Title: Problematic and Harmful Sexual Behavior in Children: a systematic review.
Background: About ten percent of all children under the age of 18 experience sexual abuse during their childhood, and one third of these offenses is committed by another child or peer. Even though this phenomenon is not rare, there exist uncertainty among parents, educators, and professionals in how to understand and manage children who exhibit problematic and harmful sexual behavior (PSB/HSB). A major part of research and reviews on the topic focus on juvenile sexual offenders. However, there are no identified systematic reviews examining quantitative studies with samples of children under the age of 12. Therefore, the need for a review on the existing evidence on children up to 12 years of age exhibiting PSB/HSB is evident.
Objectives: To review the empirical studies examining PSB/HSB in children under the age of 12, and generate a general picture of the research field, based on a twofold intention: 1) mapping aspects of key circumstances in the life and upbringing of a child with PSB/HSB, and 2) to investigate the stability of the behavior.
Methods: The systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. The literature search was conducted in PubMed, Embase and PsycInfo (date of search 3rd of March, 2020, no date restrictions). All quantitative empirical, peer-reviewed studies about PSB/HSB in children below 12 years of age were included. We included studies where the total sample was below age 12 or where the sample mean was below age 12. To present and synthesize the results, four tables presenting the extracted information was made: study characteristics, adverse childhood experiences (neglect, sexual abuse, physical abuse, psychological abuse, and witnessing domestic violence), parent- and family factors (living with at least one biological parent, substance abuse among parents, parents completed high school, parents arrested/imprisoned, mental disorders in parents, and parents’ adverse childhood experiences), and longitudinal studies. The quality of the evidence and risk of bias was assessed with five selected and revised questions from the NIH Quality Assessment tool.
Results: Of 3050 records identified, 36 studies were eligible for inclusion. These consisted of 27 unique datasets, and 19 had a low to moderate risk of bias, based on an edited and limited assessment of risk of bias . 21 studies investigated adverse childhood experiences, 15 investigated parent- and family-factors, and 3 had a longitudinal design with two measures of the same participants at least one year apart. The studies showed high prevalence of adverse childhood experiences and negative parent- and family factors on most variables measured, but these conclusions are based on wide prevalence ranges. Studies varied greatly in sample size, method for sampling and dividing samples, conceptualization of PSB/HSB and measured variables.
Discussion: Compared to general population-based data the results showed a heightened prevalence of both the measured adverse childhood experiences and parent- and family factors in the population of children with PSB/HSB. The longitudinal studies indicated a heightened risk for non-sexual criminality over time in children with PSB/HSB. Limitations of this review include variation between the study-samples, which is caused by the wide search- and inclusion-method of the review. A lack of control-groups as an eligibility criterion makes it difficult to identify any confounding variables. The study of risk of bias is limited by the applied method but demonstrates that studies with high risk of bias most likely does not influence the results. The results give a general impression of a vulnerable, understudied population, and a research field that needs more focus. Important implications are to educate professionals about this population, and to treat this behavior as a symptom or sign of a challenged upbringing.