Sexual behaviour problems (SBP) in children don’t have a universal definition. It is generally accepted that SBP are neither a mental health disorder nor a diagnosis, but rather behaviour manifestations on the margins of healthy sexual development. The working group of the Association for the Treatment of Sexual Abusers (ATSA)(1) proposed a definition in 2008 that has been used by many authors. It concerns “children ages 12 and younger who initiate behaviours involving sexual body parts (i.e. genitals, anus, buttocks or breasts) that are developmentally inappropriate or potentially harmful to themselves or others. Although the term sexual is used, the intentions and motivations for these behaviours may or may not be related to sexual gratification or sexual stimulation. The behaviors may be related to curiosity, anxiety, imitation, attention-seeking, appeasement, or other reasons”. Furthermore, “sexual behaviour problems (SBP) don’t represent a medical/psychological syndrome or a specific disorder, but rather a set of behaviors that are outside acceptable societal limits”. Some authors have established a classification which is a continuum between healthy and pathological development that should be distinguished for a better understanding of child development(2),(3). They emphasise the importance of understanding and being able to assess minors in terms of psychosexual and emotional development(4).
In terms of the prevalence of SPB: in the field of child protection, 10 to 30% of children in the United States, (5), (6) and approximately 15% in Quebec, (7), (8) are thought to have SBP. In France, there are no epidemiological studies targeting sexual behavior problems.
In terms of care, children with SBP do not always benefit from therapies adapted to their problems, (3), (5), (8) whereas cognitive-behavioral therapies centered on the minor with the participation of families/guardians/care providers are efficient. These children are sometimes even considered by professionals as future offenders, which can have an impact on their development and care. (9)
Since the 1990s, researchers have been interested in SBP on an etiological side. For some, having been sexually assaulted is the main risk factor for developing SBP, as it is for adult perpetrators of sexual violence (10). For others, SBP are not related to a history of sexual abuse (4). The development of SBP appears to follow multiple and complex trajectories (3), revealing multiple individual and familial risk factors. Children may thus present cognitive and language deficits, behavioural disorders, have witnessed domestic violence, been victims of sexual assault, physical abuse, psychological abuse or have grown up with parents who presented substance abuse or experienced psychological distress(3),(11).
In France, children in medical or social care institutions may have a life history already marked by emotional and educational deficiencies. When these children present SBP, they sometimes cause worries to professionals who do not always know how to identify and evaluate these disorders, and even less how to react to them, according to the literature (12) and the clinical experience of the professionals of the CRIAVS (Centre de Ressource et d’intervention pour les auteurs de violences sexuelles).
The lack of French epidemiological data associated with the potential difficulties of professionals to identify and reply to SBP led us to conduct a descriptive observational study with the main objective of "describing, based on self-questionnaires completed by medical, health and social professionals working with children under 12 years of age in France, the current state of knowledge and representations related to SBP in this population".
The results of this study could be used to offer training to professionals, including tools for the care of children with SBP if needs of this kind are identified.