Professional Documents
Culture Documents
BRIEF REPORTS
Robert Pauze
School of Social Service, Universite Laval
The purpose of this study was to identify personal and family predictors and correlates
of persistence of problematic sexual behaviors (PSB) in children. Participants were the
families of 49 children (ages 411 years) referred by Child Protective Services in 4
administrative districts of Quebec. Caregivers completed interviews and questionnaires
twice at a 1-year interval. Results showed that 43% of children persisted with PSB.
When age was controlled, greater exposure to sexualized behaviors in the family proved
both a correlate and a predictor of PSB persistence in children 12 months later.
Externalizing problems and somatic complaints emerged as correlates of PSB as well.
Maltreatment subtypes did not predict PSB persistence.
Research has shown that some adolescent and adult 2008; Baker et al., 2001; Friedrich et al., 2005). However,
sexual abusers exhibited problematic sexual behaviors distinguishing transient sexual misconduct from more
(PSB) at an early age (Burton, 2000; Vizard, Hickey, & persistent PSB in children may be difcult, as the litera-
McCrory, 2007). These are childhood sexual behaviors ture on this specic topic is scarce. Longitudinal studies
that involve body parts (i.e., genitals, anus, buttocks, or are needed to conrm the stability of PSB in children,
breasts) and that are developmentally inappropriate or specically with a view to determine whether these beha-
potentially harmful to the child or others (Association viors are indicative of persistent difculties requiring
for the Treatment of Sexual Abusers [ATSA], 2006). comprehensive and intensive therapy or whether they
There is extant concern that if children with PSB are left are merely a transitory phenomenon that will attenuate
untreated, their behaviors may persist over time (Burton, with minimum intervention (Friedrich et al., 2005;
2000; Manocha & Mezey, 1998). Child Protective Santtila, Sandnabba, Wannas, & Krook, 2005).
Services (CPS) have become particularly concerned that In a 10-year follow-up study that tracked 135 children
the PSB manifested by some children might compromise treated (cognitive-behavioral treatment or dynamically
the safe living environment in a residential facility (Baker, oriented treatment) for PSB, from 2% to 10% of children
Schneiderman, & Parker, 2001; Farmer & Pollock, 2003). with early PSB committed sex offenses in adolescence
The high prevalence of PSB found in residential facilities, and adulthood (Carpentier, Silovsky, & Chafn, 2006).
up to one third of the children in their charge, implies that Two other longitudinal studies have followed children
many children are directly affected, as are the many work- with PSB. In a 2-year posttreatment follow-up of 20 chil-
ers who must deal with these behaviors (Baker et al., dren 6 to 12 years old with PSB, Bonner, Walker, and
Berliner (1999) reported that from 15% to 17% of their
sample were again reported for PSB in residential
We thank the families and volunteers who participated in the
project. facility. In the other study, in a sample of 20 children
Correspondence should be addressed to Mireille Levesque, 10 to 12 years old, Friedrich et al. (2005) observed per-
Departement de Psychologie, Universite du Quebec a Montreal, C.P. sistence of PSB 1 year later in 92% of those in a residen-
8888, Succursale Centre-ville, Montreal, Quebec, H3C, 3P8 Canada. tial treatment center and 43% of those in foster families.
E-mail: mirelevesque@gmail.com
240 LEVESQUE, BIGRAS, PAUZE
Child Sexual Behavior Inventory (CSBI). This is a Measurements were not obtained at Time 2 for 36% of
38-item standardized checklist of child sexual behavior the children. The main reasons for this was the
in the past 6 months completed by caregivers (Friedrich, impossibility of reaching the caregivers and children
1997). The measure has demonstrated good psycho- 12 years or older (n 8) were excluded at Time 2
metric properties with children 2 to 12 years old. The because the CSBI was designed for children younger
internal consistency of the instrument has been shown than age 12. Sample representativeness at Time 2
to be good (alphas from .72 for a normative sample to (n 49) was nonetheless good. Chi-square and t-test
.93 for a clinical sample), as has been its stability (corre- analyses were conducted to identify any systematic dif-
lation of .91 after 2 weeks) and construct validity ferences between families who remained in the study
(Friedrich et al., 2001). In the present sample, internal for both waves and those for whom data were available
consistency yielded good Cronbachs alpha, .65 (Time only at Time 1. No differences emerged on the CBCL
1) and .80 (Time 2). Five additional items serve to assess scales, the CSBI data or demographic characteristics
child exposure to sexuality in the home (co-sleeping, (gender and age).
co-bathing, witnessing intercourse, availability of por- Of the 49 children with PSB at Time 1, most (57%)
nography, and family nudity). The scale obtained an did not manifest PSB at Time 2. We noted a signicant
alpha coefcient of .52. difference in mean age between children who persisted
Given that the measure covers normal sexual beha- with PSB and those who did not, F(1, 48) 8.13,
viors, we focused on the items most likely to identify p < .01. Specically, children who persisted (M 7.41,
PSB as dened by the ATSA (2006). These items were SD 1.81) were signicantly younger than those who
determined by a team of seven professionals. Any child desisted (M 8.97, SD 1.92). The sample was com-
who proved positive to any one of the items was con- posed of 65% boys and 35% girls, and gender was not
sidered to exhibit PSB. Analysis showed the reliability related to persistence of PSB.
of the 14 items thus selected to be good, with a
Cronbachs alpha of .77 (Table 1). The internal consist-
ency of the selected items suggested that the measure Univariate Analysis of Factors Associated With
possessed good to excellent homogeneity (alphas at Persistence of PSB
Time 1 and Time 2 of .65 and .80, respectively). Chi-square and analysis of variance (ANOVA) analy-
ses were carried out to examine the link between
Child sexual abuse. A semistructured interview personal and family factors and persistence of PSB.
was used to explore presence of child sexual abuse. Children who persisted with PSB were more exposed
The only element considered in this study was presence to sexualized behaviors in the family at Time 1 and
of sexual abuse as revealed by respondent. The psycho- Time 2, F(1, 48) 6.50, p .01, and F(1, 48) 6.26,
metric characteristics of the instrument were not avail- p .05.
able at time of writing. The interviewer did not probe Some psychological difculties at Time 2 appeared to
for different types of abuse. be associated with persistence of PSB. ANOVAs run
between six scales of the CBCL and the PSB persistence
variable proved signicant: Somatic Complaints scale,
Conflict Tactics Scales (Version 1). The short- F(1, 48) 8.90, p < .01; Thought Problems, F(1, 48)
form of Conict Tactics Scales (Straus, Hamby, 4.29, p < .05; Delinquency scale, F(1, 48) 5.21,
Finkelhor, Moore, & Runyan, 1998) consists of 10 p < .05; Aggression scale, F(1, 48) 11.62, p .001;
items on a 5-point scale encompassing physical and Externalizing scale, F(1, 48) 10.92, p < .01; and Total
verbal aggression. The caregiver must indicate whether CBCL scale, F(1, 48) 7.69, p < .01. In other words,
she or he or any other adult at home verbally or physi- children who persisted with PSB showed signicantly
cally maltreated the child. This instrument has been more symptomatology on these CBCL scales than did
shown to possess adequate internal consistency, with children who desisted after 1 year. We did not evaluate
alphas of .58 and .68 for the Physical Aggression and the effects of concurrent maltreatment given that, being
Verbal Aggression scales, respectively (Straus et al., under the care of CPS, the children were not supposed
1998), and adequate reliability (McGuire & Earls, to suffer maltreatment during the follow-up period.
1993). In the present sample, internal consistency for Chi-squares and ANOVAs run on behavior problems
scales yielded Cronbachs alpha from .52 to .63 (Time and maltreatment variables at Time 1 did not signi-
1 and 2). cantly predict persistence of PSB after 1 year.
242 LEVESQUE, BIGRAS, PAUZE
were not completed 1 year later for 36% of the children. factor associated with the development of PSB in chil-
This said, children accounted for at both times of dren under the care of these services. On the other hand,
measurement did not differ from those lost at Time 2 in children may be placed in the charge of CPS for engag-
terms of initial clinical severity or demographic charac- ing in PSB. Consequently, the exact reasons for placing
teristics. Second, information on child behaviors was children in the care of CPS need to be specied.
provided by caregivers only. Future studies would stand
to gain from the addition of other informants in this
regard. Third, given that persistence was assessed in chil- REFERENCES
dren referred by CPS and that some of these children
could have received treatment, it is not clear if treatment Achenbach, T. M. (1991). Manual for the Child Behavior Checklist=
was a factor in the abatement of PSB in children after 1 418 and 1991 prole. Burlington: University of Vermont, Depart-
year or whether it would have occurred anyway. It is also ment of Psychiatry.
Association for the Treatment of Sexual Abusers. (2006). Report of the
possible that some children changed living environment, Task Force on Children with Sexual Behavior Problems. Beaverton,
which could have had an impact on the family sexuality OR: Author.
variable. Further, the alpha for the scale used to measure Baker, A. J. L., Gries, L., Schneiderman, M., Parker, R., Archer, M.,
family sexuality was relatively weak. Last, we have no & Friedrich, W. (2008). Children with problematic sexualized beha-
information if some children have received some form viors in the child welfare system. Child Welfare, 87, 527.
Baker, A. J. L., Schneiderman, M., & Parker, R. (2001). A survey of
of mental health services from CPS in which the issue problematic sexualized behaviors of children in the New York City
of PSB might have been addressed. child welfare system: Estimates of problem, impact on services, and
need for training. Journal of Child Sexual Abuse, 10, 6780.
Bonner, B. L., Walker, C. E., & Berliner, L. (1999). Children with
Implications for Research, Policy, and Practice sexual behavior problems: Assessment and treatment. Final Report,
Grant No. 90CA1469. Washington, DC: Administration of
Within the context of these limitations, the study yielded Children, Youth, and Families, DHHS.
several important ndings. We found a signicant pro- Burton, D. L. (2000). Were adolescent sexual offenders children with
portion (43%) of children who persisted with PSB over sexual behavior problems? Sexual Abuse: A Journal of Research
a 12-month period. Although many children desisted and Treatment, 12, 3748.
Carpentier, M. Y., Silovsky, J. F., & Chafn, M. (2006). Randomized
from PSB after 1 year, we do not know if the desistance
trial of treatment for children with sexual behavior problems:
rate will rise going forward or not. Future studies should Ten-year follow-up. Journal of Consulting and Clinical Psychology,
denitely follow the progression of PSB over a longer 74, 482488.
period. Cote, S., Tremblay, R. E., Nagin, D., Zoccolillo, M., & Vitaro, F.
A major contribution of our study is to provide a (2002). The development of impulsivity, fearfulness, and helpfulness
better indication of the children with PSB for whom during childhood: Patterns of consistency and change in the trajec-
tories of boys and girls. Journal of Child Psychology and Psychiatry,
an intervention would be a priority in CPS, specically 43, 609618.
those who live in a sexualized family environment and Farmer, E., & Pollock, S. (2003). Managing sexually abused and=or
those who present EP and somatic complaints. Identify- abusing children in substitute care. Child and Family Social Work,
ing children at risk for persistent PSB would avert more 8, 101112.
victimization at an early stage on other children. Our Friedrich, W. N. (1997). Child Sexual Behavior Inventory: Professional
manual. Odessa, FL: Psychological Assessment Resources.
study has the merit of revealing greater exposure to sex- Friedrich, W. N., Baker, A. J. L., Parker, R., Schneiderman, M., Gries,
ualized behaviors in the family environment to be a pre- L., & Archer, M. (2005). Youth with problematic sexualized beha-
dictor of PSB persistence and identifying concurrent viors in the child welfare system: A one-year longitudinal study.
factors associated with persistent PSB after 1 year, Sexual Abuse: A Journal of Research and Treatment, 17, 391406.
Friedrich, W. N., Davies, H., Feher, E., & Wright, J. (2003). Sexual
namely, somatic complaints and EP. The inuence of
behavior problems in preteen children: Developmental, ecological,
somatic complaints on PSB persistence needs to be and behavioral correlates. Annals of the New York Academy of
further investigated as well. Finally, it might be worth- Sciences, 989, 95104.
while to assess children referred to CPS and mental Friedrich, W. N., Fisher, J. L., Dittner, C. A., Acton, R., Berliner, L.,
health services for PSB as a matter of routine protocol. Butler, J., . . . Wright, J. (2001). Child Sexual Behavior Inventory:
Further studies should also help guide the design of Normative, psychiatric, and sexual abuse comparisons. Child
Maltreatment, 6, 3749.
intervention models for different subtypes of children Ginsburg, G. S., Riddle, M., & Davies, M. (2006). Somatic symp-
with persistent PSB. We believe that for many children toms in children and adolescents with anxiety disorders. Journal of the
with persistent PSB, a short intervention is sufcient American Academy of Child and Adolescent Psychiatry, 45, 11791187.
to remediate these difculties. However, for others, an Haugaard, J. J. (2004). Recognizing and treating uncommon beha-
intensive and structured treatment must be considered vioural and emotional disorders in children and adolescents who
have been severely maltreated: Somatisation and other somatoform
(ATSA, 2006). Finally, future studies need to examine disorders. Child Maltreatment, 9, 161168.
the direction of the association between CPS and PSB. Hensley, L., & Varela, E. (2008). PTSD symptoms and somatic
Receiving services from CPS may be a potentiating complaints following hurricane Katrina: The roles of trait anxiety
PERSISTENCE OF PROBLEMATIC SEXUAL BEHAVIORS 245
and anxiety sensitivity. Journal of Clinical Child & Adolescent Pithers, W. D., Gray, A., Busconi, A., & Houchens, P. (1998b). Chil-
Psychology, 37, 542552. dren with sexual behavior problems: Identication of ve distinct
Hukkanen, R., Sourander, A., & Bergroth, L. (2003). Suicidal ideation child types and related treatment considerations. Child Maltreat-
and behavior in childrens homes. Nordic Journal of Psychiatry, 57, ment, 3, 384406.
131137. Santtila, P., Sandnabba, N. K., Wannas, M., & Krook, K. (2005).
Levesque, M., Bigras, M., & Pauze, R. (2010). Externalizing problems Multivariate structure of sexual behaviours in children: Associations
and problematic sexual behaviors: Same etiology? Aggressive with age, social competence, life stressors, and behavioural disor-
Behavior, 36, 358370. ders. Early Child Development and Care, 175, 321.
Manocha, K. F., & Mezey, G. (1998). British adolescents who sexually Silovsky, J., Niec, L., Bard, D., & Hecht, D. (2007). Treatment for
abuse: A descriptive study. Journal of Forensic Psychiatry & preschool children with interpersonal sexual behavior problems:
Psychology, 9, 588608. A pilot study. Journal of Clinical Child and Adolescent Psychology,
McGuire, J., & Earls, F. (1993). Exploring the reliability of measures 36, 378391.
of family relations, parental attitudes, and parentchild relations Straus, M. A., Hamby, S. L., Finkelhor, D., Moore, D. W., & Runyan,
in a disadvantaged minority population. Journal of Marriage and D. (1998). Identication of child maltreatment with the Parent
the Family, 55, 10421046. Child Conict Tactics Scales: Development and psychometric data
Pauze, R., Toupin, J., Dery, M., Mercier, H., & Joly, J. (2004). Portrait for a national sample of American parents. Child Abuse & Neglect,
des jeunes ages de 0 a 17 ans referes a la prise en charge des Centres 22, 249270.
jeunesse du Quebec, leur parcours dans les services et leur evolution Van Tilburg, M. A. L., Runyan, D. K., Zolotor, A. J., Graham, J.
dans le temps [Portrait of youths 0 to 17 years old referred to the care C., Dubowitz, H., Litrownik, A. J., . . . Whitehead, W. E. (2010).
of Quebec youth centers, their service pathway and their evolution Unexplained gastrointestinal symptoms in a prospective study of
over time]. Quebec, Canada: Universite de Sherbrooke, Groupe de children at risk for abuse and neglect. Annals of Family Medicine,
recherche sur les inadaptations sociales de lenfance. 8, 134140.
Pithers, W. D., Gray, A., Busconi, A., & Houchens, P. (1998a). Vizard, E., Hickey, N., & McCrory, E. (2007). Developmental trajec-
Caregivers of children with sexual behavior problems: Psycho- tories associated with juvenile sexually abusive behaviour and
logical and familial functioning. Child Abuse & Neglect, 22, emerging severe personality disorder in childhood: 3-year study.
129141. British Journal of Psychiatry, 190, s27s32.
Copyright of Journal of Clinical Child & Adolescent Psychology is the property of Taylor & Francis Ltd and its
content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's
express written permission. However, users may print, download, or email articles for individual use.