Psychological treatment of children with problematic sexual behaviour

Children with problematic sexual behavior and children who subject other children to sexual violence is a difficult and taboo subject. These behaviors can lead to significant consequences for all involved, which is why it is important to address the issue in an appropriate manner.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202415 Registration no: SBU 2024/385

Question

What systematic reviews have been published regarding psychological treatment of children with problematic sexual behaviour?

Method

A systematic literature search was performed using the following databases: Medline (via Ovid), Scopus and PsycInfo, CINAHL, ERIC, SOCIndex, Criminal Justice Abstracts, Psychology and Behavioral Sciences Collection och Academic Search Premier (via EBSCO).

Two authors independently assessed the abstracts of all identified studies.

Risk of bias in relevant systematic reviews was assessed using an assessment tool based on AMSTAR.

Identified literature

Two relevant systematic reviews with low to moderate risk of bias were identified [1] [2]. The results and conclusions are presented in Table 1. In six relevant systematic reviews, the risk of bias was considered to be high, therefore the results and conclusions are not reported [3] [4] [5] [6] [7] [8].

Table 1 Systematic reviews with low/moderate risk of bias.
Included studies Population, Intervention, Control Outcome and Results
Sneddon et al, 2020 [2]
Cognitive-behavioural therapy (CBT) interventions for young people aged 10 to 18 with harmful sexual behaviour (Review)
4 RCT (n=115) 

Setting:
USA: 3 studies
South Africa: 1 study		 Population:
Children aged 10–18 receiving treatment for sexual offences or harmful sexual behaviour 

Intervention:
Cognitive behavioural therapy 

Control:
Treatment as usualWait-list control		 ” Given that no study measured the same outcome using sufficiently similar measures, we were unable to combine the data in a meta-analysis”
Authors' conclusion:
“…only one of the included studies assessed the impact of CBT programmes on one of the primary outcomes of this review, namely recidivism. As a result, we cannot draw any conclusions about the effectiveness of CBT in influencing HSB”
Långström et al, 2013 [1]
Preventing sexual abusers of children from reoffending: systematic review of medical and psychological interventions
3 RCT5 observational studies
Relevant studies:
Adolescents
1 RCT
1 observational study
Children
1 RCT		 Population:
Adult or adolescent perpetrators or potential perpetrators of child sexual abuse, or children with sexual behaviour problems 

Intervention:
Pharmacological (such as antiandrogenic drugs), psychological, or psychoeducational interventions aimed to prevent reoffending behaviour. 

Control:
Treatment as usual or no treatment		 No synthesis available, only one study per outcome.
Authors' conclusion:“There are major weaknesses in the scientific evidence […]. Better coordinated and funded high quality studies including several countries are urgently needed”

References

  1. Langstrom N, Enebrink P, Lauren EM, Lindblom J, Werko S, Hanson RK. Preventing sexual abusers of children from reoffending: systematic review of medical and psychological interventions. BMJ. 2013;347:f4630. Available from: https://doi.org/10.1136/bmj.f4630.
  2. Sneddon H, Gojkovic Grimshaw D, Livingstone N, Macdonald G. Cognitive-behavioural therapy (CBT) interventions for young people aged 10 to 18 with harmful sexual behaviour. Cochrane Database Syst Rev. 2020;6(6):CD009829. Available from: https://doi.org/10.1002/14651858.CD009829.pub2.
  3. Caro P, Turner W, Caldwell DM, Macdonald G. Comparative effectiveness of psychological interventions for treating the psychological consequences of sexual abuse in children and adolescents: a network meta-analysis. Cochrane Database Syst Rev. 2023;6(6):CD013361. Available from: https://doi.org/10.1002/14651858.CD013361.pub2.
  4. Reitzel LR, Carbonell JL. The effectiveness of sexual offender treatment for juveniles as measured by recidivism: a meta-analysis. Sex Abuse. 2006;18(4):401-21. Available from: https://doi.org/10.1177/107906320601800407.
  5. Satodiya R, Bied A, Shah K, Parikh T, Ash P. A Systematic Review of Multisystemic Therapy in Adolescent Sex Offenders. J Am Acad Psychiatry Law. 2024;52(1):51-60. Available from: https://doi.org/10.29158/JAAPL.230117-23.
  6. Ter Beek E, Spruit A, Kuiper CHZ, van der Rijken REA, Hendriks J, Stams G. Treatment Effect on Recidivism for Juveniles Who Have Sexually Offended: a Multilevel Meta-Analysis. J Abnorm Child Psychol. 2018;46(3):543-56. Available from: https://doi.org/10.1007/s10802-017-0308-3.
  7. Tichelaar HK, Deković M, Endendijk JJ. Exploring effectiveness of psychotherapy options for sexually abused children and adolescents: A systematic review of randomized controlled trials. Child Youth Serv Rev. 2020;119. Available from: https://doi.org/10.1016/j.childyouth.2020.105519.
  8. Walker DF, McGovern SK, Poey EL, Otis KE. Treatment effectiveness for male adolescent sexual offenders: a meta-analysis and review. J Child Sex Abus. 2004;13(3-4):281-93. Available from: https://doi.org/10.1300/j070v13n03_14.

Search strategies

Medline via OvidSP 17 June 2024

Title: Children with PSB
/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase a. Cochrane Highly Sensitive Search Strategy for identifying randomized trials in MEDLINE: sensitivity- and precision-maximizing version (2008 revision); Ovid format. The Cochrane Collaboration; 2008. Available from Cochranes website, with modifications: the following terms are added: clinical trial, phase iii.pt. ; randomised.ab. ; ("Phase 3" or "phase3" or "phase III" or P3 or "PIII").ti,ab,kw.
Search terms Items found
Population:
1. exp Child/ or adolescent/ or minors/ or (child* or "school child*" or schoolage* or "school age*" or "elementary school*" or "primary school*" or "grade school*" or kid or kids or boy* or girl* or prepube* or "pre-pube*" or preadolescen* or "pre-adolescen*" or "junior school*" or "junior high*" or "middle school*" or tween* or preschool or "pre-school" or young* or youth* or adolescen* or teenage* or teen or teens or underage* or "high school*" or highschool*).ti,ab,kf,bt. 4 626 146
2. ("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*" or "sexual abuse*").ti,ab,kf,bt. 18 636
Intervention:
3. exp Psychotherapy/ or (psychotherap* or psychodynam* or "psycho dynam*" or (accept* adj3 commit*) or cbt or ((cognitiv* or interpersonal) adj4 (behav* or therap* or train* or treat* or method* or approach*)) or (behav* adj3 (therap* or train* or treat* or method* or approach*)) or mindfulness).ti,ab,kf,bt. 369 493
Study types: systematic reviews and meta-analysis / randomized controlled trialsa
4. ((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/)) 488 625
Combined sets:
5. 1 and 2 14 995
6. 5 and 3 1365
Final result
7. 6 and 4 55

Scopus via scopus.com 17 June 2024

Title: Children with PSB
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL = All fields; W/n = Within. Proximity operator retrieving terms within n words from each other; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. TITLE-ABS-KEY (Child* OR Schoolchild* OR ”school child*” OR schoolage* OR ”school age*” OR ”elementary school*” OR ”primary school*” OR ”grade school*” OR kid OR kids OR boy* OR girl* OR prepube* OR ”pre-pube*” OR preadolescen* OR ”pre-adolescen*” OR ”junior school*” OR ”junior high*” OR ”middle school*” OR tween* OR preschool OR ”pre-school” OR young* OR youth* OR adolescen* OR teenage* OR teen OR teens OR underage* OR ”high school*” OR highschool* OR minors) 7 629 436
2. TITLE-ABS-KEY (“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*” OR ”sexual abuse*”) 49 654
Intervention:
3. (psychotherap* OR psychodynam* OR "psycho dynam*" OR (accept* W/2 commit*) OR cbt OR ((cognitiv* OR interpersonal) W/3 (behav* OR therap* OR train* OR treat* OR method* OR approach*)) OR (behav* W/2 (therap* OR train* OR treat* OR method* OR approach*)) OR mindfulness) 574 912
Study types: systematic reviews and meta-analysis / randomized controlled trials
4. TITLE-ABS-KEY ( ( systematic  W/2  review )  OR  "meta analy*"  OR  metaanaly* ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”))   724 895
Combined sets:
5. 1 and 2 35 922
6. 5 and 3 3418
Final result
7. 6 and 4 166

SOC Index /Criminal Justice Abstracts / Psychology and Behavioral Sciences Collection / ERIC / Academic Search Premier /CINAHL /PsycInfo via EBSCO 17 June 2024

Title: Children with PSB
TI = Title; AB = Abstract; SU = Keyword, exact or part (including all other fields for indexed and author keywords); Nn = Near. Proximity operator retrieving terms within n words from each other; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. AB ( (child* or ”school child*” or schoolage* or ”school age*” or ”elementary school*” or ”primary school*” or ”grade school*” or kid or kids or boy* or girl* or prepube* or ”pre-pube*” or preadolescen* or ”pre-adolescen*” or ”junior school*” or ”junior high*” or ”middle school*” or tween* or preschool or ”pre-school” or young* or youth* or adolescen* or teenage* or teen or teens or underage* or ”high school*” or highschool*) ) OR TI ( (child* or ”school child*” or schoolage* or ”school age*” or ”elementary school*” or ”primary school*” or ”grade school*” or kid or kids or boy* or girl* or prepube* or ”pre-pube*” or preadolescen* or ”pre-adolescen*” or ”junior school*” or ”junior high*” or ”middle school*” or tween* or preschool or ”pre-school” or young* or youth* or adolescen* or teenage* or teen or teens or underage* or ”high school*” or highschool*) ) OR SU ( (child* or ”school child*” or schoolage* or ”school age*” or ”elementary school*” or ”primary school*” or ”grade school*” or kid or kids or boy* or girl* or prepube* or ”pre-pube*” or preadolescen* or ”pre-adolescen*” or ”junior school*” or ”junior high*” or ”middle school*” or tween* or preschool or ”pre-school” or young* or youth* or adolescen* or teenage* or teen or teens or underage* or ”high school*” or highschool*)) 7 904 357
2. TI ( (“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*” or ”sexual abuse*”) ) OR AB ( (“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*” or ”sexual abuse*”) ) OR SU ( (“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*” or ”sexual abuse*”) ) 126 093
Intervention:
3. TI ( (psychotherap* OR psychodynam* OR "psycho dynam*" OR (accept* N2 commit*) OR cbt OR ((cognitiv* OR interpersonal) N3 (behav* OR therap* OR train* OR treat* OR method* OR approach*)) OR (behav* N2 (therap* OR train* OR treat* OR method* OR approach*)) OR mindfulness) ) OR AB ( (psychotherap* OR psychodynam* OR "psycho dynam*" OR (accept* N2 commit*) OR cbt OR ((cognitiv* OR interpersonal) N3 (behav* OR therap* OR train* OR treat* OR method* OR approach*)) OR (behav* N2 (therap* OR train* OR treat* OR method* OR approach*)) OR mindfulness) ) OR SU ( (psychotherap* OR psychodynam* OR "psycho dynam*" OR (accept* N2 commit*) OR cbt OR ((cognitiv* OR interpersonal) N3 (behav* OR therap* OR train* OR treat* OR method* OR approach*)) OR (behav* N2 (therap* OR train* OR treat* OR method* OR approach*)) OR mindfulness) ) 1 012 499
Study types: systematic reviews and meta-analysis
4.  TI((systematic N3 review) OR "meta analys*" OR metaanalys*) OR AB((systematic N3 review) OR "meta analys*" OR metaanalys*) OR SU((systematic N3 review) OR "meta analys*" OR metaanalys*) 736 782
Combined sets:
5. 1 and 2 95 573
6. 5 and 3 8215
Final result
7. 6 and 4 124

Citation Search

Scopus via Elsevier (citation search) 1 July 2024

Title: Children with PSB
LIMIT-TO (DOCTYPE, "re" = Limit to document type review
Search terms Items found
Cited articles
1. Refined to: LIMIT-TO ( DOCTYPE ,  "re" ) Preventing sexual abusers of children from reoffending: Systematic review of medical and psychological interventionsLangstrom N., Enebrink P., Lauren E.-M., Lindblom J., Werko S., Karl Hanson R.(2013) BMJ (Online), 347 (7924) , art. no. f4630  
Citing articles
2. #1 View cited by 13
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