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7.3 Children and Young People who Display Sexually Inappropriate or Harmful Behaviours


NICE Guidance, Harmful sexual behaviour among children and young people (NG 55)



This chapter was updated in January 2018 to ensure the chapter reflects current terminology and practice in this area and to include NICE Guidance NG 55 ‘Harmful sexual behaviour among children and young people’. This includes guidance on early help assessment; risk assessment; engaging with families; developing and managing a care plan, and supporting a return to the community for accommodated children.

This chapter is currently under review.


  1. Introduction and Definition
  2. Identifying Harmful Sexual Behaviours
  3. Key Principles
  4. What You Should Do

    Appendix 1: Overall Care Pathway: Therapy Services – Victims of Sexual Abuse; Sexually Harmful Behaviour Flowchart

1. Introduction and Definition

Harmful Sexual Behaviour is defined as: '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 2014, Children and Young People with Harmful Sexual Behaviours).

See also further guidance: NSPCC What is harmful sexual behaviour.

2. Identifying Harmful Sexual Behaviours

For guidance on identifying Harmful Sexual Behaviours we recommend you refer to Brook, Sexual Behaviours – Traffic Light Tool.

Some definitions:

See NSPCC What is harmful sexual behaviour for definitions.

For adolescents, the following definition may be useful:

"Sexually abusive behaviour has been defined as any sexual interaction with person(s) of any age that is perpetrated:

  1. Against the victim's will;
  2. Without consent;
  3. In an aggressive, exploitative, manipulative, or threatening manner."

(Ryan, G. and Lane, S. 1997:3)

For younger children, a continuum of sexual behaviours is suggested (Cavanagh Johnson, T. and Feldmeth, J.R. 1993):

  • Normal sexual exploration:
    • Children in this group demonstrate age appropriate sexual behaviours;
  • Sexually Reactive:
    • Many children in this group have experienced sexual abuse or have been exposed to a sexualised environment. The focus on sexual behaviour is not in balance with other aspects of their lives. The sexual behaviours typically are not characterised by secrecy, coercion or force. These children are likely to be having difficulty making sense of their life experiences. Behaviours are likely to include excessive masturbation, and sexual behaviours towards children and adults. (Calder 2001; Carson and Wilkinson 2002);
  • Extensive Mutual Sexual Behaviours:
    • Children in this group are usually victims of sexual abuse. They will exhibit age inappropriate and/or adult type sexual behaviours, and are likely to have focused and extensive patterns of behaviour. These children are likely to have a matter of fact attitude towards the sexual behaviours with other children. (Calder 2001; Carson and Wilkinson 2002);
  • Children who Molest:
    • Children in this group exhibit sexual behaviours that are age inappropriate and typical of adult sexual behaviours. The sexual behaviours are often associated with expressions of negative feelings such as anger, loneliness or fear. Children in this group use coercion, force and secrecy, and will be able to exert power over the other child(ren). Children who exhibit these types of behaviour are likely to have been abused, either sexually or in other ways. (Calder 2001; Carson and Wilkinson 2002).

3. Key Principles

Work with children and young people who abuse others - including those who sexually abuse/offend – it should be recognised that such children are likely to have considerable needs themselves, whilst they may pose a significant risk of harm to other children they may need to be considered as vulnerable in their own right. Evidence suggests that children who abuse others may have suffered considerable disruption in their lives, been exposed to violence within the family, may have witnessed or been subject to physical or sexual abuse, have problems in their educational development, and may have committed other offences. Such children and young people are likely to be children in need, and some will in addition be suffering or at risk of significant harm, and may themselves be in need of protection.

Children and young people who (sexually) abuse others should be held responsible for their abusive behaviour, whilst being identified and responded to in a way which meets their needs as well as protecting others. Early intervention with children and young people who abuse others may, therefore, play an important part in protecting the public by preventing the continuation or escalation of abusive behaviour.

Three key principles should guide work with children and young people who abuse others:

  • There should be a co-ordinated approach on the part of youth justice, child welfare, education (including educational psychology) and health (including child and adolescent mental health) agencies;
  • The needs of children and young people who abuse others should be considered separately from the needs of their victims; and
  • An assessment should be carried out in each case, appreciating that these children may have considerable unmet developmental needs, as well as specific needs arising from their behaviour.

Additionally, Lincolnshire SCB emphasises that:

  • Children and young people of various ages, ethnic origins, family circumstances, and of both genders, can behave in a sexually harmful way to others;
  • The behaviour is harmful to the victim(s);
  • Sexual harmful behaviour is different from normal sexual development. It is necessary to distinguish between what is normal sexual development and what is sexually harmful behaviour;
  • Children/young people are more amenable to change and are less likely to have a set pattern of sexual thoughts and behaviours. The earlier the identification of the sexually abusive behaviour, the greater the potential for change;
  • The relationships staff develop with children/young people are one of the most powerful influences in whether interventions are effective;
  • Reports of apparently abusive/inappropriate sexual behaviour by a child or young person must be taken seriously and responded to appropriately;
  • An Assessment Intervention Moving on (AIM) assessment may take place when a child/young person exhibits sexually inappropriate behaviours.

Distinguishing If a Behaviour is Harmful or Not

It is useful to consider the following issues in order to determine whether there are concerns about a child's or young person's sexual behaviour:

  • Were there any power differentials? (e.g. age; size; developmental level; does one child have authority over another);
  • Whether the behaviour was legal?
  • Issues of consent (Was there true consent, or was there an element of intimidation or trickery?)
  • Was force or persuasion used?
  • Whether the behaviour falls within 'normal' sexual development;
  • Are there any features of obsession or compulsiveness?
  • What was the level of secrecy? (e.g. Did the behaviour occur openly or was it planned and in secret?);
  • Are there any concerning sexual fantasies?
  • Is there any use of distorted thinking to justify the behaviour?
  • Do other children/young people complain about the behaviour, or view it as wrong?
  • What is the victim's perception of the behaviour?
  • Is there any evidence of escalation?
  • How did the sexual behaviour come to light?
  • How persistent is the sexual behaviour? (e.g. Have there been other concerns? Does the behaviour continue despite requests for it to stop?);
  • Are there any elements of ritualistic or sadistic behaviours?
  • Were there any accompanying expressions of anger or aggression?

4. What You Should Do

Reporting Concerns

Where there are concerns about a child or young person's sexual behaviour, you should ALWAYS refer these concerns to Children's Social care and/or the Police.

Responding To The Child/Young Person

For those staff who have direct contact with the child or young person, it is important to convey that whilst the behaviour is not acceptable, you are not condemning them as a person. You need to show respect and understanding and offer hope that change is possible. Denial and embarrassment should be expected. Let the child/young person know that you are not shocked or offended and avoid confrontation.

Child Protection Referral

Police and Children's Social care will decide whether Section 47 enquiries will be initiated. In ALL circumstances, there should be a social work assessment by Children's Social Care, which includes the relevant AIM assessment model(s).

Consideration should be given to S47 enquiries in respect of the victim and their needs should be addressed within the Child Protection/TAC systems. (See Section 47 Enquiries and Social Work Assessments).

Criminal Justice Route

When a young person (aged 10 and over) admits an allegation of sexual abuse the YOS team will be notified immediately to allow for the initial (AIM) assessment. Parents and carers should be informed of this decision, if appropriate. If there is serious ongoing risk to the victim or potential victims, or where the offence is serious, the Police will consider charging the young person.

For those young people who deny the allegation, the Police will process the allegation in the usual manner. However, the AIM assessment can be considered at any stage.

Criminal Justice and Child Protection Routes

Where consent is not given to conduct the AIM assessment, but concerns remain, the assessment can be done as a paper exercise, using existing information. This will limit the validity of the assessment.

Following the completion of the AIM assessment and S47 enquiries, a decision will be made by the Practice Manager (Social Care), whether to convene a Child Protection Conference or a Multi-Agency Case Planning Meeting. Where a child or young person is Looked After, the usual Looked After Children procedures will consider issues relating to the sexually harmful or inappropriate behaviour. This meeting will determine the child or young person's needs, subsequent interventions, and how risk will be managed. Victim issues should be shared at the Multi-Agency 16.18 Case Planning Meeting to inform plans for the child/young person with inappropriate/harmful sexual behaviours. The Multi-Agency Case Planning Meeting will consider the following agenda:

  • Child protection concerns;
  • Victim safety and relevant issues;
  • Risk management (home, school, community) - safe care plans to be completed as required;
  • Accommodation/living arrangements;
  • Education issues;
  • Support for the young person and their family;
  • Needs of the young person;
  • Intervention/treatment needs;
  • Ensuring clarity of professional roles and tasks;
  • Any outstanding assessment needs;
  • In exceptional circumstances, consideration of need to refer to Multi-Agency Public Protection Arrangements;
  • Review date.

The Assessment Intervention Moving on (AIM) Assessment

The AIM assessment model was developed by the AIM Project in Greater Manchester. This is a social work assessment model, with assessment modules that assess children under twelve; adolescents; families and carers; and those who engage with technology-assisted Harmful Sexual Behaviour. The AIM assessments compliment the DHSC National Assessment Framework for Children in Need and their Families and the Criminal Justice National Assessment Framework (ASSET+).

The AIM assessments should be co-worked. Where applicable, this should be undertaken by workers from two different agencies.

Safe Care and Managing Risk

Alongside the AIM assessment, consideration should also be given to developing safe care plans for the child's living environment and school setting. This should be undertaken at an early stage of the intervention by agencies. (See Safe Care Protocol).


Appendix 1: Overall Care Pathway: Therapy Services – Victims of Sexual Abuse; Sexually Harmful Behaviour Flowchart