Preadolescent Peer Sexual Abuse: A Systematic Literature Review

Abstract

Child sexual abuse (CSA) is a worldwide social problem which has received much attention from policy makers, researchers, and practitioners. A considerable portion of CSA research has focused on adult offenders, the result of which is that most of our existing knowledge regarding prevention and intervention has been based on abuse perpetrated by this population. The current literature review, by contrast, was designed to spotlight the phenomenon of preadolescent peer sexual abuse (PAPSA), focusing on children ages 12 and under, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The results revealed scant empirical data, with only nine studies focusing on this phenomenon. As the basis of their investigations, most of the reviewed studies used definitions of sexual harassment among peers, rather than definitions of more severe forms of sexual abuse, and showed conflicting results depending on the ages and genders of the peers involved. In addition, prevention programs for peer sexual abuse/harassment were not targeted toward preadolescents. Additional findings indicated a lack of empirical knowledge with respect to core aspects such as victims’ personal characteristics and subjective experience, the dynamic of the abuse, and the disclosure process. This systematic literature review emphasizes the need for an in-depth and thorough conceptualization and empirical examination of the PAPSA phenomenon and its unique characteristics.

Keywords

preadolescent child sexual abuse peer sexual harassment peer sexual victimization children molesting children child sexual abuse peers

Child sexual abuse (CSA) is a well-studied phenomenon; however, the phenomenon of peer-to-peer sexual abuse specifically among young children (preadolescents) has been and continues to be understudied (Finkelhor, Shattuck, Turner, & Hamby, 2013; Johnson, 1988; Sperry, & Gilbert, 2005). The main aim of the current systematic literature review was to spotlight the research that has been carried out on preadolescent peer sexual abuse (PAPSA), to date, in order to portray what is already known and where future efforts in this area should be directed.

In general, the definition of CSA has hinged on the understanding that the abuser is older than the victim (e.g., Finkelhor, 1979; Haugaard, 2000; Roosa, Reyes, Reinholtz, & Angelini, 1998; Sperry & Gilbert, 2005). And indeed, when studies do address the PAPSA phenomenon, it is often referred to not as sexual abuse but rather as, for instance, sexual harassment (Espelage, Hong, Rinehart, & Doshi, 2016). Espelage, Hong, Rinehart, and Doshi (2016) defined sexual harassment as unwanted sexual conduct which might include verbal, nonverbal, and physical behaviors that hamper the children’s right to receive an equal education. As is evident, this definition relates directly and only to the school context and overlooks additional core contexts in the children’s lives (e.g., neighborhoods and communities), contexts we wished to explore in this literature review.

Spotlighting the phenomenon of PAPSA inevitably brings up the inherent confusion between sexual abuse and sexual play (Araji, 1997; Cantwell, 1988; Sperry & Gilbert, 2005). Making a distinction between these two constructs, and being able to identify what constitutes sexual abuse, provided another focus for the current review.

Peer Sexual Abuse (PSA) and Sexual Play

Several studies have pointed to a number of criteria that are helpful in differentiating between PSA and sexual play: (1) whether the relationship was mutual, whether there was coercion and/or physical penetration, and the duration and frequency of the sexual activity and (2) the motivation for the sexual behavior, and whether it was dominated by normative curiosity or precocious gratification (Ballantine, 2012; Carlson, Maciol, & Schneider, 2006).

Looking at these criteria closely, the difficulty of the task at hand becomes evident; that is, one must assess both the power relations and the nature of the abusive acts (Mathews & Collin-Vezina, 2017). Assessing power relations is particularly challenging in this context (PSA) because both the victims and the offenders are children (and oftentimes friends), and in some countries, the offenders are under the age of legal responsibility (meaning that even the area of legal responsibility is murky). In addition, power relations and the nature of the abusive incidents are hard to assess and often elusive and unclear given the various contexts in children’s lives including their cultural contexts.

Studies on PSA

Most studies on the topic of PSA have been conducted among adolescents (e.g., Friedman et al., 2011; Small & Kerns, 1993), with the vast majority focusing on “dating violence,” meaning sexual victimization within dating relationships. Finkelhor, Turner, Shattuck, and Hamby (2013) contended that CSA most often refers to sexual acts committed by older caregivers and adults and suggested that when speaking specifically of peer victimization, it should be referred to as “childhood sexual abuse and assault.” In their national lifetime study of youths between the ages of 15 and 17, they found that over half of the total estimated offenses were committed by juvenile perpetrators, with many of them being acquaintances and/or peers of the victims. The rate for these offenses was 17.8% for girls and 3.1% for boys. An additional study that was carried out by Young, Grey, and Boyd (2009) also pointed to the high rates of peer sexual assault, with 26% of the boys and 51% of the girls reporting on such offenses, with the most common location for the assault being the school.

There is a general consensus among researchers with respect to both the risk factors and the consequences of PSA. Among the reported consequences, studies have pointed to absenteeism, decreased quality of school performance, and loss of friends (Duffy, Wareham, & Walsh, 2004; Lee, Croninger, Linn, & Chen, 1996). Among the reported risk factors, researchers have pointed to a lack of adult supervision (Jacobson & Crockett, 2000), a history of sexual abuse, excessive alcohol use, and a high score on peer conformity questionnaires (Friedman et al., 2011; Small & Kerns, 1993). However, it is important to highlight that these studies were conducted with adolescents and not with young children.

The Current Literature Review

PAPSA is an understudied phenomenon; however, recent studies have pointed to an increasing number of contexts in which preadolescents are involved as victims and offenders, for example, in cases of sibling sexual abuse (SSA; e.g., Tener, Tarshish, & Turgeman, 2017; Yates, 2018). It is important to state that the current literature review was designed in order to focus on PAPSA that takes place outside the family context in order to explore the way young and preadolescent children are exposed to PSA in other life contexts.

Several questions guided our exploration of the data, questions which were based on existing CSA theories: (1) Is there a definition of the nonfamilial PAPSA phenomenon? (2) What are the known rates of nonfamilial PAPSA? (3) What do we know about the dynamic and characteristics of nonfamilial PAPSA in comparison with the knowledge we have about CSA? and (4) Which perspectives were explored in the studies and who were the informants?

Method

The studies for this review were identified by searching the following primary databases—Criminal Justice Abstracts, PsycNET, PubMed, ScienceDirect, Springer, and Web of Science—and were filtered in several stages in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. During the first stage, all of the databases were searched via the use of the following key words: (1) preadolescent peer sexual abuse; (2) child peer sexual abuse; (3) peer; sexual abuse; childhood; (4) peer sexual victimization; (5) children molesting children; (6) peer sexual assault; and (7) peer sexual harassment.

This review was prepared in accordance with the PRISMA statement (Moher, Liberati, Tetzlaff, Altman, & Prisma Group, 2009). Figure 1 illustrates the stages that were followed to create a systematic review of the literature.

Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.

Inclusion Criteria

For articles to be considered eligible, they had to meet the following inclusion criteria: (1) articles addressing PSA among children younger than 12, (2) articles published in peer-reviewed journals, (3) articles written in the English language only, and (4) articles published between 2008 and 2018. The rationale behind the fourth criterion was that, given the evolving nature of what we know and what we have learned over recent years about this specific topic, we wished to focus on the most up-to-date material published in peer-reviewed journals only; we felt that to do so was essential in order to allow this systematic literature review to guide future research efforts in this area.

Although hundreds of studies were identified via the key words in the different databases (n = 754), only nine studies were ascertained to be relevant to the current study’s aims (PAPSA) and to have met all of the inclusion criteria. See Table 1 for an overview.

Table 1.
Description of Reviewed Articles.

Study Sample Characteristics Sample Size Methodology Objectives Measurements That Were Used

Ajduković, Sušac, and Rajter (2013)
Croatia To examine age and gender differences in the prevalence and incidence of child sexual abuse, the level of acquaintance of the child and the perpetrator, and correlations between experiencing family violence and sexual abuse in minors Quantitative survey 3,644 Children and youth Nationally representative sample, with an aim of assessing victimization in the general population of children ages 11, 13, and 16. (Part of an international project of a Balkan epidemiological study on child abuse and neglect) An international instrument for the assessment of the incidence and prevalence of children’s exposure to abuse and neglect

Espelage, Basile, De La Rue, and Hamburger (2015)
United States To investigate the intersection of youth bullying experiences and sexual violence perpetration and to evaluate individual and contextual influences on the phenomenon Quantitative survey 979 Children and youth Students from four middle schools (Grades 5–7) Bullying perpetration; sexual harassment perpetration; homophobic teasing—perpetration

Espelage, Hong, Rinehart, and Doshi (2016)
United States To examine sexual harassment victimization among middle school youth Mixed-method design: questionnaires included open questions 858 Children and youth Male and female students, 10–15 years of age (M = 13.04) Sexual harassment victimization experiences, location and most upsetting; Perpetrators of sexual harassment victimization experiences

Finkelhor, Turner, Shattuck, and Hamby (2013)
United States To provide estimates of and trends for childhood exposure to a broad range of violence, crime, and abuse victimizations Quantitative survey 4,503 Children and youth National sample of ages 1 month to 17 years, divided into five groups: 0–1, 2–5, 6–9, 10–13, 14–17 The enhanced version of the Juvenile Victimization Questionnaire including sexual assault, child maltreatment, conventional crime, Internet victimization; peer and sibling victimization, witnessing and indirect victimization

Finkelhor, Vanderminden, Turner, Shattuck, and Hamby (2014)
United States To assess children’s exposure to prevention programming as part of a national survey on children’s exposure to violence Quantitative survey 3,391 Children and youth National sample of ages 5–17 years, divided into three groups: 5–9, 10–14, 15–17 Prevention programming victimization; an enhanced version of the Juvenile Victimization Questionnaire including peer/sibling victimization; conventional crime; sexual victimization; Bullying perpetration; Disclosure

Moore et al. (2017)
Australia To explore how young people perceive and experience safety in residential care, for the Royal Commission into Institutional Responses to Child Sexual Abuse Qualitative in-depth interviews 27 Children and young people Children and young people ages 10–21 years who had lived in residential care. The study made a distinction between children under and over 13 years of age. Face-to-face interviews on the participants’ experiences of a lack of safety or harm; their concerns in residential care and their recommendations

Petersen and Hyde (2009)
United States To describe longitudinal trends in sexual harassment by adolescent peers and to highlight gender, pubertal status, attractiveness, and power as predictors of harassment victimization. Quantitative longitudinal survey 242 Children and youth Students were assessed in fifth grade, when they were between the ages of 10 and 12; in seventh grade, when they were between the ages of 12 and 14; and in ninth grade, when they were between the ages of 14 and 16. Pubertal status
Social power
Sexual harassment

Taylor, Stein, and Burden (2010a); Taylor, Stein, and Burden (2010b)
United States To assess the effectiveness of two approaches to youth gender violence/sexual harassment prevention programming and to explore gender differences in program success as well as levels of gender violence/sexual harassment Quantitative survey (a baseline and two follow-up surveys) 1,356 Children and youth from sixth and seventh grades 123 Sixth- and seventh-grade classrooms from seven middle schools Sexual and nonsexual (physical) violence victimization and perpetration prevalence and incidence

Turner, Finkelhor, and Ormrod (2010)
United States To examine the effects of child internalizing and externalizing symptoms on victimization. Quantitative survey 1,467 Children and youth Children and youth 2–17 years old compared by age-groups, including 2–5, 6–9, 10–13, 14–17. Juvenile Victimization Questionnaire; nonvictimization adversity child mental health

The Qualitative Analysis of the Studies

The two authors thoroughly read through the identified nine studies and performed a thematic analysis, including the identification and categorization of main themes, and a summary of the findings using thematic headings (Dixon-Woods, Agarwal, Jones, Young, & Sutton, 2005). The studies were reviewed until a consensus was reached between the two authors, including discussions when necessary to resolve disagreements and the final assignment of themes reflected both authors’ determination. Studies were analyzed using MAXUDA: professional software for qualitative and mixed-methods research (https://www.maxqda.com/). The studies were first entered into the program and then thoroughly and carefully read several times, so that the authors could familiarize themselves with the material. Next, each study was reviewed in detail, by each author, with the aim of identifying initial categories, which were grouped together as initial themes. During the analysis, some themes were removed or revised, and more categories were added (Strauss & Corbin, 1998). The authors referred back to the studies for additional information needed to develop the categories (Maykut & Morehouse, 1994).

Descriptive Overview

Seven of the nine studies employed a quantitative methodology, one study employed a qualitative methodology, and one used a mixed-methods design. Seven studies were conducted in the United States, one in Australia, and one in Croatia. Studies reported various experiences of sexual victimization/harassment/violence/abuse. The number of respondents ranged from 242 to 4,503 in the quantitative studies and 27 in the qualitative study. All of the studies were based on the children’s/youths’ self-reports, except in the case of three studies which were based on telephone surveys. In those three studies, the caregivers reported on the children if they were under the age of 10.

There was diversity in the ages of the children/youth examined in the various studies. Three studies reported on children/youth between the ages of 1 and 17, with internal divisions into several age groups (e.g., 2–5, 6–9, 10–13, 14–17). One study reported on children and youth between the ages of 10 and 21, differentiating between those under and over the age of 13. Five studies grouped the children/youth by grade, rather than by age, with samples from the fifth to the ninth grade, comparing between the different grades.

Main Findings

In order to obtain a comprehensive and in-depth picture of the PAPSA phenomenon, we posed a number of basic questions including (1) how was this type of abuse defined in the selected studies? (2) What were the various characteristics of this type of abuse and how was it similar or different from sexual abuse conducted by nonpeer perpetrators? Additionally, what were the similarities and differences between sexual abuse among preadolescent peers (i.e., PAPSA) and sexual abuse among adolescent peers (in cases where such a comparison was made in the study)? (3) What were the implications of this abuse for the lives of the abuse survivors during childhood and adulthood? (4) How did the disclosure of these cases occur and what were the societal responses to these disclosures? (5) What were the interventions offered to children, families, and communities in cases of PAPSA and how effective were they?

Our analysis yielded very few (and often only partial) answers to these questions, highlighting the serious lack of research into this phenomenon. This “low yield” may, in turn, have resulted from a number of preassumptions, including the assumption that there is no significant difference between the different ages, an assumption which resulted in studies that did not distinguish between different peer age groups and therefore could not be reviewed. Another assumption may have been that sexual abuse does not exist at such young ages and that sexual acts, if they do occur between preadolescent peers, can only be interpreted as inappropriate sexual behavior or developmentally normative curiosity, an interpretation which may explain why most PSA studies deal with adolescent peers only. Accordingly, the current systematic literature review provided only partial and initial answers to some of the questions raised above.

How Is PAPSA Defined and Conceptualized?

The conceptualization of PAPSA varied across studies. Some of the studies used general terms such as “sexual victimization” or “sexual abuse/harm/violence” (Ajduković, Sušac, & Rajter, 2013; Moore, McArthur, Death, Tilbury, & Roche, 2017). At times these general terms were combined with more specific terms such as “peer victimization” and with specific items such as “peer genital assault” or “peer and sibling victimization” (Finkelhor, 1979; Finkelhor et al., 2013; Turner, Finkelhor, & Ormrod, 2010). Other studies specifically described sexual behavior which characterized peer groups. In these studies, peer sexual behavior was described as “sexual harassment/victimization” or “sexual violence” among peers and included a range of sexual behaviors: making sexual comments, jokes, or gestures; giving sexual looks; spreading sexual rumors; physically blocking someone in a sexual way; shoving or pushing; sending sexual pictures or illustrations, sexual messages, or notes; flashing or mooning, touching, grabbing, or pinching in a sexual way, or specifically pinching someone’s privates parts; and intentionally brushing up against someone, pulling down clothing, and forcing someone to kiss (Espelage, Basile, De La Rue, & Hamburger, 2015; Espelage et al., 2016; Petersen & Hyde, 2009; Taylor, Stein, & Burden, 2010a; Taylor, Stein, & Burden, 2010b).

Accordingly, it is important to note that six of the reviewed studies only included “sexual harassment” between peers, rather than more severe forms of “sexual abuse/assault.” Finkelhor and colleagues (2013) made a specific distinction between sexual harassment and sexual assault: Sexual assault excludes sexual harassment and includes attempted and completed rape, plus contact sex offenses by adults and peers. As previously stated, sexual assault was not the focus of most of the studies. For example, in Espelage, Basile, De La Rue, and Hamburger’s article (2015), the most extreme form of sexual behavior was forced kissing or forced touching of the private parts, and in Ajduković, Sušac, and Rajter (2013), the most extreme form of sexual behavior was “tried to have sex with you when you did not want to.” Espelage and colleagues (2015) included this factor to be one of their study’s limitations, stating that their study could not include more severe forms of sexual violence. They also stated that “sexual harassment was the outcome of focus for this study rather than forced contact acts of sexual violence like rape, mainly because those more severe forms of sexual violence were less likely to be endorsed by middle school students in the sample” (Espelage et al., 2015, p. 2554). From our point of view, there seemed to be an underlying assumption that severe forms of sexual abuse (such as forcible or penetrative acts) were not typical of younger children and therefore would not be examined in the studies.

Only one study (Petersen & Hyde, 2009) directly specified the need to differentiate definitions when it came to younger aged peers. The authors of this study regarded the “developmental patterns” of peer sexual harassment as an important factor in understanding the phenomenon. Further, it should also be noted that five of the reviewed studies did not focus solely on sexual assault or harassment but included other forms of peer abuse (e.g., bullying) as well. In a study by Espelage and colleagues (2015), which looked at the reports of students from four middle schools regarding their perpetration of sexual harassment, the authors combined these forms of abuse and focused on testing the “Bully-Sexual Violence Pathway.” Their findings indicated that youth who engaged in high levels of bullying and homophobic teasing were more likely to report perpetrating sexual harassment over time.

What Is the Meaning of Gender in PAPSA?

Three of the reviewed studies specifically addressed gender among PAPSA victims, with a mix of results. In one study, girls were found to be at higher risk of peer sexual harassment and victimization than boys. This study also found that girls were more likely to report that their perpetrators were boys than girls; boys also reported that their perpetrators were boys (Espelage et al., 2015). Yet another study found that among fifth to ninth graders, boys received more overall harassment than girls and suggested that boys were more likely to be targeted by peers of both genders, as opposed to girls who were victims of males only. They stated that although sexual harassment is often portrayed as an issue of female victimization, their study suggested that the sexual harassment of boys occurs at least as frequently as, or even more frequently than, it does among girls (Petersen & Hyde, 2009). Yet it should be noted that this study only addressed sexual harassment and not more severe forms of sexual acts, such as penetration.

Another interesting result concerning gender emerged from a study conducted in Croatia. In this study, it was found that girls indicated male peers (adolescent or preadolescent males), mostly ones with whom they were acquainted, as being the ones who most commonly perpetrated contact and noncontact sexual abuse against them. Younger boys, however, indicated adult men as the most frequent perpetrators of noncontact sexual abuse and female peers (adolescent or preadolescent females) as the ones who most commonly perpetrated contact sexual abuse against them (Ajduković et al., 2013).

What Is the Meaning of Age in PAPSA?

Several reviewed studies indicated that sexual abuse or harassment was less common among preadolescent peers than among older children. Thus, Espelage and colleagues (2016) found that eighth graders were significantly more likely to be sexually harassed than fifth graders. Ajduković et al. (2013), who showed that peers were reported to be the most common perpetrators, also indicated that the number of children who experienced sexual abuse increased with age. Furthermore, at younger ages, verbal sexual harassment was more frequent than physical sexual harassment and sexual assault (Espelage et al., 2015). Similar results were also found in Petersen and Hyde (2009) who indicated that fifth graders were less likely to report experiences of sexual harassment than were children in sixth to ninth grades.

Developmental patterns were also evident in a study by Turner, Finkelhor, and Ormrod (2010), who indicated that having high levels of internalizing and externalizing symptoms (and at times internalizing symptoms which occurred without externalizing symptoms) was a more salient predictor of victimization among elementary school children than among preschoolers or adolescents. The authors explained that such symptoms make children especially vulnerable to peer victimization when they first enter school and are exposed to a wider range of peers and opportunities for interaction, with less supervision than they had in preschool. They also suggested that cases of sexual victimization among prepubescent children might be more attributable to the perpetrator or to situational factors that allow perpetrators access to children, rather than to the personal characteristics of the child victims themselves.

Other Contexts of PAPSA

During the study analysis, several other issues related to PAPSA were identified. These issues included, among others, children’s subjective experiences, as well as their ethnicity, mental health difficulties, and/or elements of the PAPSA disclosure.

One study (Moore et al., 2017) addressed PSA in the context of residential homes. It indicated that most of the study participants—that is, children and adolescents living in residential care in Australia—reported during in-depth interviews that they felt unsafe most of the time. Harassment seemed to be a major concern among younger participants, as reported by them, whereas older participants talked about the constant threats of violence, sexual harassment, and assault. One of the participants in the study described his feeling that if a person stayed in residential care long enough, he would either become a bully or a victim in order to survive. It should also be noted that the children and youth in this Australia study felt that it was unlikely they would be abused by a team member.

Few details were found with respect to the victims’ personal characteristics in cases of PAPSA. One study discussed the victims’ ethnicity and indicated that the highest rates of peer physical sexual assault were reported by African American girls, followed by African American boys. Additionally, African American students reported that the perpetrator was often older and/or a current romantic partner, whereas for the White students, the perpetrator was usually someone of the same age and/or a friend (Espelage et al., 2016).

Another study focused on children with mental health problems—defined in the study as high levels of both internalizing and externalizing symptoms—stating that these symptoms should be considered important risk factors for increased victimization. They found that children dealing with such symptoms were more likely to experience increased exposure to several types of victimization, including peer victimization and sexual victimization, with elementary school children who had high levels of symptoms being especially vulnerable to victimization by peers, and youth suffering from symptoms in early adolescence being particularly vulnerable to sexual victimization (Turner et al., 2010).

Prevention and Interventions for PAPSA

Only two studies specifically focused on prevention programs for preadolescents. The first study (Finkelhor, Vanderminden, Turner, Shattuck, & Hamby, 2014) examined children’s exposure to programs for preventing various kinds of violence perpetration. The authors found that 65% of the school-age children (5–17) had been exposed to such programs, with 21% exposed to sexual assault prevention programs. Yet the authors noted that fewer 5- to 9-year-olds, than older children, were exposed to programs, especially programs with sexual victimization content. The study’s results indicated that higher quality prevention programs (ones including, e.g., practice skills or meetings for parents) were associated with a reduction of peer victimization among younger children (5–9) but not among older children (10–14 or 15–17). The authors explained that this lack of reduced victimization among older children may have been due to their overall less positive view of or cynicism toward these programs.

Reducing peer victimization was one aspect of the program, but the authors also noted that children ages 10–17 who participated in high-quality programs were also more likely to report being victimized by peers to their parents and authorities or to make their victimization known to formal authorities (school personnel and police). This was not the case, however, when the abuse involved sexual victimization.

The other study (Taylor et al., 2010a; Taylor et al., 2010b) was based on an evaluation of two prevention programs for sixth- and seventh-grade students: The first program was based on “interaction-based” contents and the second on “law and justice” contents. The interaction-based program included contents such as the meaning of relationships/friendships, and the continuum between friendship and intimacy, as well as wanted versus unwanted behaviors, and the role of the bystander, highlighting the complexity and ambiguity of these topics. The law and justice program provided information on laws, definitions, information, and data about penalties for sexual assault and sexual harassment as well as empirical research findings about consequences for perpetrators of such abuse. Both programs were aimed at reducing gender violence and sexual harassment. The study’s results indicated that no significant findings were detected immediately after the interventions, but that 6 months after the program ended, participants in the interaction-based group (but not the law and justice group) reported that they experienced lower levels of sexual victimization by their peers.

Studies’ Limitations

It is important to note that the discussion on the studies’ limitations is based primarily on the limitations raised in the studies themselves. One limitation identified was the tendency in some of the studies to allow caregivers to fill out the surveys when they involved younger children (younger than 10), instead of the researchers obtaining information from the children themselves (Finkelhor et al., 2014; Turner et al., 2010), thus making it difficult to obtain a coherent picture of how the children themselves defined and experienced PAPSA and the unique meanings they ascribed to it. Other studies were based on only one source of information, for instance, participant self-reports (Ajduković et al., 2013; Espelage et al., 2016; Turner et el., 2010) and thus lacked multiple perspectives such as those of children, caregivers, and professionals.

Second, as previously mentioned, most of the reviewed studies focused primarily on noncontact harassing behaviors or touching behaviors without severe acts such as penetration or forced sexual acts (Ajduković et al., 2013; Espelage et al., 2015). This factor may, in turn, have resulted in only a partial view of PAPSA.

Some studies were limited by the fact that they didn’t differentiate between different kinds of sexual and violent acts, including acts such as grabbing or kicking someone in their private parts, combined with more severe forms of sexual abuse (Taylor et al., 2010a; Taylor et al., 2010b). Some studies focused only on a few general CSA questions (Ajduković et al., 2013), and in some studies, it was impossible to identify the age gap between the offending peer and the victimized peer. Thus, in the Ajduković et al. (2013) study, some of the items about the perpetrating peer included a description such as “child/adolescent male” or “child/adolescent female,” without specifying the exact age range.

In addition, the age range among preadolescent children was broad and included both preschool and school-age children. In this review, we did not have the ability to classify the differences between these ages or to understand the different experiences according to the different developmental stage in preadolescence. Further, nearly all of the reviewed studies were based on American samples. In addition, most of them were based on White middle-class participants (Petersen & Hyde, 2009; Taylor et al., 2010a; Taylor et al., 2010b), therefore precluding an exploration of the cultural and societal aspects of the phenomenon.

In general, there was very little information available when it came to children’s experiences of PAPSA. We also could not find sufficient data on how children perceived what had happened to them and whether they themselves perceived the events as abusive. For example, in a study by Espelage, Hong, Rinehart, and Doshi (2016), when students were asked to describe the sexual harassment experiences that had been most upsetting to them, they had a tendency to first describe these events as unwanted behaviors that were physically or verbally directed at them but then to immediately dismiss them as “joking” and “meaningless.” Such responses may represent personal and societal attitudes concerning the phenomenon—an idea that needs further exploration. We were also unable to find any information concerning the more ambiguous forms of PAPSA, such as when a victim is also a perpetrator of PAPSA or the possible consequences of PAPSA. In addition, there was no information, to the best of our knowledge, on the systems surrounding PAPSA cases, such as parents’ and professionals’ attitudes, or policy and treatment issues.

Discussion

The aim of the current paper was to provide a detailed mapping and analysis of the existing literature on PAPSA. Unfortunately, the review could not provide a full or comprehensive overview. Only a few studies focusing on this specific age-group in the context of PSA were identified, making it clear that this field has received only minor scientific recognition. Even in the studies analyzed for the current review, where indeed it was possible to identify younger children who were involved in sexual acts with their peer group, the focus was not necessarily put on this age-group or on trying to present its unique aspects.

The evident lack of studies in this area is particularly surprising given the impact on children and youth of early and frequent exposure to Internet pornography, which has grown at alarming rates (Gewirtz-Meydan, Walsh, Wolak, & Finkelhor, 2018; Wolak, Mitchell, & Finkelhor, 2007). One cannot underestimate the effect that this exposure has on very young children. For one thing, frequent and early exposure to pornography on the Internet may result in inappropriate sexual behaviors among peers of similar ages. As such, it is particularly important to heighten the awareness of the PAPSA phenomenon among, for instance, child protective services workers who are far more accustomed to seeing adults/caretakers—rather than young children—as perpetrators of sexual abuse and who will have to contend with the challenges of approaching/questioning minors.

The review does enhance our understanding with respect to the PAPSA definition, highlighting the core informants’ tendency to define such acts as “sexual harassment,” rather than as “sexual abuse/assault,” and to combine them with other forms of peer victimization. The findings clearly show that experiencing PSA increases with age and that girls are mostly targeted by boys, whereas boys are targeted by peers of both genders. We also found that PSA/harassment programs seem to be less targeted toward preadolescents, but that exposure to high-quality prevention/intervention programs led to a reduction in peer victimization among younger children and increased the likelihood that they would disclose general (but not sexual) victimization. Very few details were found concerning the personal characteristics of the victims (such as ethnicity or mental health issues) or the abuse itself. Nevertheless, we believe that the contribution of the present review is not in emphasizing what exists, but rather in what is absent. Its strength also lies in bringing to the surface what we believe to be preassumptions surrounding PAPSA (expressed in the existing literature), as well as in the absence of PAPSA in general. The four preassumptions that will be addressed forthwith are the nonseverity assumption, the low prevalence/nonexistence assumption, the one-dimensional (as opposed to the complexity) assumption, and the uniformity assumption.

The Nonseverity Assumption

One societal assumption is that sexual acts between young peers cannot be severe. Thus, in this review, most of the studies’ instruments/scales did not allow for the possibility of severe sexual acts such as oral, anal, or vaginal penetration. This absence, in turn, may have stemmed from the assumption that such acts are less likely to happen at younger ages. Although many social media sites are loaded with explicit sexual content, and preadolescent children may engage in a variety of sexual behaviors with their peers, these behaviors tend to be considered normative aspects of development. Society continues to view children as innocent and pure and lacking sexuality, passions, thoughts, and impulses (Heiman, Leiblum, Esquilin, & Pallitto, 1998). Sexual behavior among children is therefore defined as reciprocal, as harmless natural curiosity, and as a part of normative development (Rowntree, 2007; Russell, 1986).

It seems to be almost impossible for people to believe that children of this age can engage in severe peer-to-peer sexual behaviors (Sperry & Gilbert, 2005). Yet such beliefs contradict initial empirical findings. A study that was conducted by the second author (Katz, In press), focused on the narratives of 30 children, ages 6–10, who disclosed PAPSA. That study focused on severe sexual abuse only, including contact sexual acts such as touching/fondling of private parts/penetration, and revealed that the dynamic in these cases was sometimes characterized in the same way that a “typical” offender–victim dynamic would be characterized: one in which the perpetrators employed strategies of isolation, threats, and violence.

The Low Prevalence/Nonexistence Assumption

The second assumption is that PAPSA simply does not exist and that CSA can only exist in certain, limited social scripts, mostly those of a child victim and an adult perpetrator. The danger here is that “atypical” survivors, such as in cases of PAPSA, might feel that there is no social legitimization for their abuse (Draucker & Martsolf, 2008; Tener & Murphy, 2015).

The One-Dimensional (as Opposed to the Complexity) Assumption

Our review failed to provide a multidimensional or complex view on PAPSA experiences. The existing literature does not provide data rich enough to capture how preadolescent peers experience what happened to them or how these experiences affected their lives. In this context, it seems appropriate to mention another phenomenon which is very much related to PSA, and that is SSA, which resembles PSA in nature. Several studies on SSA emphasize the complex aspects of this phenomenon including, for example, siblings who are both victims and perpetrators of SSA, as well as cases in which the abuse, even if severe and penetrative, is experienced by peers as normative or as a part of their daily routine (Katz & Hamama, 2017; Tener et al., 2017). All of these aspects may be relevant to the PAPSA phenomenon as well.

Another characteristic of SSA which may be relevant to cases of PAPSA as well is that the sexual abuse involves many systems in addition to the offender and the victim, including the entire family, which generally undergoes a major crisis following the disclosure of SSA (Caffaro & Conn-Caffaro, 2005; Tener, Lusky, Tarshish, & Turjeman, 2018). In the same way, PAPSA involves multiple systems, such as the entire family, other members of the peer group, the educational framework, the community, and others, all of whom are likely to be affected by the sexual acts. Such complexities have been found to be a cause of confusion, hardship, and despair for professionals working with SSA cases (Tener & Silberstein, 2019; Kambouridis, 2013; Lafleur, 2009) and must therefore be addressed when dealing with PAPSA as well.

The Uniformity Assumption

The last assumption is the uniformity assumption. Most of the studies reviewed here were based on U.S. samples, representing a very specific cultural and societal context. However, according to context-informed perspectives, the potential to profoundly fine-tune the creation of knowledge grounded in evolving and intertwined multiple contexts lies in acknowledging the importance of the various contexts in which individuals interact, whether sociocultural, economic, ethnic, or religious (Nadan, Spilsbury & Korbin, 2015; Shalhoub-Kevorkian & Roer-Strier, 2016). It is important to recognize that although the cross-cultural literature does address specific characteristics of ethnocultural groups as they relate to CSA (e.g., Reid, Reddock, & Nickenig, 2014; Thoburn, Chand, & Procter, 2005), this body of knowledge is usually rooted in “universal” models based largely on Western empirical research and clinical practice (Fontes, 2005; Henrich, Heine, & Norenzayan, 2010; Korbin, 1981). Thus, it is almost impossible to understand PAPSA without examining it in different social and cultural contexts.

Research Implications

The peer group can be a very positive force in the lives of young children, providing them with opportunities for growth and joy. Yet it can also pose dangers, and in order to ensure that children have a safe and protective environment, we must address these dangers. In our view, PAPSA must receive appropriate research visibility. First, we need studies that will examine the experiences of those involved in PAPSA, including victims, perpetrators, family members, and professionals, while concentrating on various methodologies that will enrich the understanding of the phenomenon. There is still so much that we do not know about the motivation to perpetrate such abuse, the different arenas in which it takes place, the dynamics involved, and issues regarding disclosure. There seems to be no information on either the potential short-term or long-term implications of PAPSA nor on the different cultural and societal contexts in which it takes place.

There is also an urgent need for future studies to include, apart from a scale for acts of sexual harassment, a scale that allows for the disclosure of more severe forms of sexual abuse, such as penetration. In an epidemiological study conducted in Israel (Eisikovits & Lev Wiesel, 2016), children reported that being asked a direct question enabled them to disclose the abuse. The absence of direct questions concerning severe forms of PAPSA may also, unintentionally, exclude or prevent the disclosure of such abuse.

Finally, it is essential that future studies focus on the way professionals (such as social workers, therapists, and educators) respond to and cope with cases of PAPSA, especially because of its ambiguity and challenging nature. Most of these cases do not include legal interventions, as these peers are mostly under the age of legal responsibility, a situation which may result in the children not receiving treatment at all. One of the main conclusions of the current literature review is the imperative need to provide professionals with a firm body of knowledge and tools with which to prevent, identify, and intervene in a way that will be most beneficial to the children involved.

Practice and Policy Implications

The current study stresses the urgent need to promote the awareness of PAPSA among policy makers and practitioners from various disciplines. For policy makers, it is essential that a better allocation of resources be dedicated to the adaptation of prevention and intervention efforts targeted toward preadolescents. For practitioners, it is important to integrate into their practices with children questions about severe forms of sexual abuse—even in cases of young children—in order to give them a place to disclose their experiences. It is essential that practitioners make these adaptations, as identifying PSA at young ages is crucial. Not only does early identification benefit children, it may also serve to prevent more severe forms of abuse at older ages. In addition, given that during preadolescence children are under the age of legal responsibility, the context and strategies of intervention at this point can be more flexible.

Study	Sample Characteristics	Sample Size	Methodology	Objectives	Measurements That Were Used
Ajduković, Sušac, and Rajter (2013) Croatia	To examine age and gender differences in the prevalence and incidence of child sexual abuse, the level of acquaintance of the child and the perpetrator, and correlations between experiencing family violence and sexual abuse in minors	Quantitative survey	3,644 Children and youth	Nationally representative sample, with an aim of assessing victimization in the general population of children ages 11, 13, and 16. (Part of an international project of a Balkan epidemiological study on child abuse and neglect)	An international instrument for the assessment of the incidence and prevalence of children’s exposure to abuse and neglect
Espelage, Basile, De La Rue, and Hamburger (2015) United States	To investigate the intersection of youth bullying experiences and sexual violence perpetration and to evaluate individual and contextual influences on the phenomenon	Quantitative survey	979 Children and youth	Students from four middle schools (Grades 5–7)	Bullying perpetration; sexual harassment perpetration; homophobic teasing—perpetration
Espelage, Hong, Rinehart, and Doshi (2016) United States	To examine sexual harassment victimization among middle school youth	Mixed-method design: questionnaires included open questions	858 Children and youth	Male and female students, 10–15 years of age (M = 13.04)	Sexual harassment victimization experiences, location and most upsetting; Perpetrators of sexual harassment victimization experiences
Finkelhor, Turner, Shattuck, and Hamby (2013) United States	To provide estimates of and trends for childhood exposure to a broad range of violence, crime, and abuse victimizations	Quantitative survey	4,503 Children and youth	National sample of ages 1 month to 17 years, divided into five groups: 0–1, 2–5, 6–9, 10–13, 14–17	The enhanced version of the Juvenile Victimization Questionnaire including sexual assault, child maltreatment, conventional crime, Internet victimization; peer and sibling victimization, witnessing and indirect victimization
Finkelhor, Vanderminden, Turner, Shattuck, and Hamby (2014) United States	To assess children’s exposure to prevention programming as part of a national survey on children’s exposure to violence	Quantitative survey	3,391 Children and youth	National sample of ages 5–17 years, divided into three groups: 5–9, 10–14, 15–17	Prevention programming victimization; an enhanced version of the Juvenile Victimization Questionnaire including peer/sibling victimization; conventional crime; sexual victimization; Bullying perpetration; Disclosure
Moore et al. (2017) Australia	To explore how young people perceive and experience safety in residential care, for the Royal Commission into Institutional Responses to Child Sexual Abuse	Qualitative in-depth interviews	27 Children and young people	Children and young people ages 10–21 years who had lived in residential care. The study made a distinction between children under and over 13 years of age.	Face-to-face interviews on the participants’ experiences of a lack of safety or harm; their concerns in residential care and their recommendations
Petersen and Hyde (2009) United States	To describe longitudinal trends in sexual harassment by adolescent peers and to highlight gender, pubertal status, attractiveness, and power as predictors of harassment victimization.	Quantitative longitudinal survey	242 Children and youth	Students were assessed in fifth grade, when they were between the ages of 10 and 12; in seventh grade, when they were between the ages of 12 and 14; and in ninth grade, when they were between the ages of 14 and 16.	Pubertal status Social power Sexual harassment
Taylor, Stein, and Burden (2010a); Taylor, Stein, and Burden (2010b) United States	To assess the effectiveness of two approaches to youth gender violence/sexual harassment prevention programming and to explore gender differences in program success as well as levels of gender violence/sexual harassment	Quantitative survey (a baseline and two follow-up surveys)	1,356 Children and youth from sixth and seventh grades	123 Sixth- and seventh-grade classrooms from seven middle schools	Sexual and nonsexual (physical) violence victimization and perpetration prevalence and incidence
Turner, Finkelhor, and Ormrod (2010) United States	To examine the effects of child internalizing and externalizing symptoms on victimization.	Quantitative survey	1,467 Children and youth	Children and youth 2–17 years old compared by age-groups, including 2–5, 6–9, 10–13, 14–17.	Juvenile Victimization Questionnaire; nonvictimization adversity child mental health

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 iD

Dafna Tener

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