Child Sexual Behavior Research Articles

Child Sexual Behavior Inventory: normative, psychiatric, and sexual abuse comparisons.

A normative sample of 1,114 children was contrasted with a sample of 620 sexually abused children and 577 psychiatric outpatients on the Child Sexual Behavior Inventory (CSBI), a 38-item behavior checklist assessing sexual behavior in children 2 to 12 years old. The CSBI total score and each individual item differed significantly between the three groups after controlling for age, sex, maternal education, and family income. Sexually abused children exhibited a greater frequency of sexual behaviors than either the normative or psychiatric outpatient samples. Test-retest reliability and interitem correlation were satisfactory. Sexual behavior problems were related to other generic behavior problems. This contributed to the reduced discrimination between psychiatric outpatients and sexually abused children when compared to the normative/sexually abused discrimination.

Sexual Behaviors of Young Children That Occur in Schools

Although very little research exists on children's sexual behaviors, it has been suggested that young children today are expressing more sexual behavior and interest in sexual matters than they have in the past. Consequently, it is likely that they will express some of this behavior publicly within a school setting. When these behaviors occur at school, it is incumbent upon educators to be able to accurately determine whether their students' sexual behaviors are normative or problematic, along with how they should be addressed. This study describes the observations and reactions of 29 kindergarten, 1st-, and 2nd-grade teachers towards the sexual behaviors of their students over a 6-month period. Of the 378 sexual behaviors that were observed, 162 were determined to be within the normative range of children's sexual behavior. A total of 184 behaviors were identified as problematic or potentially problematic, requiring varying levels of adult intervention, including therapeutic follow-up. Sexual behaviors o...

The Association of Sexual Behavior with Externalizing Behaviors in a Community Sample of Prepubertal Children

Abstract On the basis of the problem-behavior theory for adolescence, we hypothesized that already during childhood sexual behavior is associated with (non-sexual) externalizing behaviors and tested the hypothesis in a community sample. In the context of a postal questionnaire survey of 6-10 year old children, the parents of 349 girls and 326 boys completed the Child Behavior Checklist (CBCL). The CBCL Sex Problems scale did not differ between genders, ethnic groups, or age groups. For both girls and boys, the scores on the Sex Problems scale correlated significantly but modestly (maximum r = 0.35) with all other CBCL scales; only in boys did the correlations with externalizing behaviors exceed those with other scales. We conclude that children from a community sample who show sexual behavior as defined by the CBCL tend to be the ones with increased behavioral/emotional problems in general, with only modest specificity in symptomatology.

Cultural Differences in Sexual Behavior: 2-6 Year Old Dutch and American Children

Abstract Three samples, one American (N = 500) and two from the Netherlands (N = 460, N = 297) of 2-6 year old children, screened for the absence of sexual abuse, were assessed with 25 items derived from the Child Sexual Behavior Inventory (Friedrich et al. 1992). Considerable differences existed between the three groups across a number of the behaviors rated, with a persisting tendency for the parents of the children from the Netherlands to report higher rates of sexual behavior. Family nudity was related to sexual behavior in all three samples. Although the studies used an equivalent questionnaire and all three of the samples are predominantly middle class, the observed differences can be explained by methodological factors such as sample composition and the way data have been collected. The observed differences might, however, also reflect actual differences, and can be understood as resulting from cultural differences in sexual socialization. More rigorous research is needed to assess which explanatio...

Sexual Behavior in Dutch and Belgian Children as Observed by Their Mothers

Abstract Mothers' observations (N = 670) of child sexual behavior have been collected using an adapted version of the Child Sexual Behavior Inventory as developed by Friedrich et al. (1991). The ages of the boys (N = 351) and girls (N = 319) observed range from 0 to 11 years. The results show that there is a lot of variance in the frequency with which specific sexual behaviors are observed. The occurrence of specific behaviors varies with age. While some behaviors are observed more frequently as the child gets older, others are observed less frequently. Boys and girls only differ in a few behaviors. The finding that the behavioral items form an internally consistent scale suggests that there is a general tendency to show sexually related behaviors, which is more or less strongly present in children, which might be a precursor of differential levels of sexual desires in adults.

Child sexual behavior inventory: A Dutch-speaking normative sample.

To describe normative sexual behavior in Dutch-speaking children; to assess the frequencies of different types of sexual behaviors reported in children by their parents; to analyze the relation of these sexual behaviors to demographic, personal, familial, and general behavioral variables; and to compare the Dutch-speaking sample with American samples. Nine hundred seventeen children (2-12 years of age), screened to exclude sexual abuse, were rated by their caregiver via parent report consisting of the translated Dutch version of the Child Sexual Behavior Inventory, the Child Behavior Checklist, a life event checklist, and a questionnaire assessing family nudity and parental attitudes regarding sexuality. Frequencies of a wide variety of sexual behaviors for 2- to 5-, 6- to 9-, and 10- to 12-year-old children are presented. Sexual behavior was found to be related to the child's age, maternal education, family nudity, and parental attitudes toward sexuality. The positive relation to general behavioral problems was confirmed. Findings were primarily similar to previously published American studies. Our study confirms that sexual behavior in children is varied and related to developmental, personal, and familial factors. The relative frequency of the wide variety of sexual behaviors in a Dutch-speaking normative sample is comparable to American samples.

Deviant Sexual Behavior in Children and Young Adolescents: Frequency and Patterns

A descriptive statistical study was performed to assess the characteristics of youth who began committing sexual offenses in childhood. The youth in this study ranged in age from 12 to 15. They had been committed to the Virginia Department of Juvenile Justice for sexual offenses and met the criteria for residential sexual offender treatment. Three instruments were used in this study. A questionnaire was independently administered to each youth by an examiner and corroborated, when possible, by information in the youth's file. The questionnaire was supplemented by the Hare Psychopathy Scale—Revised and by information from the Risk Assessment Interviewing Protocol for Adolescent Sex Offenders. The results suggested that deviant sexual behavior may begin in early childhood, with some offenders developing patterns of offending prior to the onset of adolescence. These youth committed a median of 69.5 sexual offenses each, with each offender having a median of 16.5 victims. They used either force, threats, or violence in the large majority of their contact offenses. They predominantly came from multiproblematic families, were abused in early childhood, and were exposed to pornographic materials at a young age. The results suggest that children have the capacity to commit serious sexual offenses similar to those of older juvenile and adult offenders. The clinical implications of this study are discussed.

Practice parameters for the forensic evaluation of children and adolescents who may have been physically or sexually abused

These practice parameters describe the forensic evaluation of children and adolescents who may have been physically or sexually abused. The recommendations are drawn from guidelines that have been published by various professional organizations and authors and are based on available scientific research and the current state of clinical practice. These parameters consider the clinical presentation of abused children, normative sexual behavior of children, interview techniques, the possibility of false statements, the assessment of credibility, and important forensic issues.

Child Sexual Abuse and Bulimic Behaviors: An Exploratory Investigation of the Frequency and Nature of a Relationship

ABSTRACT Clinical and research literature have both described a possible relationship between a history of child sexual abuse and the development of eating disorders, particularly Bulimia; however, previous investigations have resulted in widely varied results. Dissociation has been suggested as a possible link between the two phenomena but has rarely been studied empirically. This study used a large non-clinical sample (N = 391) to investigate the frequency with which the two phenomena co-occur and to examine dissociation as a possible explanation for this co-occurrence. Child sexual abuse (CSA) was reported by 16.6% of the sample, while 9.4% reported bulimic behaviors. Results demonstrated minimal overlap between the two groups, however, suggesting that CSA and bulimic tendencies may be separate, albeit not uncommon, phenomena. Further, while higher levels of dissociation were found among those with a history of child sexual abuse (compared to those without a history of child sexual abuse) and with those with bulimic behaviors (compared to those without bulimic behaviors), there was no interaction found between child sexual abuse and bulimic behaviors. Additionally, multiple other trauma symptoms were found to be elevated both among those with a history of child sexual abuse and those with bulimic behaviors.

A Comparative Survey of Beliefs About “Normal” Childhood Sexual Behaviors

Objective: This study sought to collect data on what adults believe constitutes normal childhood sexual behaviors, and how variables, such as role, gender, and life experience might contribute to the formation of one’s beliefs. Methods: A survey describing 20 different scenarios of children under the age of 13 interacting with themselves or other children in a sexual manner was administered to four groups of adults: sexual abuse experts; therapists involved in a sexual abuse training program; medical students attending a human sexuality program; and group facilitators of the human sexuality program. Results: Behaviors that involved oral, vaginal, or anal penetration were judged by a majority of adults to be abnormal sexual behaviors in children under 13 years of age. Professionals working with sexually abused children rated certain sexual behaviors as more abnormal than adults participating in a human sexuality course. Both sexual abuse trainees and facilitators of the human sexuality course showed more directional biases than other groups, with trainees always rating behaviors in the direction of abnormal and facilitators always rating behaviors in the direction of normal. Females also judged many of the sexual behaviors to be more abnormal than males. Conclusions: Role and gender significantly influence what adults believe constitutes normal and abnormal childhood sexual behavior.

Normative sexual behavior in children: a contemporary sample.

Sexual behavior in children can cause uncertainty in the clinician because of the relationship between sexual abuse and sexual behavior. Consequently, it is important to understand normative childhood sexual behavior. Sexual behavior in 1114 2- to 12-year-old children was rated by primary female caregivers. These children were screened for the absence of sexual abuse. A 38-item scale assessing a broad range of sexual behavior (Child Sexual Behavior Inventory, Third Version) was administered along with the Child Behavior Checklist and a questionnaire assessing family stress, family sexuality, social maturity of the child, maternal attitudes regarding child sexuality, and hours in day care. Sexual behavior was related to the child's age, maternal education, family sexuality, family stress, family violence, and hours/week in day care. Frequencies of sexual behaviors for 2- to 5-, 6- to 9-, and 10- to 12-year-old boys and girls are presented. A broad range of sexual behaviors are exhibited by children who there is no reason to believe have been sexually abused. Their relative frequency is similar to two earlier studies, and this reinforces the validity of these results.

Childhood sexual abuse and HIV risk-taking behavior among gay and bisexual men.

We explored the prevalence of childhood sexual abuse among adult gay and bisexual men and measured the association between childhood sexual abuse and high-risk sexual behavior in adulthood. Two separate population-based samples of gay and bisexual men (n = 1,941) residing in Portland and Tucson were surveyed. Over one quarter reported a history of childhood sexual abuse (sexual behavior with someone at least 5 years older prior to age 13, or with someone at least 10 years older when between ages 13 and 15). Men who were abused were more likely to engage in sexual risk behavior than men who were not abused (e.g., unprotected anal intercourse with non-primary partners in the previous 12 months: 21.4% vs. 15.0%, p < .001). Perception of having been coerced was associated with greater sexual risk. Furthermore, childhood sexual abuse and level of coercion were associated with reported levels of HIV infection among gay and bisexual men. It is recommended that existing programs for those at risk for HIV be modified to deal with these issues, and that efforts to bring about behavior change will require approaches that go beyond simply increasing knowledge and awareness.

Factors That Mediate Treatment Outcome of Sexually Abused Preschool Children: Six- and 12-Month Follow-up

The role of familial, demographic, developmental, and treatment-mediating factors on treatment outcome of sexually abused preschool children was evaluated 6 and 12 months after treatment. Forty-three sexually abused preschool children and their parents who were evaluated shortly after disclosure of sexual abuse and then were provided with one of two treatment interventions were reevaluated at the completion of treatment and 6 and 12 months after treatment. Parents completed the Child Behavior Checklist, the Child Sexual Behavior Inventory, and the Weekly Behavior Report to measure a variety of emotional and behavioral symptoms in children. Parents also completed the Beck Depression Inventory, the Family Adaptability and Cohesion Evaluation Scales-III, the Parent Emotional Reaction Questionnaire, the Parental Support Questionnaire, and the Maternal Social Support Index. Children completed the Battelle Developmental Inventory and the Peabody Picture Vocabulary Test at pretreatment to assess developmental levels. Correlational and stepwise multiple regression analyses were conducted to analyze the role of the hypothesized mediating variables in predicting scores on outcome measures across the two treatment groups. While the Parent Emotional Reaction Questionnaire was the strongest familial predictor of treatment outcome at posttreatment, parental support became a stronger predictor of outcome at the 6- and 12-month follow-up points. Treatment group was the strongest overall predictor of outcome at posttreatment and at 12-month follow-up. Demographic and developmental factors did not strongly predict outcome. Findings indicate the strong impact of parental support on treatment outcome in sexually abused preschool children over the course of a 12-month follow-up and emphasize the importance of including parental interventions in treating sexually abused preschool children. They also support the superior effectiveness of cognitive-behavioral therapy over supportive counseling for this population.

The evaluation of Franco-Quebec victims of child sexual abuse and their mothers: The implementation of a standard assessment protocol

Objective: There were two aims: first, to evaluate the feasibility of applying a standard assessment protocol to Franco-Quebec victims of child sexual abuse and nonoffending mothers; and second, to compare results from an initial sample with available data from English-speaking samples. Method: A standard individual case study design was used for victims and mothers, and the satisfaction of the nine participating youth workers was assessed. Four self-report instruments for victims and five for mothers were chosen on the bases of workers' priorities, sensitivity to the impact of CSA, and the availability of published norms on English-speaking samples. Results are reported on 48 confirmed victims and 40 nonoffending mothers. Results: The protocol was favorably received by the CPS workers, supervisors and all mothers and victims. Percentages of clinically distressed victims varied from highs of 68% on the externalization difficulties of the Child Behavior Checklist and 67% for 2- to 6-year-olds on the Child Sexual Behavior Inventory, to lows of 10% on hostility symptoms and 13% on the Dissociation Scale of the Trauma Symptom Check for Children. The rate of symptom-free children was lower (19%) and that of revictimization higher (30%) than most published estimates (Kendall-Tackett, Williams, & Finkelhor, 1993). Most mothers reported elevated emotional distress (depression, 59%) and symptoms of post-traumatic stress (intrusiveness, 67%). Although 87% of mothers believed the allegations, only 45% offered adequate emotional support. Conclusion: The implementation phase of this research was successful, given the positive reactions of workers and clients. Results on standard instruments from this French-speaking sample were similar to profiles of English-speaking victims and their mothers but firm conclusions on appropriate norms will require larger samples, cross cultural contrasts, and the evaluation of additional variables.

Group treatment for prepubescent boys with sexually aggressive behavior: Clinical considerations and proposed treatment techniques

Descriptive and treatment outcome studies regarding sexually aggressive prepubescent boys are lacking. Preliminary data, however, are available from five studies on this difficult-to-treat population. This article has multiple goals: 1) to summarize descriptive and treatment outcome data of problematic sexual behavior in children; 2) to describe general considerations regarding treatment for sexually aggressive prepubescent male children; 3) to address two traditional clinical goals (e.g., eliminating perpetration behavior and enhancing victim empathy) for treating sexual aggression; and 4) to broaden the concept of empathy as a treatment goal. In addition, useful activities are described and available resources are referenced for practitioner use.

Children with Sexual Behavior Problems and Their Caregivers: Demographics, Functioning, and Clinical Patterns

This article is the first report from a 5-year demonstration project examining the comparative efficacy of specialized and traditional treatments with children who have exhibited sexual behavior problems. Baseline data concerning the demographics, psychological adjustment, and victimization and perpetration histories of 72 6 to 12-year-old children who have engaged in sexual misbehavior are reported in this article. Information regarding the caregivers and extended families of these children is also presented. The data clearly demonstrate that families of children with sexual behavior problems are marked by an array of characteristics indicative of parental and familial distress, including high rates of (1) violence between parents; (2) sexual victimization and perpetration with the extended family; (3) physical abuse of the children who have exhibited sexual behavior problems; (4) children who have witnessed violence between their parents; (5) parental arrest; (6) denial of responsibility for perpetration of sexual abuse by members of the extended family; (7) poverty; (8) special educational services; (9) prior therapy for children; and (10) clinical scores on behavioral rating instruments. In particular, several significant differences emerged between younger children (6-9 years) and older children (10-12). Younger children had (1) been sexually and physically abused at an earlier age; (2) been more likely to have witnessed physical violence between parents; (3) performed problematic sexual behaviors at an earlier age; (4) a higher annual rate of problematic sexual behaviors; (5) had a higher percentage of hands-on sexual behaviors; and (6) had higher scores on measures indicative of sexual behavior problems (e.g., Child Sexual Behavior Inventory, Child Behavior Checklist - Sexual Problems Subscale). Based on these data, treatment recommendations are made for families containing children with sexual behavior problems. Given the extensive data suggesting parental characteristics that could serve as mediating variables in the sexual behavior problems of their children, effective intervention requires the involvement of the children's caregivers. The comparative efficacy of specialized and traditional treatments for these families will be reported in subsequent articles.

A Treatment Study for Sexually Abused Preschool Children: Outcome During a One-Year Follow-up

Treatment outcome in sexually abused preschool children was evaluated 6 and 12 months after treatment. Forty-three sexually abused preschool children and their parents were evaluated 6 and 12 months after completion of either Cognitive-Behavioral Therapy for Sexually Abused Preschoolers (CBT-SAP) or nondirective supportive therapy (NST). Parents completed the Child Behavior Checklist, Child Sexual Behavior inventory, and Weekly Behavior Report to measure a variety of symptoms in their children. Repeated-measures analyses indicated that there were significant group by time interactions on several outcome measures from the beginning of the study to the end of the 12-month follow-up period, with the CBT-SAP group exhibiting significantly more improvement over time than the NST group. Clinical findings also indicated the superior effectiveness of CBT-SAP over NST in reducing sexually inappropriate behavior. Findings support the superior efficacy of CBT-SAP over NST in maintaining symptom reduction in the year after treatment completion. The importance of using cognitive-behavioral interventions for sexually inappropriate behaviors and including nonoffending parents in the treatment of sexually abused preschool children is discussed.

A pilot study of the relationship between childhood sexual abuse and compulsive sexual behaviors in adults

An investigation of the relationship between childhood sexual abuse and adult compulsive sexual behaviors was conducted among attendees of Sex and Love Addicts Anonymous meetings. Forty-five participants voluntarily completed a questionnaire involving demographics, sexual behaviors, and childhood sexual abuse. Women reported higher levels and greater severity of childhood sexual abuse. Men scored higher on the severity of sexual addiction scale. A tentative relationship between severity of childhood sexual abuse (measured by the frequency and severity of abusive behaviors suffered) and the severity of sexual addiction was observed. Wide variability in the prevalence estimates of childhood sexual abuse using different instruments highlights the need for agreement on the definition of childhood sexual abuse. This would help clarify the relationship between childhood sexual abuse and compulsive sexual behaviors.

Dissociative and Sexual Behaviors in Children and Adolescents With Sexual Abuse and Psychiatric Histories

Dissociative and sexual behaviors were assessed in a sample of 350 children ages 7-18. Four groups were evaluated: a nonpsychiatric comparison sample, a psychiatric sample with no history of sexual abuse, a psychiatric sample with clear evidence of sexual abuse, and another group for whom sexual abuse was likely but not substantiated. All children completed the Trauma Symptom Checklist-Children (TSC-C), and varying numbers completed the Rorschach and MMPI. Parents completed the Child Behavior Checklist (CBC), Child Sexual Behavior Inventory (CSBI), and Child Dissociation Checklist (CDC). Mean differences on the Dissociation and Sexual Concerns subscales of the TSC-C existed between the nonpsychiatric and psychiatric groups. The Dissociation subscale was significantly correlated with MMPI Scale 8 and CDC. Sexual Concerns were significantly related to sexual content on the Rorschach, CBC sex problems, and the CSBI. Duration and nature of abuse significantly contributed over and above age and gender in predicting total score on the Dissociation subscale.

Clinician's views on sexually aggressive children and their families: A theoretical exploration

Behavioral and family characteristics of sexually aggressive children were obtained from a national convenience sample of treatment providers to gain descriptive data and to investigate the tentative use of a social learning theory model of sexual aggression of children. One hundred fifty-five professionals responded to a questionnaire of their work with a total of 287 sexually aggressive children aged 12 and under. A number of family variables may have impacted the children's sexual behavior. The average child resided in a two-parent home, and in most of these families (70%), at least one caretaker was chemically dependent; 48% have at least one parent known to have been sexually abused; and 72% of the children were sexually abused themselves (60% by a caretaker). The children with known sexual abuse histories were younger at the first sign of sexual aggression than those without known sexual abuse histories. Children under 6 years of age were more likely to perceive their sexually aggressive behavior as normal than were older children. Differences based on gender of the children were not found for sexual aggression. These results suggest the potential for use of a social learning theory with sexual aggression in children. Implications for practice and suggestions for further research are discussed.