24.1 DIAGNOSIS AND MISDIAGNOSIS OF SEXUAL BEHAVIOR IN CHILDREN

Abstract

Problematic sexual behavior (PSB) in children has often been interpreted as a sign of sexual abuse. However, research indicates that some sexual behaviors are an expected and developmentally appropriate part of childhood. Sexual behaviors such as exposing one’s genitals to others, self-stimulation, standing too close to others, and attempting to look at people who are naked are not uncommon. These behaviors are most often noted in children younger than 6 years old, tend to occur more often at home than in school, and decline with age. Problematic or nonnormative behaviors include imitation of adult intercourse, masturbation with an object, insertion of objects into the vagina or rectum, and oral-genital contact. Likewise, the use of coercion in sexual behaviors and behaviors directed toward much younger children are cause for concern. PSB can be associated with a number of mental health diagnoses in childhood, including OCD, bipolar disorders, and developmental disorders associated with intellectual disability and other impulse control disorders. A case example will illustrate the misdiagnosis of sexual behaviors in a young girl with OCD. Normative and inappropriate sexual behavior in children will be reviewed as will the assessment and differential diagnosis of PSB in children. Interactive techniques will be used with the audience to poll opinions about normative vs PSB in children and in which mental health disorders PSB is most prominent. Participants will understand the differential diagnosis of PSB in children and be able to identify behaviors that are often a part of normal development. The audience will have a chance to express their own views of what is normative vs inappropriate sexual behavior in children. Specific red flags for suspicion of sexual abuse will be discussed, providing a foundation for the review of specific evidence-based screening tools to be presented in the next section. Sexual behavior in children is not often discussed and can be easily misunderstood. It is important for clinicians to be able to distinguish developmentally appropriate sexual behavior from PSB. Likewise, specific patterns of PSB can be observed in a variety of mental health disorders. The topic of evidence-based screening tools for sexual abuse will be introduced.