Problematic and Harmful Sexual Behavior in Children: a systematic review.

Problematisk og skadelig seksuell atferd blant barn: et systematisk review

Andersen, Emilie Wiig ; Jahr, Lina Fryd

4. term

Psychology, Master

2021

2021-05-28

789

Background: About one in ten children experience sexual abuse during childhood, and roughly one third of these offenses are committed by another child or peer. Despite this, parents, educators, and professionals often lack clarity on how to understand and respond to children who show problematic or harmful sexual behavior (PSB/HSB)—that is, sexual behaviors that are not age-appropriate or that harm others. Much of the existing research focuses on adolescents, while children under 12 are less studied. This systematic review brings together quantitative evidence on PSB/HSB in children under 12. Objectives: (1) To map key circumstances in the lives and upbringing of children with PSB/HSB, and (2) to examine whether these behaviors persist over time. Methods: The review followed PRISMA guidelines. Searches were conducted in PubMed, Embase, and PsycInfo on March 3, 2020, with no date limits. We included quantitative, peer-reviewed studies on PSB/HSB in children under 12 (entire samples under 12 or mean age under 12). Findings were organized into four areas: study characteristics; adverse childhood experiences (neglect, sexual, physical and psychological abuse, and witnessing domestic violence); parent and family factors (living with at least one biological parent, parental substance use, parental high school completion, arrests/imprisonment, mental disorders, and parents’ own adverse childhood experiences); and longitudinal findings. Study quality and risk of bias were assessed using five selected and adapted questions from the NIH assessment tool. Results: Of 3,050 records, 36 studies were included (27 unique datasets). In a limited bias assessment, 19 studies had low to moderate risk of bias. Twenty-one studies examined adverse childhood experiences, 15 examined parent and family factors, and 3 were longitudinal with at least one year between measurements. Overall, there were high rates of adverse experiences and negative family factors, though estimates varied widely. Studies also differed greatly in sample size, sampling methods, definitions of PSB/HSB, and variables measured. Discussion: Compared with population-based data, children with PSB/HSB had higher rates of adverse childhood experiences and family challenges. The longitudinal studies indicated an increased risk of non-sexual criminal behavior over time. Limitations include high variation across samples, broad search and inclusion strategies, lack of control groups as an eligibility requirement, and a limited risk-of-bias assessment. Overall, the findings depict a vulnerable, understudied group and a research field needing more attention. Key implications are to improve professional education about this population and to view the behavior as a possible sign of a challenged upbringing.

Baggrund: Omtrent hvert tiende barn oplever seksuelle overgreb i barndommen, og omkring en tredjedel af disse begås af et andet barn eller en jævnaldrende. Alligevel er der usikkerhed blandt forældre, pædagoger og fagfolk om, hvordan man forstår og håndterer børn, der udviser problematisk eller skadelig seksuel adfærd (PSB/HSB) – altså seksuel adfærd, der ikke er alderssvarende eller som skader andre. Meget forskning retter sig mod unge lovovertrædere, mens børn under 12 år er mindre belyst. Denne systematiske gennemgang samler kvantitativ evidens om børn under 12 år med PSB/HSB. Formål: 1) At kortlægge centrale forhold i livet og opvæksten hos børn med PSB/HSB, og 2) at undersøge, om adfærden er stabil over tid. Metode: Gennemgangen fulgte PRISMA-anbefalingerne. Der blev søgt i PubMed, Embase og PsycInfo den 3. marts 2020 uden tidsbegrænsninger. Inklusion omfattede kvantitative, peer-reviewede studier om PSB/HSB hos børn under 12 år (enten hele stikprøven under 12 eller gennemsnitsalder under 12). Resultaterne blev organiseret i fire områder: studiekarakteristika; belastende barndomsoplevelser (omsorgssvigt, seksuelle, fysiske og psykiske overgreb samt at overvære vold i hjemmet); forældre- og familieforhold (bo med mindst én biologisk forælder, forældres rusmiddelbrug, forældres uddannelsesniveau [high school], anholdelse/fængsling, psykiske lidelser og forældres egne belastende barndomsoplevelser); samt longitudinelle fund. Kvalitet og risiko for bias blev vurderet med fem udvalgte og tilpassede spørgsmål fra NIH’s vurderingsværktøj. Resultater: Af 3.050 fund blev 36 studier inkluderet (27 unikke datasæt). I en begrænset biasvurdering havde 19 studier lav til moderat risiko for bias. 21 studier undersøgte belastende barndomsoplevelser, 15 så på forældre- og familieforhold, og 3 var longitudinelle med mindst ét år mellem målingerne. Overordnet fandtes høj forekomst af belastende oplevelser og negative familieforhold, men estimaterne varierede bredt. Studierne varierede også markant i størrelse, udvælgelsesmetoder, definitioner af PSB/HSB og målte variabler. Diskussion: Sammenlignet med befolkningsdata havde børn med PSB/HSB højere forekomst af både belastende barndomsoplevelser og familieudfordringer. De longitudinelle studier tydede på øget risiko for ikke-seksuel kriminalitet over tid. Begrænsninger omfatter stor variation mellem stikprøver, bred søge- og inklusionsstrategi, fravær af kontrolgrupper som krav og en begrænset biasvurdering. Samlet tegner resultaterne et billede af en sårbar og underbelyst gruppe og et forskningsfelt med behov for mere opmærksomhed. Vigtige implikationer er at styrke fagfolks viden om denne gruppe og at betragte adfærden som et muligt symptom på en udfordret opvækst.

[This apstract has been rewritten with the help of AI based on the project's original abstract]

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