Sexual Behavior Problems Among Sexually Abused Children: Associations With Co-Occurring Symptoms

Abstract

Sexual behavior problems (SBPs) and interpersonal SBPs (ISBPs) among sexually abused children often occur alongside a variety of other clinical difficulties, such as externalizing problems, attentional difficulties, social concerns, and posttraumatic stress symptoms (PTSS). Yet, as few studies have examined these links in a multivariate manner, it is unclear which symptoms are most strongly related to SBPs and ISBPs. Research regarding children’s reports of their difficulties and SBPs and ISBPs is also very limited. The current study investigated the relations between both caregiver- and child-reported trauma-related symptoms and SBPs and ISBPs among 248 treatment-seeking sexually abused children (ages 6–12; M = 8.06, SD = 2.52; 64.5% female; 55.6% white). Children’s caregiver-reported trauma-related sexual concerns and anger were associated with SBPs. For ISBPs, only caregiver-reported sexual concerns were related to ISBPs. Surprisingly, none of the child-reported symptoms were associated with either SBPs or ISBPs. Trauma-related sexual concerns and anger may be tied to SBPs, whereas other clinical difficulties may be less strongly implicated. Trauma-related sexual concerns may be most important in understanding interpersonally focused SBPs. Children’s self-reported difficulties may be unrelated to caregiver-reported SBPs, or these results may be a function of a low degree of caregiver and child symptom concordance.

Children with sexual behavior problems: Ties to child maltreatment, family functioning, and help‐seeking

“…The present study investigated potential risk factors for children's SBPs that have received less attention, including parenting attitudes and behaviors, family functioning, and help‐seeking. Moreover, although prior research has attempted to identify links between maltreatment types and SBPs, this approach has overlooked the majority of children who have experienced several forms of maltreatment (Allen, 2017; Lussier et al., 2019) while accounting for the importance of children's emotional and behavioral difficulties (Elkovitch et al., 2009; Wamser‐Nanney & Campbell, 2020b). Finally, the current study expands the prior literature by including an examination of ISBPs as a distinct SBP subtype, as suggested in preliminary work (Allen, 2017; Wamser‐Nanney & Campbell, 2020a).…”

“…Approximately 7%–22% of children in clinical samples (Allen, 2017; Gray et al., 1997) and 10%–47% of sexually abused children and those in the child welfare system (Baker et al., 2008; Wamser‐Nanney & Campbell, 2019, 2020a, 2020b) exhibit sexual behavior problems (SBPs), defined as age‐inappropriate, problematic, or potentially harmful sexual behaviors that may be self‐ or other‐directed and occur in children 12 years of age and younger (Chaffin et al., 2008; Shawler et al., 2018; Smith et al., 2019). Children with SBPs have experienced high rates of maltreatment (i.e., 52%–63%), yet research has focused almost solely on the contribution of individual maltreatment types, overlooking the potential importance of multiple victimization experiences, which often co‐occur (Elkovitch et al., 2009).…”

“…An ecological framework is, thus, needed to conceptualize SBPs. Ample work has focused on the role of child‐level factors, and preschool‐aged children have been found to more frequently exhibit SBPs than school‐aged children (Elkovitch et al., 2009; Silovsky & Niec, 2002; Wamser‐Nanney & Campbell, 2020b). The findings regarding gender have been mixed, likely based on age, with higher rates of SBPs observed in school‐aged boys (Carpentier et al., 2006; Wamser‐Nanney & Campbell, 2019) and preschool‐aged girls (Silovsky & Niec, 2002).…”

Symptoms of Posttraumatic Stress and Sexual Concerns: The Intermediary Effects of Executive Functioning on Profiles of Youth Who Have Sexually Harmed

“…SC, including preoccupation with sex or recurrent self-stimulation, can be a consequence of sexual abuse; there is evidence that YSH have many of these residual behavioral and emotional concerns resulting from sexual abuse (Burton et al, 2002; Grabell & Knight, 2009). In fact, researchers have found such trauma-related SC to be particularly salient in associating with sexual behavior problems among children who have been sexually abused (Wamser-Nanney & Campbell, 2020). Although trauma-related SC can co-occur with other trauma symptomatology (e.g., nightmares), researchers have yet to determine their relative effects on executive functioning deficits; trauma-related SC and other trauma symptoms may be discrete but related constructs (Smiljanich & Briere, 1996).…”

Etiological Pathways to the Emergence of Preteen Problematic Sexual Behavior: An Exploratory Mediational Model

“…For instance, Silovsky and Niec (2002) found that, of 13 cases of preschool children displaying PSB and having a CSA history, only two met diagnostic criteria for PTSD. Using continuous measures, Allen (2017) observed only weak evidence linking PTS to the display of PSB among CSA survivors and Wamser-Nanney and Campbell (2022) found that PTS did not explain the connection between CSA and PSB. Data from Simon and Feiring (2008) suggested the opposite effect, that PTS, particularly posttraumatic avoidance of sexual topics, may predict lower rates of PSB among children with CSA histories.…”