Title: Clinical Report—The Evaluation of Sexual Behaviors in Children | American Academy of Pediatrics
Headings: Clinical Report—The Evaluation of Sexual Behaviors in Children
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Clinical Report—The Evaluation of Sexual Behaviors in Children
Abstract
INTRODUCTION
DIFFERENTIATING NORMAL SEXUAL BEHAVIORS FROM SEXUAL BEHAVIOR PROBLEMS
Types of Sexual Behaviors
Age
FACTORS THAT AFFECT FREQUENCY AND TYPES OF SEXUAL BEHAVIORS
Situational Factors
Environments in Which Sexuality Is More Open
Family Dysfunction and Stress
Children With Developmental Disabilities
Abuse and Neglect
Comorbid Diagnoses
CLINICAL ASSESSMENT AND TREATMENT
PARENTAL GUIDANCE
CONCLUSIONS
COMMITTEE ON CHILD ABUSE AND NEGLECT, 2008–2009
LIAISONS
STAFF
Footnotes
REFERENCES
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Sexual behaviors that involve children who are developmentally dissimilar or use of coercion and control by 1 child are abusive. 12 Distinct developmental differences occur when children are at least 4 years apart in age or cognitive abilities. Children who are fewer than 4 years apart in age may still engage in abusive sexual contact when 1 child uses physical force or threat of harm against the other child. Abusive behaviors generally occur without other witnesses, and threats to “keep the secret” are common. Abusive sexual behaviors require immediate and effective intervention. Children with sexual behavior problems are more likely than children with normal sexual behaviors to have additional internalizing symptoms of depression, anxiety, withdrawal, and externalizing symptoms of aggression, delinquency, and hyperactivity. 9 This association suggests that some sexual behaviors occur within a continuum of behavioral problems with multifactorial causes. Another group of children may engage in a greater variety and frequency of sexual behaviors that may be disruptive to others but not necessarily abusive. These behaviors are often noted after a shift in caregiving environments; examples include children placed in foster homes and children who attend child care.