Barriers to Accessing Treatment Services: Child Victims of Youths with Problematic Sexual Behavior

Scoping Review of the Definitions Used to Describe and Understand Harmful Sexual Behaviors in Children and Young People

There is a growing body of evidence that adolescents, and other children, are responsible for a significant proportion of sexual abuse against children. However, there are substantial differences in how this phenomenon is defined and conceptualized between and within sectors. This scoping review explored the current definitions of harmful sexual behaviors (HSB), and other similar terms, used across a range of stakeholder groups. In all, 141 papers were reviewed from both empirical and gray literature sources, including key policy and practice documents. Included papers needed to list a clear definition for the behavior of interest. There was disagreement and inconsistency across the included papers in their conceptualization of harmful, abusive, or problematic sexual behavior (PSB) in children and adolescents. Although the term HSB has been adopted as an umbrella term or continuum in many policy, practice, and research settings, there is a large variance in behaviors, treatment needs, etiology, and harms present across different types of sexual behavior. Relying solely on one term to describe a wide range of sexual behaviors in children and young people may limit the understanding of this issue and imply similarities between groups that are not present. We suggest that clearly defined subsets of HSB, such as sexual abuse, technology-assisted HSB, and PSB, may give more context to the behavior of concern and may be helpful in informing further research, prevention, and best practice approaches.

Characteristics of preschool-age children who engage in problematic sexual behaviors with siblings

BACKGROUND

Problematic sexual behavior (PSB) between siblings can be a form of sibling sexual abuse (SSA). A notable gap in research are studies examining PSB among preschool-age children with siblings.

OBJECTIVE

This study examined the impact of child maltreatment, exposure to family sexuality, and use of coercive sexual behavior on preschool-aged children PSB with siblings and with nonsiblings.

PARTICIPANTS AND SETTING

All 284 children were ages 3-6 years with PSB who had siblings in the home (197 initiated PSB with siblings and 87 initiated PSB with non-siblings).

METHODS

The two groups were compared on types of PSB, use of coercion, child maltreatment history, exposure to family sexuality, and caregiver attitudes. Caregiver report measures were the Child Sexual Behavior Inventory- Third Edition (CSBI-III), the Family Sexuality Index, and intake form on maltreatment experienced (i.e., physical abuse, sexual abuse, emotional abuse, neglect, exposure to domestic violence, caregiver drug use, and failure to protect).

RESULTS

Maltreatment history was significant, t(258) = -3.36, p < .001; sibling initiators were associated with higher rates of sexual and physical abuse, and neglect than non-sibling. Exposure to family sexuality was significant with non-sibling initiators demonstrating greater exposure than the sibling group, t(282) = 2.66, p = .008. There was no significance between groups for types of PSB including use of coercion.

CONCLUSIONS

Results illuminated unique dynamics of PSB with siblings of preschool-aged children. A developmental framework integrating child maltreatment, impulsivity, environmental factors, and capabilities are key considerations for conceptualization, prevention, and response that is distinct from SSA of adolescents.

Impressions of child advocacy center leaders: How problematic sexual behavior in children and adolescents is perceived by community professionals

BACKGROUND

Consistent with the goals of National Children's Alliance, Children's Advocacy Centers (CACs) are optimal for addressing needs related to problematic sexual behavior (PSB) of youth due to their multidisciplinary approach and emphasis on community-level evidence-based interventions (Kelley et al., 2019). To promote child well-being and safety, decisions of the CAC's multidisciplinary team must be based on an accurate understanding of youth with PSB, child sexual development, and best-practice responses. However, misperceptions about youth who have engaged in PSB appear to broadly persist (Hackett, Masson, et al., 2013), leading to obstacles for CACs in addressing PSB.

OBJECTIVE

To better understand and address the training and service needs of CACs across the country, the goal of this study was to assess CAC community professionals' (e.g., MDT members) perceptions of children and adolescents with PSB, as reported by CAC leaders.

PARTICIPANTS AND SETTING

Participants were 351 CACs from 47 US states, a representative sample based on regional and community distributions.

METHOD

A designated point-of-contact (e.g., the Director) for each CAC completed an online survey reflecting on their CAC's professional community's perceptions of youth with PSB.

RESULTS

Findings suggested that a number of misperceptions about youth with PSB, particularly adolescents, are commonly reported for CAC professional communities. Prevalent misperceptions surrounded the etiology of PSB, treatment-related needs, and differences between youth with PSB and adults.

CONCLUSIONS

Results can be used to inform policy, practice, training, and resource utilization to address youth with PSB in CACs, with specific recommendations provided to enhance an evidence-based approach.

A conceptual analysis of system responses to the issue of problematic sexual behaviors in children and recommendations for future work in Children's Advocacy Center multidisciplinary teams

Problematic sexual behavior (PSB) in children is a common, yet frequently misunderstood and mishandled issue facing communities. Because of the intersection of children both causing harm and being harmed, societies across the globe struggle with whether to punish or support during these times. For Children's Advocacy Centers (CACs), whose mandate it is to support victimized children, this tension is exacerbated. CACs have historically relied on identifying a "perpetrator" and "victim" when providing their services, however PSB displaying youth do not fit this classic dichotomy. Compared with other children, PSB displaying youth are more likely to experience greater incidents and types of violent childhood trauma, have increased parent instability, decreased familial support, and struggle with co-occurring mental health diagnoses. Due to the stigma and fear surrounding sexual behaviors in children and systemic barriers including varied definitions of PSB, uncertainty regarding how to respond within the context of child-serving roles, and the criminalization of children's behaviors, access to supportive services is complicated and challenging. Treatment completion rates for this population are as low as 13%, despite most methods being short-term, non-invasive, and community based. This conceptual analysis paper identifies five key themes in the literature that influence these barriers and proposes an interdisciplinary approach for CAC multidisciplinary teams (MDTs) to better support this vulnerable population.

Exposure to sexual content and problematic sexual behaviors in children and adolescents: A systematic review and meta-analysis

BACKGROUND

Exposure to sexual content, such as online pornography or live sexual content, has been posited in the literature as a risk factor for problematic sexual behaviors (PSBs) in children and adolescents, and has been identified as an important avenue for research and intervention, particularly given the ubiquitous access to technology among children.

OBJECTIVE

To examine the association between live/violent and non-violent sexual content exposure and PSB among children and adolescents. Objectives also include informing future research on sexual content exposure as a risk factor for PSB, and providing clinical recommendations related to prevention and intervention.

PARTICIPANTS AND SETTING

Results are based on 16,200 participants (28.65 % female; Mage = 14.26; range = 4.74-17.92) and 27 studies conducted in North America, Europe, Asia, and Africa.

METHODS

A systematic review was conducted of available literature published up to September 2021. Abstract and full-text review were conducted to assess whether studies met inclusion criteria. Random-effects meta-analyses were conducted on included studies.

RESULTS

Significant associations were found between exposure to non-violent sexual content and likelihood of engaging in PSB (OR = 1.82; p < .001; 95 % CI: 1.50-2.21), and between exposure to violent/live sexual content and PSB (OR = 2.52; p < .001; 95 % CI: 1.75-3.61). Sex emerged as a moderator of the association between exposure to non-violent sexual content and PSB, such that the association was stronger in studies with a greater proportion of females.

CONCLUSIONS

Results support the need for future research on risk factors and mechanisms implicated in PSB. Prevention and intervention programs for children with PSB and their families could benefit from incorporating education on sexual content exposure.