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.

Engaging young people and their caregivers in support services following harmful sexual behaviors: Qualitative analysis

BACKGROUND

Harmful sexual behavior (HSB) displayed by children and young people under the age of 18 has been described as developmentally inappropriate, may be harmful towards self or others, or be abusive towards another child, young person, or adult. Early intervention and treatment completion are crucial to cease HSB, reduce impacts and address underlying issues for the child who has displayed HSB. Considerable shame attaches to seeking help for this stigmatized behavior which may result in dropout from support services. Understanding young people and caregivers' experiences of what facilitates or hinders their engagement with support services is therefore critical to preventing re-occurrence of HSB and keeping children safe.

OBJECTIVE

This article draws on the first-hand experience of young people and caregivers to address the question: What have they found helpful and unhelpful when engaging with services for harmful sexual behavior?

PARTICIPANTS AND SETTING

Participants were recruited from public health and youth justice services in the state of New South Wales, Australia. The 31 participants included 11 young people (aged 14 to 17) and 20 caregivers (parents, foster or kinship carers).

METHODS

Qualitative data were collected through individual semi-structured interviews, following which thematic analysis was conducted.

RESULTS

Data analysis identified three helpful responses: (1) non-judgmental recognition of crisis; (2) child-centred and family-focused orientation; and (3) multi-dimensional interventions. Unhelpful responses included: (1) closed doors (an inability to access a service) (2) stigmatization of HSB; and (3) reduced caregivers' autonomy.

CONCLUSIONS

Greater involvement of caregivers, non-stigmatizing language and coordinated responses between generalist and specialist services are needed to facilitate service engagement.

Comparison of children's advocacy center responses to harmful sexual behavior among siblings: An international perspective

BACKGROUND

Harmful sexual behavior (HSB) is sexual behavior exhibited by children and adolescents that is developmentally inappropriate and/or harmful or abusive towards themselves or others. Victims of children with HSB are commonly siblings. Multiple professionals may be involved in cases of youth HSB involving siblings, which places Children's Advocacy Centers (CACs) in a key position to directly address intrafamilial HSB. Approximately 25% of all cases seen at CACs in the U.S. are youth-initiated HSB. However, no known research has examined how CAC professionals approach decision-making and response to intrafamilial and sibling HSB, particularly across regions and cultures.

OBJECTIVES

To examine the perspectives of professionals from three separate CACs in Israel, eastern U.S., and southwestern U.S. regarding their decision-making and response process for sibling HSB.

PARTICIPANTS AND SETTING

Thirty-seven multidisciplinary team members from the three CACs, including representatives from child welfare, law enforcement, family advocacy, mental health, and the court system, among others, participated in the study.

METHODS

Participants completed focus groups that asked them to discuss how their system would respond to a vignette case. Dedoose was used for thematic analysis.

RESULTS

Using qualitative thematic analysis, results indicate all sites perceived sibling HSB as a family crisis, and they prioritized establishing safety and providing therapeutic interventions. Differences across sites were on how to establish safety and when to use legal actions.

CONCLUSIONS

The study draws attention to the influences that formal policy and community contexts have on CAC decision-making, particularly around the availability of evidence-based treatments and caregiver engagement.

Preventing harmful sexual behavior in primary schools: Barriers and solutions

BACKGROUND

Schools are recognized as crucial stakeholders in preventing and combating public health problems such as sexual violence and abuse. While prevention efforts have often focused on safeguarding children from adult perpetrators, less attention has been dedicated to safeguarding against harmful sexual behavior (HSB) displayed by children and young people at school. As little is known about teachers' understanding of and responses to HSB in primary school more research is needed.

OBJECTIVE

The objective of the study is to explore and identify barriers to the prevention of HSB in primary school. Possible solutions to these identified barriers are pursued through a transformative lens.

PARTICIPANTS AND SETTING

Nineteen informants from six schools participated in focus-group interviews at their respective schools in the south-eastern region of Norway in May and June 2019. Fifteen of the informants were primary school teachers, three were school principals and one was a social worker.

METHODS

The focus-group interviews were transcribed verbatim, and the transcripts and field notes were analyzed using thematic analysis.

FINDINGS

Primary school teachers report a lack of HSB competence and limited multi-agency cooperation or coordinated practice. Under these circumstances, the teachers perceive the prevention of HSB as an overwhelming individual professional responsibility.

CONCLUSIONS

The study suggests that the following three policy initiatives need to be prioritized.

Future directions in child sexual abuse prevention: An Australian perspective

BACKGROUND

Child sexual abuse is a problem of significant proportion in Australia and globally. Prevention efforts have tended to occur on an ad hoc basis and to be poorly evaluated. A measured, evidence-based public health approach to preventing child sexual abuse is necessary to enhance the prevention agenda.

OBJECTIVE

The objective of this paper was to engage with the work of Letourneau and colleagues about a public health approach to child sexual abuse prevention from an Australian perspective.

METHODS

In this commentary paper, following on from Letourneau and colleagues, policy resistance to addressing the problem of child sexual abuse and its prevention in the Australian context is explored. Promising pockets of research, policy and practice are described that indicate greater readiness and a lessening policy resistance to address child sexual abuse through a comprehensive public health approach. Finally, ideas for enhancing primary, secondary, and tertiary prevention strategies in Australia are highlighted.

CONCLUSIONS

The Australian child sexual abuse prevention agenda would benefit from adopting a measured public health approach involving the design, implementation, and evaluation of primary, secondary, and tertiary interventions. Early intervention strategies are particularly underdeveloped in an Australian context.

'Snitches get stitches': School-specific barriers to victim disclosure and peer reporting of sexual harm committed by young people in school contexts

BACKGROUND

School based, peer-to-peer sexual harm is under-researched despite its prevalence and adverse effects on young people across the globe. Understanding barriers to victim disclosure and peer reporting might help towards the prevention and protection of young people.

OBJECTIVE

This study explores dual perspectives of young people and educational staff about school-specific environmental barriers to 1) young people's disclosure of sexual harm experienced, and 2) young people's reporting of sexual harm on behalf of others.

PARTICIPANTS AND SETTING

Participants include 59 young people aged 13-21 and 58 educational staff, drawn from seven schools across four local authorities in England whom formed part of a wider study on harmful sexual behavior and safety in schools.

METHODS

Focus groups were carried out with young people and education staff. The sessions were thematically analysed and focused on barriers to disclosure within the school context.

RESULTS

Peer groups set powerful 'rules' that influence the ability and willingness of young people to report sexual harm. Some school responses for addressing sexual harm are sub-optimal and sexual harm is not adequately prioritised. Some schools appear to struggle to manage more subtle forms of sexual harm compared with more recognized forms of violence and abuse. A significant proportion of sexual harm is so prevalent that it is 'normalised', and therefore under-reported. This resigned acceptance to sexual harm consequently shapes young people's disclosures.

CONCLUSIONS

School systems of responding to sexual harm require strengthening to increase feelings of safety and empowerment of young people.