that coercion and 'accidental' penetration of women were normalised. Further, that men were expected to persuade or coerce reluctant partners, and that competition between men was a key element in how young people explained incidence of anal sex.^[41]

Impact of Life Experiences

"Children with sexual behaviour problems are not miniature adults or adolescent sexual offenders… Not only is children's sexuality different than adults and adolescents, their emotional, social, and cognitive awareness and relationship to the world is different. It is dangerous to children that we do not recognize the differences and treat the child, not our projections onto the child".^[42]

A 2012 study^[43] examined a randomised sample of 2,275 children and young people in the UK aged 11-17 and reported that most incidents of physical, sexual or emotional abuse are perpetrated by other children and young people. From that study:

• 35.3% of individuals reported this happening over the previous year, 59.5% at some time during their childhood;
• 16% of individuals reported HSB in the previous year by siblings 31.8% at some time during childhood;
• 2.5% (1 in 40) reported exposure to parental domestic violence in the previous year, and 17.5% (1 in 6) had experienced this at some time during their childhood; and
• 5% (1 in 20) reported victimisation from their own intimate partner (boyfriend or girlfriend) in the previous year, 7.9% (1 in 13) had experienced this before reaching the age of 18.

A separate report, in which 700 children and young people in the UK who had sexually abused others were studied, found that 50% of the sample had been victims of sexual abuse and 50% had experienced physical abuse or domestic violence.^[44]

HSB in children can be a reaction to trauma or victimisation. Studies of very young children exhibiting HSB suggest that a significant proportion have been sexually victimised and the younger the child who engages in HSB, the more likely the child is to have experienced sexual abuse.^[45]

Young people with sexually abusive behaviour are 5 times more likely than young people with non-sexual criminal behaviour to have been sexually abused.^[46] However, sexual abuse is not the only precursor to a child displaying HSB. Children and young people can engage in atypical sexual behaviours for a range of reasons including being victims of sexual abuse, experiencing physical or emotional maltreatment such as neglect^[47] or abandonment, exposure to family violence, exposure to sexuality and sexual behaviour in the media, and other causes, including the influence of wider gender roles and expectations in relation to sexual behaviour.^[48]

For some young people, learning disability and developmental delay^[49] may be significant factors that impact on aspects of social, relational and sexual development in adolescence.^[50] Others may have also experienced considerable adversity in their lives, have excessive unmet emotional needs, use coercion and aggression as coping strategies, and/or have poor emotional regulation skills and pre-adolescent sexualisation. Other aspects of unresolved trauma may also be present and may help account for a shift from typical sexual experimentation to forms of sexual aggression for some adolescents.^[51]

Although there can be various developmental pathways into HSB in adolescence, the existing evidence base confirms that children who display such behaviours often come from families that are described as multiply troubled and dysfunctional and in which chaos and stress is present^[52]; affected by factors such as childhood adversity, trauma, learning disability and developmental delay^[53]; family instability and unstable living conditions, domestic violence, personal histories of neglect and abuse, and other disruptions to optimal child development^[54]; dysfunctional patterns of family life^[55]; and where experiences of violence, abuse and neglect are common.^[56] Other researchers argue that fractured attachment within the life of a child can lead to intimacy deficits and ultimately HSB.^[57]

Recent research in the UK and elsewhere suggests that the responses to stress caused by Adverse Childhood Experiences (ACEs) can lead to physical changes in the way that the brain develops. It is often referred to as 'toxic stress' and is thought to have an effect on how someone adapts to future adverse experiences and in the chance of developing health harming behaviours.^[58] This is of significance in understanding children who cause harm as a result of their lived experiences, and also in respect of the children and young people harmed.

A recent study considering young people who are part of the Interventions for Vulnerable Youth (IVY)^[59] project, indicated that 93.1% of the 130 individuals questioned had experienced at least one adverse childhood experience such as abuse, neglect or growing up in a household where there is domestic violence; 58.5% of the sample had experienced four or more.^[60]

The single peer-reviewed Scottish study available^[61] highlights that children and young people aged between 5 and 20 who were involved in HSB were at a higher risk in relation to negative life experiences such as independent living outcomes, unemployment, poverty, mental illness, addiction, exposure to trauma, homelessness, incarceration, re-victimisation and suicide.

Gender and Age Differences

Research identifies similar gender differences of displaying HSB, with girls tending to be younger when their HSB is identified. The peak age for occurrence of HSB is early teenage, most of which is displayed by boys.^[62]

Children with HSB differ from adolescents and adults who engage in HSB. While upwards of 95% of adolescents and adults who sexually offend are male^[63] , 65% of preschool children (below the age of criminal responsibility) with HSB are female.^[64]

Differences also exist between very young (aged 9 and younger) and older (aged 10-12) children. In general, the younger the child, the more limited their cognitive development, and the more limited their repertoire of coping strategies.^[65]

When compared to adults who sexually offend, children and young people with HSB are more likely to engage in impulsive sexual activity rather than well-planned or rationalised acts. The failure of children and young people to empathise with their victims in these situations may not be pathological^[66], but merely a product of their stage of development.

Similar to adolescents, children with HSB are a heterogeneous group. As a result, working from an individualised approach which includes a comprehensive assessment is recommended. Given the level of trauma experienced, a flexible service delivery model may be required, in which assessment and intervention focuses on the child's own trauma and associated symptoms alongside their harmful sexual behaviour

Overall research emphasises the importance of viewing HSB as just one aspect of a child or young person's behaviour, instead of a reflection of the child as a whole.

Best practices include involving families and caregivers in service decisions and provision and collaborating with other agencies who work with the child and family.

Provided there is detection and effective intervention, children and young people exhibiting HSB are at a relatively low risk for future behaviours. Most interventions use a cognitive behavioural theory (CBT) approach, while some interventions also have a trauma focus. Few intervention programs have been systematically documented and assessed. Allardyce and Yates (2018) offer a helpful brief overview of interventions.^[67]

Use of the internet in HSB

While a significant proportion of online-facilitated sex offences are committed by young people, limited research has been carried out into young people engaging in HSB with an 'internet', 'online', or 'technology-assisted^[68]' element.

A recent and recurrent challenge for legislative systems across the globe, is the issue of children and young people producing and sharing intimate images.

Leukfeldt et al. (2014) examined this. They analysed 159 Dutch police files relating to images of child abuse and sexual exploitation, and found that almost a quarter of the suspects were under 24 years of age. Of that group, 35% were younger than 18 years. Their analysis indicated that these are children and young people who take sexualised pictures and/or make videos of themselves and/or each other which, if the material is distributed via the internet, becomes a matter for law enforcement agencies.^[69]

Their report evidences the tensions around how these scenarios should be managed and whether these activities should result in prosecutions. For example, Gillespie (2013) argued that self-produced images when taken consensually are an expression of the adolescent's sexual identity and thus protected by Articles 8 and 10 of the European Convention on Human Rights. This is a clear area of tension between legislation that is perceived as necessary to protect children and young people from harmful behaviours of others^[70], but which may also be felt by them in some instances to be denying exercise of their right to developmental sexual exploration on their own terms.

Although the consequences of self-produced sexual images for adolescents have largely been seen as negative^[71], some researchers have argued that assumptions about coercion and harm do not reflect the experiences of the majority of girls who engage in sexting and who are motivated by pleasure and desire.^[72] Others suggest a need for more 'nuanced understandings of sexting' to distinguish between the 'consensual and non-consensual creation and distribution of sexual images', and to more usefully inform policy-making and educational resources.^[73]

The key findings of recent NSPCC research^[74] using their Turn the Page project for children presenting with Technology Assisted-Harmful Sexual Behaviour (TA-HSB)^[75] highlighted differences in characteristics between those involved in TA-HSB only, those involved in dual behaviours (i.e.: TA-HSB and offline HSB) and those involved in only offline HSB.

"The children who presented with only TA-HSB appeared to come from more stable backgrounds with less incidents of parental separation, less adversity or trauma during their childhood, more positive parental relationships, no contact with statutory services prior to the presenting HSB and were approximately three years older at the onset of their HSB. This group demonstrated better emotional regulation, less impulsivity and less anger, aggression and general offending behaviours than those involved in either dual or offline only."^[76]

These findings are very different from those in relation to children and young people with HSB that is not technology-assisted. However, the NSPCC research shows that this group experienced higher levels of online abuse and victimisation than children with either offline or dual HSB that may correspond with their own presentations of HSB. The study hypothesised that engaging in TA-HSB (only) may relate to the onset of puberty, pornography use and/or the young male's own online sexual victimisation and grooming.

Impact of Use of Pornography

There is growing concern that viewing adult pornography can have an impact on young people's sexual behaviour, especially young people under the age of 13.^[77] Exposure to pornography is increasingly being identified as a contributory factor in the emergence of HSB.^[78] This resonates with wider concerns around the extent to which children have access, or are exposed, to online sexual and or violent material.^[79]

Stanley et al (2016) found significant statistical associations between pornography use and self-reported sexually coercive behaviour. There is further observation in chapter 5 about the use of pornography by children and young people, seen from a sample of cases analysed by the Expert Group's Data and Intelligence Sub-Group.

One of the most significant UK studies conducted to date^[80], on behalf of the NSPCC and the Office of the Children's Commissioner in England and Wales suggests that:

• More boys view online pornography through choice than girls
• At the age of 11, most children have not seen online pornography
• By the age of 15, children are more likely than not to have seen online pornography
• Children are as likely to stumble across pornography via a "pop up" as to search for it deliberately, or to be shown it by other people.
• The proportions wishing to emulate pornography increase with age; 21% for 11-12 year olds, 39% for 13-14 year olds, and 42% for 15-16 year olds.
• Some 44% of males, compared with 29% of females, reported that the online pornography they had seen had given them ideas about the types of sex they wanted to try out.

Evidence suggests that children and young people who are educated about online pornography during sex education classes are less likely to be negatively influenced by online pornography than those who have had no lesson on the topic.

Police Scotland and other statutory authorities have identified children and young people becoming involved in HSB by use of image viewing and sharing, who would not have previously come to the notice of statutory authorities. These children and young people do not appear to have the background challenges that have traditionally been associated with most children and young people involved in HSB. Smallbone (2016) commented on this, inferring that this may be related to availability of access to online extreme and illegal adult pornography and child abuse images.

Peer on Peer Abuse

The definition of Peer on Peer abuse differs depending on professional discipline, and may even differ between branches of the same profession.

Some professions and third sector organisations use the term to cover all children and young people interacting with other children and young people^[81] , some use the term to describe those close to each other in developmental stage, while others like the sub group describe it as specific to young people close in age.

As the Expert Group established sub groups to consider Children and Young People with Intellectual Disabilities; Intra-familial Behaviours; and the Involvement of Younger Children, the sub group specifically tasked with considering Peer on Peer Abuse chose to focus on adolescents from 13 years old, where both young people involved were close in age.

It was noted that analysis of HSB involving young people close to each other in age showed that females are much more likely to report being victims of HSB caused by their male peers, although there were also reports of same sex incidents.

Much of the information provided by the sub group considering Peer on Peer abuse has been included widely throughout this report.

Intra-familial HSB

Intra-familial HSB refers to HSB that occurs within a family environment.^[82] It can involve children and young people who are full siblings, half-siblings, step-siblings, foster and adoptive siblings, 'social' siblings (who are a constant in the family environment), cousins, nephews, nieces, etc. Most of the literature regarding intra-familial HSB refers more specifically to sibling sexual abuse.

There have been various studies on the prevalence of sibling HSB with different populations in different countries, although there are no Scotland-specific studies. In the wider UK, studies estimate that where there are children and young people involved in HSB, between one third and one half of victims are siblings or close family members.^[83]

Sibling sexual abuse entails on average a greater number of sexual acts over a longer period of time and is more likely to involve sexual intercourse than harmful sexual behaviour within the community. It may be at least as harmful as sexual abuse by a parent. Some children who display harmful sexual behaviour towards siblings also do so within the community, and they make up some of the higher risk adolescents who display harmful sexual behaviour.

As with all HSB, sibling sexual abuse results in a family in crisis, though in these circumstances there is the added factor that both the child causing harm and the child harmed are part of the same family, with the harm often having occurred in the family home. This can make it very difficult to determine the dynamics of the behaviour and throws up issues about how best to accommodate each child while issues are examined and addressed. There is also a need to consider the consequences for the life-long relationship that each child is necessarily going to have with other members of the family but also with each other. There is considerable consensus that sibling sexual abuse should prompt a family-based, rather than individual, response requiring a co-ordinated, multi-agency approach including schools and other community groups.

Living and contact arrangements need to be decided on a case-by-case basis, founded upon an evidenced-based risk assessment, the safety and emotional needs of both children, and an assessment of the quality and value of the sibling relationship. There is a clear need to take a restorative approach to help both children and the family to recover, which can be difficult to achieve in cases where the age of the child causing harm may increase the likelihood of criminal proceedings. Access to resources and supports can be delayed awaiting the outcome of the legal proceedings, which prevents the earliest possible restorative interventions for both children. On the other hand (and as in cases that are not intra-familial), no system can mandate treatment without a criminal prosecution or referral to the Children's Hearing System.

Young People with Additional Needs

Whilst there is a great deal of individual variation in this population, it is generally recognised that people with Intellectual Disabilities (ID) can be more vulnerable in this context due to a range of factors. These include: impaired communication abilities; level of psycho-social and psycho-sexual development; impaired ability to anticipate consequences to self and others; impaired ability to identify risk; poor emotional stability; vulnerability to be adversely influenced by peers; and difficulties understanding the needs or intentions of others.

These challenges can be particularly relevant in an online environment.

It is not only children and adolescents with ID who can be more vulnerable in this way. Those children and adolescents with a range of neurodevelopmental conditions including Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), Traumatic Brain Injuries (TBI) and Foetal Alcohol Syndrome (FAS) can also have difficulties in managing interactions online and in person.

In Scotland, social care staff contributed to the 2018 Secure Care Census.^[84] The census identified a range of mental health needs in the 87 young people who were in secure care on the census date. Of these, 23% had a diagnosis of ASD (compared with approximately 1% of the general population), and 16% were identified as having Social Learning and Communication Needs. A trauma diagnosis was identified in 28% of the sample.

Population rates of ID in the UK are 1-2%, and research highlights an over-representation of young people with ID engaging in HSB. However, young people with ID are also over-represented in studies of adolescents who display general harmful behaviour.^[85] Current evidence suggests that between a third and a half of the HSB towards other children and young people is by individuals who either have ID or who have significant education problems.

Research conducted by Hackett et al in 2013, which studied 700 children and young people referred to nine UK services over a nine year period as a result of sexually abusive behaviours, showed that 38% of the sample had an ID (compared with 1-2% of the general population). This over-representation merits consideration and specific recommendations, because the needs of this group differ in material aspects from the needs of the general population. It is relatively common for young people with ID to display inappropriate sexual behaviour, but the majority of individuals with ID do not engage in HSB.

The benefits of healthy relationships for this group, and initiatives to promote healthy relationships should be supported. For professionals working with individuals with ID, it is common to encounter families and carers who see individuals with ID as essentially asexual, or who actively discourage sexual education or sexual expression by individuals with ID.^[86] These attitudes can hamper efforts to address inappropriate sexual behaviours when these are displayed, with parents or carers perhaps being less likely to report concerning sexual behaviours.

Expert Group Findings and Conclusions

No single theory explains HSB. It is a complex area and many different influences can be relevant to the behaviour of a person at different times in their lives.

The research available indicates that International and UK findings are broadly similar in most instances.

Research also emphasises the importance of viewing HSB as just one aspect of a child's behaviour instead of a reflection of the child as a whole.

There is a growing body of evidence suggesting that ACEs and trauma may be part of the underlying cause of some children and young people being harmed as a result of HSB by other children, or causing such harm.

There is also significant evidence that gender plays a key role in shaping attitudes and behaviours in relation to sexual relationships, with clear gendered dimensions shown across studies and datasets.

There is generally a lack of research regarding HSB involving children and young people.

There are particular issues to HSB occurring which is intra-familial or which involves children and young people with intellectual disabilities.

The use of modern technology by children and young people in exploratory sexual development, and the impact that access to adult pornography and/or extreme and illegal images has on children and young people in respect of HSB is not well understood.

Expert Group Proposals

Research in Scotland should be commissioned into potential causes of HSB involving children and young people; and all current preventative responses and other interventions should be evaluated.

In particular there should be focus on aspects of HSB which are specific to:

• experiences of those children and young people with intellectual disabilities and other neurodevelopmental disorders (including Autism, Attention Deficit Hyperactivity Disorder and Foetal Alcohol Spectrum Disorder)
• intra-familial incidents
• younger children
• childhood experiences leading to vulnerabilities that in turn can increase the risks of harming or being harmed by HSB involving other children and young people
• the impact of access to pornography in childhood

The research should include consideration of situational crime prevention and safeguarding approaches.