Journal of Child Sexual Abuse

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Child Sexual Behaviors in School Context: Age and

Gender Differences

Sarah Miragoli, Elena Camisasca & Paola Di Blasio

To cite this article: Sarah Miragoli, Elena Camisasca & Paola Di Blasio (2017) Child Sexual
Behaviors in School Context: Age and Gender Differences, Journal of Child Sexual Abuse, 26:2,
213-231, DOI: 10.1080/10538712.2017.1280866

To link to this article: http://dx.doi.org/10.1080/10538712.2017.1280866

Published online: 28 Mar 2017.

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JOURNAL OF CHILD SEXUAL ABUSE
2017, VOL. 26, NO. 2, 213–231
http://dx.doi.org/10.1080/10538712.2017.1280866

Child Sexual Behaviors in School Context: Age and Gender

Differences
a b a
Sarah Miragoli , Elena Camisasca , and Paola Di Blasio
a
C.R.I.d.e.e., Psychology Department, Catholic University of the Sacred Heart, Milan, Italy; bDepartment
of Psychology, e-Campus University, Novedrate, Como, Italy

ABSTRACT ARTICLE HISTORY

The main purpose of the study was to explore the child sexual Received 27 April 2016
behaviors that Italian teachers have observed in the school Revised 27 December 2016
context. A representative sample of 227 children, from 5 to Accepted 3 January 2017
10 years old, was rated by their teachers through the Child KEYWORDS
Sexual Behavior Inventory. Frequencies of sexual behaviors Child sexual behavior; Child
among children aged 5 to 6, 7 to 8, and 9 to 10 are presented. Sexual Behavior Inventory;
Younger children showed a broader range of sexual behaviors domestic violence; family
that decrease with the growing age, such as males in compar- sexual attitudes; teachers
ison to females. Moreover, findings showed that child sexual
behavior is not only related to age and gender but also to
family characteristics. These results suggested that child sexual
behaviors reported by teachers through the Child Sexual
Behavior Inventory may provide useful information about the
development of children’s sexuality. The knowledge of age
appropriate sexual behaviors can help teachers discern normal
sexual behaviors from problematic sexual behaviors.

In the developmental psychology, an area of interest is within the sphere of

sexual behavior. From a methodological and descriptive point of view, to
obtain information about normative sexual behaviors in children, researchers
asked parents or day care providers to complete a checklist of sexual beha-
viors, often using the Child Sexual Behavior Inventory (CSBI; Friedrich,
1993a, 1995, 2001). The CSBI is a 38 item-questionnaire that is widely used
to examine both normative and problematic sexual behaviors and that allows
the clinical evaluation of childhood sexual development. In most cases, the
CSBI was administered to parents to assess their children’s sexual behaviors.
Notably, parents reported a wide range of sexual behaviors in their children,
varying from high-frequency (more general behaviors) to low-frequency
(specific or rare behaviors). Specific or rare behaviors (Friedrich,
Grambsch, Broughton, Kuiper, & Beilke, 1991, 1998; Friedrich, Sandfort,
Oostveen, & Cohen-Kettenis, 2000; Schoentjes, Deboutte, & Friedrich,
1999) are typically considered non-normative or problematic and include
intrusive and aggressive behaviors or behaviors that are more imitative of the

CONTACT Sarah Miragoli sarah.miragoli@unicatt.it. Catholic University of Milan, Department of

Psychology, L.go Gemelli 1, Milano, MI 20123, Italy.
© 2017 Taylor & Francis Group, LLC
214 S. MIRAGOLI ET AL.

adult sexuality (such as attempted intercourse, oral–genital contact, mastur-

bating with an object, and inserting objects into vagina/rectum). Day care
providers and teachers (in nursery and elementary schools) were used as
reporters in several studies, and they observed a lower frequency of sexual
behaviors (in particular, of genital touching) than parents did (Baker et al.,
2008; Larsson & Svedin, 2002; Lindblad, Gustafsson, Larsson, & Lundin,
1995; Lopez-Sanchez, Del Campo, & Guijo 2002). They also observed that
children (already in preschool age) interact spontaneously in sexual ways and
tend to imitate sexual behaviors they have seen or heard about with relatively
low frequencies of intrusive or aggressive behaviors (Lindblad et al., 1995).
Some behaviors were rare both at home and at the day care centers.
In the current literature, it has become clear that, similarly to other areas
of the child development, sexual behavior is influenced by individual, famil-
ial, and environmental factors. At the individual level, the child’s age and
gender are among the most investigated and predictive factors; several
studies reveal sexual knowledge and behaviors in normative and clinical
groups are strongly related to child’s age (Friedrich et al., 1991, 1992, 1998;
Gordon, Schroeder, & Abrams, 1991). Age is negatively connected with the
frequency of sexual behaviors (Friedrich et al., 1991, 2001; Sandnabba &
Santtila, 2003; Santtila, Sandnabba, Wannäs, & Krook, 2005) and plays an
important role on the type of sexual behavior. Pithers, Gray, Busconi, and
Houchens (1998) suggested that some sexual behaviors are common at a
given age, while others are extremely rare. For example, touching genitals in
public is frequently observed in preschool age, much less common in school
age, and it is certainly uncommon in adolescence (Friedrich et al., 1991, 1992,
1998). Regarding the influence of the gender, many studies explained that
both boys and girls exhibit sexual behaviors but at different age and in
different contexts (e.g. Bonner, Walker, & Berliner, 1999, 1998; Friedrich
et al., 1991, 1992; Sandnabba & Santtila, 2003). Girls express more sexual
behaviors mostly during preschool years and in familial context (Bonner
et al., 1999) and show a significant increase with ascending age in behaviors
characterized by interrelation and imitative and socially explorative sexual
behavior (Sandnabba & Santtila, 2003), while for boys, sexual behaviors and
verbalization increase with age (e.g., interest in sexuality, showing and view-
ing body parts) with a peak during school-age years (Bonner et al., 1999;
Sandnabba & Santtila, 2003). In addition, boys are more likely to be active in
exploring sexuality and do not change their behavior as much between
different settings (Larsson & Svedin, 2002).
In regard to family factors, in recent literature, attention is devoted to
individual maternal characteristics (e.g. the level of education and the pre-
vious experience of violence), family life stressors, and family sexual attitudes
(Bonner et al., 1999; Friedrich et al., 1991, 1992, 2001; Kellogg, 2010; Thigpen
& Fortenberry, 2009). Some studies illustrate mothers who receive a longer
 JOURNAL OF CHILD SEXUAL ABUSE 215

education are more likely to report sexual behaviors in their children than
less educated ones (1998; Friedrich et al., 1991, 1992; Gordon et al., 1991)
and that mothers with a history of sexual abuse may be even more prone to
over- or underreport such behaviors (Friedrich, Davies, Feher, & Wright,
2003). Moreover, numerous studies showed the negative effect of having
experienced significant traumatic events at the familial (e.g., death and
separation from parents) or the individual (e.g., maltreatment and sexual
abuse) level on the development of atypical sexual behaviors (e.g., Baker
et al., 2008; Chaffin et al., 2008; Friedrich et al., 1991, 1992, 2001). In a
sample of Finnish preschool children (Santtila et al., 2005), an increase in all
types of sexual behaviors (frequent and specific) were found to interest both
boys and girls who were living at least one life stressor: findings pointed out a
significant difference between girls with no reported life stressors and girls
with reported life stressors on scale “masturbatory/genital self-touch” and for
boys on scale “closeness seeking/gender confusion.” Moreover, some studies
that compared children with sexual behavior problems (SBP; Chaffin et al.,
2008) with other groups of children (normative and psychiatric counterparts)
noticed that children with SBP are more likely to have experienced stressful
life events (Baker et al., 2008; Bonner et al., 1999; Friedrich et al., 1991, 1992,
2001), specifically, domestic violence, child maltreatment or child sexual
abuse (Curwen, Jenkins, & Worling, 2014; Elkovitch, Latzman, Hansen, &
Flood, 2009; Tarren-Sweeney, 2008). Regarding the growth in violent con-
texts, Johnson (2002, 2004) argues that the child’s sexual development may
be disrupted as a result of the family dysfunction evinced by the violence and
that some children who live in violent families can believe that sex and
aggression are complementary elements. This pairing may also cause confu-
sion for the child’s sexual development. Some studies showed that domestic
violence is common in families of children exhibiting more sexually inap-
propriate and intrusive behaviors (Friedrich et al., 1998, 2001; Friedrich &
Trane, 2002; Silovsky & Niec, 2002).
The negative effect of violence on the development of inappropriate sexual
conducts seems to apply both for the assisted violence, but above all, for the
suffered violence. Some studies indicated a significant correlation between
atypical sexual behavior and exposure of some form of child maltreatment
(Baker et al., 2008; Bonner et al., 1999; Curwen et al., 2014; Gray, Busconi,
Houchens, & Pithers, 1997; Silovsky & Niec, 2002; Tougas et al., 2016). These
studies report that, as far as the child physical abuse is concerned, the
prevalence rates of sexual behavior problems range from 32% to 48%
(respectively for verified reports and parent reports; Bonner et al., 1999;
Gray, Pithers, Busconi, & Houchens, 1999; Silovsky & Niec, 2002). In regard
to neglect, they range from 16% to 18%, and, as for emotional abuse, they
vary from 29% to 39% (Bonner et al., 1999; Gray et al., 1997). Research has
consistently demonstrated that children who have been sexually abused
216 S. MIRAGOLI ET AL.

exhibit a higher frequency of sexual behaviors than children who have not
(Friedrich, 1993a; Friedrich et al., 1992, 1997; Hall, Mathews, & Pearce, 2002;
Kendall-Tackett, Williams, & Finkelhor, 1993; Letourneau, Schoenwald, &
Sheidow, 2004; Pithers et al., 1998) and that sexual abuse experiences are
found in high percentages in children with SBP (Friedrich & Luecke, 1988;
Johnson, 1988). The literature reported clinically significant levels of sexua-
lized behaviors in 30%–40% of abused samples and statistically significant
differences between abused and nonabused samples on many specific sexual
behaviors (Friedrich, 1993a, 2007; Friedrich et al., 2001; Friedrich, Olafson, &
Faller, 2007). Rare sexual behaviors (compulsive masturbation and sexual
intrusive behaviors: e.g., puts objects in vagina or rectum, puts mouth on sex
parts, asks others to do sex acts, and tries to have intercourse) were much
more frequent in samples of sexually abused children.
Finally, living in a highly sexualized environment and exposure to sexually
explicit contents can also stand as important factors contributing to the
development of inappropriate sexual conducts (Curwen et al., 2014;
Friedrich et al., 2003). Family sexual attitudes include: family nudity, oppor-
tunities to witness sexual intercourse and looking at pornographic magazine
or movies, co-sleeping, and co-bathing (Friedrich et al., 1991, 1992, 1998,
2000, 2001, 2003). In Friedrich and colleague’s (2003, 2001, 1991, 1992, 2000)
studies, parents with a more open and relaxed attitude toward sexuality and
nudity reported higher levels of sexual behavior in their children, regardless
of whether the child had a history of sexual abuse.

The present study

In situations of potential risk for children, teachers (as all care providers
working with children) are expected to be able to assess child behavior and to
assume the necessary attitude toward the behaviors. To do this, teachers and
care providers need to refer to representative samples to report about the
normality or abnormality of the children’s behavior. To date, no studies have
been published about child sexual behaviors in the Italian context. As noted
by Elkovitch and colleagues (2009), the impact of culture on the development
of sexual behaviors’ problems has yet to receive empirical attention, and we
hope that this study may contribute to the literature of other cultures on the
theme of child sexual development and that it may be used as a source of
information for intervention programs.
For these reasons, this exploratory study aims to (a) analyze the relation
between age, gender, and sexual behaviors of a representative sample of
school-aged Italian children (5–10 years old) observed by teachers in the
school context; (b) check the ability of the CSBI, compiled by teachers, to
detect at risk sexual behaviors, analyzing the relationship between the CSBI
Total Score and socioeconomic, individual, and family variables; (c) evaluate
 JOURNAL OF CHILD SEXUAL ABUSE 217

the possible role of family variables in the relationship between individual

variables and sexual behaviors.
In line with literature, we hypothesize that sexual behaviors of children,
observed by teachers in the school context, will change per age and gender of
children. We expect that younger children (5–6 years) will show a higher
number of sexual behaviors and that males exhibit sexual conduct more
commonly than females. Moreover, we anticipate the most common beha-
viors to be stimulation, sexual curiosity, and body exploration, and we
anticipate the least common to be the imitation of adult sexuality (regardless
of age and gender of child). We also expect that the CSBI, compiled by
teachers, can identify normative and at risk sexual behaviors. For this reason,
we hypothesize that, in line with literature, the CSBI Total Score is associated
with socioeconomic, individual, and family variables. Finally, in an ecological
perspective, we suppose that familial factors (negative life events and family
sexual attitudes) are important to be considered when explaining the devel-
opment of sexual behaviors and that could play a mediational role in the
relationship between individual variables (age and gender of the child) and
sexual behaviors.

Method
Participants
Children were recruited from two elementary schools in Milan (North Italy).
Teachers were used as reporters and were contacted by a trained research
assistant. Each family was informed that their child’s sexual behavior was to
be examined in a study about children’s behavior. Parents were required to
sign the consent form. Parents were assured about the anonymity and
confidentiality of the data that would be obtained and that they were
completely free to choose whether or not to take part in the study.
Teachers received their questionnaires, attended a meeting with the research
staff where staff clarified instructions and explained the background and aims
of the study. The research was approved by ethical requirements of the
Italian Psychological Society.
A total of 302 families were approached, and 240 agreed to participate
(79.5% participation rate). From this group, 13 children (5.4%) were
excluded because of mental retardation or physical handicap. The final
representative sample comprised a total of 227 children, and it was balanced
in terms of gender (50.7% female) with an average age of 92 months
(SD = 21.3 range: 60–134 months). Mothers had, on average, 10.5 years of
education (SD = 3.9; low-middle level of education, corresponding to the
attendance of early high school years) and fathers 11.1 years (SD = 3.5; low-
middle level of education, corresponding to the attendance of early high
218 S. MIRAGOLI ET AL.

Table 1. Demographic Data (N = 227)

%
Child’s gender
Female (n = 115) 50.7
Child’s age
5–6 years old (n = 92) 40.5
7–8 years old (n = 89) 39.2
9–10 years old (n = 46) 20.3
Family income
Higher (n = 18) 8
Middle (n = 179) 78.6
Lower (n = 30) 13.4
Marital status
Single (n = 3) 1.3
Married (n = 201) 88.6
Separated or Divorced (n = 23) 10.1
Birth order
Only child (n = 40) 17.6
First-born (n = 78) 34.4
Second-born (n = 80) 35.2
Third-born (n = 29) 12.8

school years). Other specific demographic elements of the normative sample

are presented in Table 1.
Twenty-six teachers observed the behavior of children. They were all
female and, on average, they were 47 years old (SD = 5.3, range: 39–58).
Each teacher was tenured and spent at least 24 hours per week in the
classroom, performing the traditional educational activities and numerous
workshop activities, during which it was possible to talk individually with
children and to gather information about their family life. In addition,
teachers met monthly with the parents of the pupils and had the opportunity
to obtain information on the family dynamics.

Measures
The CSBI (Friedrich, 1993b, 1995, 2001) is a widely used tool in studies
examining both normative and non-normative sexual behaviors, and its
items are capable to discriminate between sexually abused and nonabused
groups (Friedrich, 1993b). The CSBI consists of a questionnaire divided into
three sections: a demographic data sheet, a life events checklist, and 38 items
to assess a wide range of sexual behaviors. The demographic data sheet
obtained information about age and gender of the child; marital, financial
and educational status of parents; family size; and peer relationships of the
rated child. The life events checklist obtained information about suspected or
verified sexual abuse or maltreatment; about the possibility that the child had
ever experienced child maltreatment or sexual abuse, domestic violence,
parental death, parental imprisonment, other family deaths, divorce among
 JOURNAL OF CHILD SEXUAL ABUSE 219

parents, parental illness requiring hospitalization, personal illness requiring

hospitalization; and about family sexual attitudes (e.g., co-sleeping, co-bath-
ing, liberal television/video standards, witnessing intercourse, availability of
pornography, etc.). Each item was coded dichotomously as the child had
lived the event (1) or not (0). Finally, the 38 items on the CSBI asked for the
frequency of behaviors during the past 6 months and they were scored as 0,
1, 2, or 3 to reflect levels of frequency (0 = never; 1 = less than once a month;
2 = 1 to 3 times a month; and 3 = at least 1 time per week). According to
literature (Friedrich et al., 1991, 1992), the CSBI Total Score was calculated
by summing answers to the 38 items. This total score ranged from 0 (no item
was endorsed) to 114 (every item was rated 3), and it was used as a
continuous variable for ascertaining the strength of the association between
the CSBI and the other variables. Internal consistency for normal and clinical
populations ranged from .82 to .93, and test–retest reliability for a normative
sample was .85 (Feindler, Rathus, & Silver, 2003). The CSBI was found to
have good convergent, discriminant, and construct validity (Friedrich, 1997).
For this study the CSBI was translated into Italian by a bilingual Italian-
English speaker and, to ensure the meaning equivalence, the Italian transla-
tion was then translated back into English by a native speaker. Moreover, in
our sample, the item number 12 (“Touches sex part at home”), number 15
(“Touches animal’s sex parts”), number 20 (“Tries to look at people when
they are nude”), number 21 (“Pretends toys are having sex”), and number 32
(“Wants to watch TV nudity”) of the CSBI were excluded from the analyses
because the majority of teachers (80%–97%) declared not to be aware of the
response.

Results
Age and gender differences
To explore the relation between age and gender in the development of sexual
behaviors, the mean of each item was calculated and plotted across each year
of age for the total sample and for both boys and girls (see Figure 1). The
correlation analysis confirmed the associations between age and sexual beha-
viors (r = –.26, p < .0001) and between gender and sexual behaviors (r = –.19,
p < .005). Specifically, for the total sample, our data suggested that younger
children (5–6 years) expressed on average a higher number of sexual beha-
viors than older children (F (260,2) = 12.84, p < .001). It was noted that over
time, the expression of sexual behaviors in the school context decreases
gradually and especially that children between 9–10 years old showed just
few sexual behaviors. This finding is confirmed in both males (F (109,2) = 4.88,
p < .01) and females (F (112,2) = 9.70, p < .001).
220 S. MIRAGOLI ET AL.

0.120

0.100

CBSI Item Mean Score

0.080

0.060

0.040

0.020

0.000
5–6 years old 7–8 years old 9–10 years old
Male 0.104 0.037 0.021
Female 0.050 0.004 0.004

Figure 1. Plot of CSBI item mean scores across ages for both genders.

Moreover, males seemed to exhibit a higher number of sexual behaviors

than females, both in the total sample (t (225) = 2.92, p < .005, M = .066 versus
M = .026) and in the group of 7–8 years old (t (87) = 2.20, p < .05, M = .050
versus M = .010), suggesting even further the need to consider age in the
calculation of frequencies.
To calculate the frequencies of the various sexual behaviors, the propor-
tion of children endorsing each item of the CSBI was computed across the
three ages and gender groups. Endorsement was defined as a score of either
1, 2, or 3, meaning that the child had exhibited the behavior in the school
context at least once in the preceding 6 month period. A more detailed
representation of the frequencies of the sexual behavior items by age and
gender can be seen in Appendix A. Our data showed that in the school
context, children between 5–6 years old (Table 2) exhibited some specific
sexual conducts more frequently (over 20% and 10%–20%) than others.
These were self-stimulating, exhibitionism, and voyeurism behaviors (e.g.,
masturbation, tries to look at pictures of nude people, stand too close to
people, etc.). Furthermore, males illustrated a higher number of sexual
behaviors than females: in particular, the most relevant differences were
revealed for the items 4 (“Touches sex parts in public”), 5 (“Masturbates
with hand”), 9 (“Touches other child’s sex parts”), 27 (“Kisses other chil-
dren”), and 33 (“Shows sex parts to children”).
Sexual behaviors were significantly reduced in the group of 7- to 8-year-
old children (see Table 3): specifically, in this group there was an important
reduction in the expression of sexual behaviors in both males and females in
comparison to the 5–6 years old group. Furthermore, for both, the most
frequent behavior concerned a general curiosity toward the opposite sex
(10%–20%). The same conducts of masturbation remained among males,
but in very small percentage (2%–5%).
 JOURNAL OF CHILD SEXUAL ABUSE
Table 2. Frequencies of Reported Sexual Behaviors (5–6 Years Old)
Item No. (Abbreviated)
M (n = 52)
More than 20% 4. Touches sex parts in public
19. Tries to look at people when they are
nude
22. Tries to look at pictures of nude
people
33. Shows sex parts to children
37. Knows more about sex
20–10% 2. Stand too close
5. Masturbates with hand
9. Touches other child’s sex parts
23. Talks about sex acts
35. Very interested in opposite sex
10–5% 1. Dresses like opposite sex
16. Asks others to do sex acts
17. Rubs body against people
21. Shows sex parts to adults
29. Undresses other children
30. Wants to watch TV nudity
2–5% 6. Draws sex parts
7. Touches breasts
15. Makes sexual sounds
20. Pretends toys are having sex
28. Talks flirtatiously
Less than 2% 8. Masturbates with toy or object
13. Touches adult’s sex parts
Nonreported 3. Wants to be opposite sex
behaviors 10. Tries to have intercourse
11. Puts mouth on sex parts
14. Touches animal’s sex parts
18. Puts objects in vagina or rectum
24. Kisses adults not known well
25. Gets upset when adults kiss
26. Overly friendly with men
27. Kisses other children
31. Puts tongue in mouth when kissing
32. Hugs adults not known well
34. Undresses adults against their will
36. Puts mouth on breasts
38. Other sexual behaviors
221
F (n = 40)
2. Stand too close
17. Rubs body against people
22. Tries to look at pictures of nude
people
35. Very interested in opposite sex
1. Dresses like opposite sex
19. Tries to look at people when they are
nude
27. Kisses other children
37. Knows more about sex
3. Wants to be opposite sex
4. Touches sex parts in public
5. Masturbates with hand
9. Touches other child’s sex parts
10. Tries to have intercourse
16. Asks others to do sex acts
23. Talks about sex acts
25. Gets upset when adults kiss
26. Overly friendly with men
29. Undresses other children
32. Hugs adults not known well
33. Shows sex parts to children
34. Undresses adults against their will
6. Draws sex parts
7. Touches breasts
8. Masturbates with toy or object
11. Puts mouth on sex parts
13. Touches adult’s sex parts
14. Touches animal’s sex parts
15. Makes sexual sounds
18. Puts objects in vagina or rectum
20. Pretends toys are having sex
21. Shows sex parts to adults
24. Kisses adults not known well
28. Talks flirtatiously
30. Wants to watch TV nudity
31. Puts tongue in mouth when kissing
36. Puts mouth on breasts
38. Other sexual behaviors
222 S. MIRAGOLI ET AL.
Table 3. Frequencies of Reported Sexual Behaviors (7–8 Years Old)
Item No. (Abbreviated)
M (n = 42)
20–10% 35. Very interested in opposite sex
10–5% 9. Touches other child’s sex parts
28. Talks flirtatiously
37. Knows more about sex
2–5% 2. Stand too close
4. Touches sex parts in public
6. Draws sex parts
19. Tries to look at people when they are
nude
22. Tries to look at pictures of nude
people
23. Talks about sex acts
26. Overly friendly with men
27. Kisses other children
29. Undresses other children
30. Wants to watch TV nudity
Nonreported 1. Dresses like opposite sex
behaviors 3. Wants to be opposite sex
5. Masturbates with hand
7. Touches breasts
8. Masturbates with toy or object
10. Tries to have intercourse
11. Puts mouth on sex parts
13. Touches adult’s sex parts
14. Touches animal’s sex parts
15. Makes sexual sounds
16. Asks others to do sex acts
17. Rubs body against people
18. Puts objects in vagina or rectum
20. Pretends toys are having sex
21. Shows sex parts to adults
24. Kisses adults not known well
25. Gets upset when adults kiss
31. Puts tongue in mouth when kissing
32. Hugs adults not known well
33. Shows sex parts to children
34. Undresses adults against their will
36. Puts mouth on breasts
38. Other sexual behaviors
F (n = 47)
35. Very interested in opposite sex
37. Knows more about sex
1. Dresses like opposite sex
2. Stand too close
3. Wants to be opposite sex
4. Touches sex parts in public
5. Masturbates with hand
6. Draws sex parts
7. Touches breasts
8. Masturbates with toy or object
9. Touches other child’s sex parts
10. Tries to have intercourse
11. Puts mouth on sex parts
13. Touches adult’s sex parts
14. Touches animal’s sex parts
15. Makes sexual sounds
16. Asks others to do sex acts
17. Rubs body against people
18. Puts objects in vagina or rectum
19. Tries to look at people when they are
nude
20. Pretends toys are having sex
21. Shows sex parts to adults
22. Tries to look at pictures of nude
people
23. Talks about sex acts
24. Kisses adults not known well
25. Gets upset when adults kiss
26. Overly friendly with men
27. Kisses other children
29. Undresses other children
30. Wants to watch TV nudity
31. Puts tongue in mouth when kissing
32. Hugs adults not known well
33. Shows sex parts to children
34. Undresses adults against their will
36. Puts mouth on breasts
38. Other sexual behaviors
 JOURNAL OF CHILD SEXUAL ABUSE 223

Finally, in children between 9–10 years old (both male and female)
teachers did not indicate sexual conduct except for interest toward the
opposite sex (5–10%). In general, our data showed that more intrusive
behaviors and behaviors imitating the adult sexuality (e.g., tries to have
intercourse, puts mouth on sex parts, touches animal’s sex parts, puts objects
in vagina or rectum, etc.) were not detected by teachers regardless of age and
sex of the child.

CSBI and influence of family characteristics on child sexual behaviors

To determine if the items could be added to calculate a total score (CSBI
Total Score), α coefficient was calculated and then adequate (for total sample
α = .84; for males α = .85 and for females α = .79). Moreover, to check the
ability of the CSBI, compiled by teachers, to detect at risk sexual behaviors,
associations were verified among the CSBI Total Score and socioeconomic
(parental education and family income) and family (life stressors and family
sexual attitudes) variables. The analyses of the data proceeded in two steps.
First, the analysis of correlations among the variables investigated to examine
initial bivariate associations. Second, a set of multiple regression analyses
with variables associated to the child sexual behaviors was conducted.

Socioeconomic variables
The relationships between several demographic variables (parental education
and family income) and the child sexual behaviors (CSBI Total Score) were
calculated with correlations. The analysis of the correlations showed that
child sexual behaviors were not related either to the number of years of
schooling of mother (r = .93, p = .227) or father (r = .67, p = .175) or to the
economic level of the family (rho = .97, p = .201).

Life stressors and family sexual attitudes

Similarly, the relationships between several life stressors (suspected or ver-
ified sexual abuse or maltreatment, domestic violence, divorce among par-
ents, parental death, parental imprisonment, other family deaths, parental
illness requiring hospitalization, and child illness requiring hospitalization),
family sexual attitudes (co-sleeping, co-bathing, liberal television/video stan-
dards, witnessing intercourse, availability of pornography), and the child
sexual behaviors (CSBI Total Score) were computed with correlations and
multiple regressions in the entire sample.
As for life stressors (encoded in dichotomous form: 0 = absence, 1 = pre-
sence), in the total sample, the correlations’ analysis showed that domestic
violence (r = .56, p < .0001) and parental imprisonment (r = .44, p < .0001)
224 S. MIRAGOLI ET AL.

Table 4. Predictors of CSBI Total Score (N = 227)

Step 1 Step 2
B SE B β B SE B β
Age −.04 .01 −.26** −.01 .01 −.08
Gender −.92 .52 −.14 −.05 .35 −.01
Domestic Violence 2.71 1.22 .17*
Parental Imprisonment 4.69 1.05 .31**
Divorce 2.10 .92 .13*
Family Sexual Attitudes 2.51 .26 .54**
R2 .09 .62
F 8.18** 41.52**
ΔF 33.34**
Notes. *p < .05, **p < .01.

are positively related to the child sexual behaviors. Our data namely high-
lighted that children who live in dysfunctional and violent familiar contexts
exhibited sexual behaviors with a higher frequency at school. These data are
confirmed also by separately considering males (respectively: r = .57,
p < .0001 and r = .46, p < .0001) and females (respectively r = .55,
p < .0001 and r = .43, p < .0001), albeit in males emerged a further positive
correlation between sexual behaviors and divorce among parents
(r = .21, p < .05).
Moreover, the correlations’ analysis showed that, in our study, the pre-
sence of some family sexual attitude (encoded in dichotomous form:
0 = absence, 1 = presence of one or more sexual attitudes) is strongly
connected to the CSBI Total Score (r = .66, p < .0001) for both males
(r = .65, p < .0001) and females (r = .57, p < .0001).
With the aim to better investigate the meaning of these associations, a set
of multiple regressions’ analyses was conducted in the total sample. First, the
block of child variables (age and gender) was entered in order to define the
variance determined by these variables for the individual. In the second
block, domestic violence, parental incarceration, divorce, and family sexual
attitudes were entered (see Table 4). Afterward, our data confirmed the
importance of family variables on child sexual behaviors. Particularly, in
the expression of sexual behaviors (CSBI Total Score), the family variables
(domestic violence, parental incarceration, divorce, and family sexual atti-
tudes) obscure the direct effect of the child variables (age and gender),
carrying out a total mediation in the relationship between individual vari-
ables and sexual behaviors.

Discussion
This study aims to investigate the sexual behavior of a representative sample
of school-age children in the Italian school context. Specifically, Italian
teachers observed their students’ sexual behaviors through the Child Sexual
 JOURNAL OF CHILD SEXUAL ABUSE 225

Behavior Inventory (CSBI; Friedrich, 1993b, 1995, 2001), with adequate levels
of reliability for the Total Score (α = .84).
Regarding the frequency of sexual behaviors in the school context, in line
with literature (Bonner et al., 1999, 2001; Friedrich et al., 1991, 1992; Gray
et al., 1999; Pithers et al., 1998; Sandnabba & Santtila, 2003; Santtila et al.,
2005; Silovsky & Niec, 2002) our data illustrates the significant effects of
child’s age and gender on the expression of sexual behaviors. Although this
was not a longitudinal study, our results illustrate the tendency for children
to progressively exhibit a lower number of sexual behaviors as they grow
older. Younger children (5–6 year old) show a wider variety of sexual
behaviors and a more active manifestation of their sexual curiosity through
acts of exhibitionism, self-stimulatory, and explorative behaviors. Per the
literature (1998; Friedrich et al., 1991, 2000; Lindblad et al., 1995;
Sandnabba et al. 2003; Schoentjes et al., 1999), growing older, children
maintain some interest toward sexuality (especially toward the opposite
sex), but in extrafamilial contexts (such as school context), sexual manifesta-
tions are less overt and obvious. In our representative sample, sexual beha-
viors did not usually persist over 8–9 years of age. This could be due, in part,
to the fact that at this point, children begin to assume social norms and
taboos regarding sexuality and sexual behaviors. As for gender differences,
our data showed that in general, males display a higher number of sexual
behaviors than females do. The major differences are found in younger
children (5–6 years old) with respect to the conduct of masturbation and
exhibitionism.
Our data pointed out that in the daily observations of teachers, certain
behaviors are quite unusual and rarely fulfilled. We namely refer to those
behaviors that are either more intrusive and more imitative of adult sexual
behavior (e.g., tries to have intercourse, puts mouth on sex parts, puts objects
in vagina or rectum, puts mouth on breasts, etc.), regardless of age and
gender of the child. As literature has often illustrated, these sexualized
behaviors are atypical and represent an important indicator of the child’s
maladjustment (e.g., Friedrich, 1993a, 1997, 2001; Friedrich et al., 1992, 1997;
Hall et al., 2002; Kendall-Tackett et al., 1993; Letourneau et al., 2004;
Schoentjes et al., 1999). Behaviors that had been indicated as relatively
unusual in the previous studies were also unusual among Italian children.
In addition, our data confirmed that the child sexual behavior must be
interpreted considering individual, family, and cultural variables (1998, 2001;
Friedrich et al., 1991, 1992, 2000). Of note, both age and gender of the child
are certainly meaningful variables, but the child’s sexual conduct is especially
related to the child’s family context and to familial cultural beliefs. In our
study, children living in conflicting and violent families or in sexually open
families exhibited more sexual behaviors and even the teachers were able to
identify in their daily observations. As showed by literature (Buehler, Lange,
226 S. MIRAGOLI ET AL.

& Franck, 2007; Camisasca, Miragoli, & Di Blasio, 2014, 2015, 2016; Fosco &
Grych, 2008; Procaccia, Miragoli, & Di Blasio, 2013), the relationship
between conflicting or violent parents and child adjustment is affected by
the dysregulation effect of interparental bonds, the inability to adjust the
interpersonal boundaries, and the use of aggression as relational patterns.
Some scholars highlighted the relationship between family background and
inappropriate sexualized behavior in children (Friedrich, 1995; Johnson,
2002, 2004) and some studies (Curwen et al., 2014; Friedrich et al., 2003)
displayed that children whose parents carry out a more relaxed approach to
sexuality (co-sleeping, co-bathing, family nudity, opportunities to look at
adult movies or magazines, and witness intercourse) manifest higher levels
of sexual behaviors (Friedrich et al., 2000).
Finally, as it is suggested by Friedrich and colleagues (1992, 2000), the CSBI,
having been administered to ethnically different groups, provides interesting clues
for understanding the influence of cultural differences in the development of
sexual behavior in children. To our knowledge, in literature there are two studies
with respect to the recognition of sexual behaviors by teachers/educators at a day
care center. Larsson and colleagues (2002; Sweden children aged 3 to 6 years) and
Sandnabba and colleagues (2003; Finnish children aged 2 to 7 years) show how the
sexual curiosity of Swedish and Finnish children is less open and direct than the
curiosity of Italian children of the same age. In fact, the more detected sexual
conduct in these studies covered the desire for physical contact (hugging, kissing,
etc.), the exploration of the body through the game (“playing doctor” or “playing
house”), the sex-talk words and looking at the genitals of others children, or people
get naked. More explicit masturbation (touch own genitals in public) is instead
recognized as common (10–20%) only in the study of Sandnabba and colleagues
(2003). In general, Italian preschool children showed sexual behaviors that were
like those displayed by children of previous studies, with age and gender differ-
ences comparable. The only exception is the conduct of masturbation and self-
stimulation, that Italian children perform with greater ease, even in public settings.
Unusual behaviors, such as behaviors more often seen in sexually traumatized
children, are equally low among Italian children.
The present study dealt with several limitations that may reduce the
validity of the findings’ generalization. First, our information was based on
teachers’ observations and the reported sexual behaviors depended on the
teacher’s observation ability. Moreover, teachers did not likely know the full
extent of prior traumatic events in the lives of children. Finally, it is note-
worthy that, as a consequence of the gender situation in schools, teachers
who answered were primarily females. This is relevant because, per other
studies (Heiman, Leiblum, Cohen Esquilin, & Melendez Pallitto, 1998), males
tend to consider some sexual behaviors more liberally than females, which is
explained as a result of how males and females are differently sensitized
toward the perception of sexual behaviors in childhood. These limitations
 JOURNAL OF CHILD SEXUAL ABUSE 227

clearly represent directions for future research, and for these reasons, our
data should be considered as preliminary and should be replicated in a larger
sample with a wider range of measures.
In summary, despite these limitations, the information provided by this study
can be used by teachers to help with guidance about the relative normalcy of
many sexual behaviors in children. The frequency of the occurrence of child
sexual behaviors provides a context for the understanding and for the evaluation
of whether a certain behavior is within the normal range or to be considered
problematic (Bromberg & Johnson 2001; Chaffin et al., 2008; Heiman et al.,
1998). Moreover, some practical directions emerge from this study. First, chil-
dren of school age show a natural curiosity about their own bodies and those of
others and can undertake explorations and fun activities of a sexual nature even
within the school context (especially if male and in the early years of elementary
school). Second, certain sexual behaviors in childhood are expected and appro-
priate, whereas others are “developmentally inappropriate” or potentially mala-
daptive. The most worrisome sexual behaviors are those that mimic adult
sexuality, which are particularly invasive and that are put in place with aggres-
siveness, anxiety, or compulsion. Considering this, the primary school teachers
have a duty to educate children to sexuality through the explanation of inter-
personal distances and respect for self and other’s bodies and to provide the
correct information to parents on typical sexual development and why some
behavior can be troubling or indexes of maladjustment.

Notes on contributors
Sarah Miragoli, Psychology Department, CRIdee, Catholic University of the Sacred Heart,
Milan, Italy.
Elena Camisasca, e-Campus University, Novedrate (CO), Italy.

Paola Di Blasio, Psychology Department, CRIdee, Catholic University of the Sacred Heart,
Milan, Italy.

ORCID
Sarah Miragoli http://orcid.org/0000-0002-1294-4557
Elena Camisasca http://orcid.org/0000-0001-5309-9399
Paola Di Blasio http://orcid.org/0000-0001-7456-3840
228 S. MIRAGOLI ET AL.

References
Baker, A. J. L., Gries, L., Schneiderman, M., Parker, R., Archer, M., & Friedrich, B. (2008).
Children with problematic sexualized behaviors in the child welfare system. Child Welfare,
87, 5–27.
Bonner, B. L., Walker, C. E., & Berliner, L. (1999). Children with sexual behavior problems:
Assessment and treatment (Final Report, Grant No. 90-CA-1469). Washington, DC:
Administration of Children, Youth, and Families, Department of Health and Human
Services. Retrieved from http://www.calib.com/nccanch/pubs/otherpubs/childassessment
Bromberg, S. D., & Johnson, B. T. (2001). Sexual interest in children, child sexual abuse, and
psychological sequelae for children. Psychology in the Schools, 38, 343–355. doi:10.1002/
pits.1023
Buehler, C., Lange, G., & Franck, K. L. (2007). Adolescents’ cognitive and emotional
responses to marital hostility. Child Development, 78, 775–789. doi:10.1111/cdev.2007.78.
issue-3
Camisasca, E., Miragoli, S., & Di Blasio, P. (2014). La disorganizzazione dell’attaccamento
spiega i sintomi post-traumatici nei bambini vittime di violenza? [Does disorganization of
attachment explains the post-traumatic symptoms in children who are victims of vio-
lence?] Maltrattamento E Abuso All’infanzia, 16(35–55). doi:10.3280/MAL2014-002003
Camisasca, E., Miragoli, S., & Di Blasio, P. (2015). Families with distinct levels of marital
conflict and child adjustment: Which role for maternal and paternal stress?. Journal of
Child and Family Studies. doi:10.1007/s10826-015-0261-0
Camisasca, E., Miragoli, S., & Di Blasio, P. (2016). Conflittualità genitoriale e sintomatologia
da stress post-traumatico nei figli: Uno studio esplorativo [Parental conflict and posttrau-
matic stress symptoms in children: An exploratory study]. Maltrattamento E Abuso
All’infanzia, 18, 141–151. doi:10.3280/MAL2016-002008
Chaffin, M., Berliner, L., Block, R., Johnson, T. C., Friedrich, W. N., Louis, D. G., . . . Madden,
C. (2008). Report of the ATSA task force on children with sexual behavior problems. Child
Maltreatment, 13, 199–218. doi:10.1177/1077559507306718
Curwen, T., Jenkins, J. M., & Worling, J. R. (2014). Differentiating children with and without
a history of repeated problematic sexual behavior. Journal of Child Sexual Abuse, 23, 462–
480. doi:10.1080/10538712.2014.906529
Elkovitch, N., Latzman, R. D., Hansen, D. J., & Flood, M. (2009). Understanding child sexual
behavior problems: A developmental psychopathology framework. Clinical Psychology
Review, 29, 586–598. doi:10.1016/j.cpr.2009.06.006
Feindler, E. L., Rathus, J. H., & Silver, L. B. (2003). Self-report inventories for the assessment
of children. In E. L. Feindler, J. H. Rathus, & L. B. Silver (Eds.), Assessment of family
violence: A handbook for researchers and practitioners (pp. 171–175). Washington, DC:
American Psychological Association.
Fosco, G. M., & Grych, J. H. (2008). Emotional, cognitive, and family systems mediators of
children’s adjustment to interparental conflict. Journal of Family Psychology, 22, 843–854.
doi:10.1037/a0013809
Friedrich, W. N. (1993a). Sexual behavior in sexually abused children. Violence Update, 3, 7–11.
Friedrich, W. N. (1993b). Sexual victimization and sexual behavior in children: A review of
recent literature. Child Abuse & Neglect, 17, 59–66. doi:10.1016/0145-2134(93)90008-S
Friedrich, W. N. (1995). Psychotherapy with sexually abused boys: An integrated approach.
Thousand Oaks, CA: Sage.
Friedrich, W. N. (1997). Child Sexual Behavior Inventory professional manual. Lutz, FL:
Psychological Assessment Resources.
 JOURNAL OF CHILD SEXUAL ABUSE 229

Friedrich, W. N. (2007). Children with sexual behavior problems: Family-based, attachment-

focused therapy. New York, NY: W.W. Norton.
Friedrich, W. N., Davies, W. H., Feher, E., & Wright, J. (2003). Sexual behavior problems in
preteen children: Developmental, ecological, and behavioral correlates. Annals of the N.Y.
Academy of Sciences, 989, 95–104. doi:10.1111/j.1749-6632.2003.tb07296.x
Friedrich, W. N., Fisher, J., Broughton, D., Houston, M., & Shafran, C. R. (1998). Normative
sexual behavior in children: A contemporary sample. Pediatrics, 101, 1–8. doi:10.1542/
peds.101.4.e9
Friedrich, W. N., Fisher, J. L., Dittner, C., Acton, R., Berliner, L., Butler, J., & Wright, J.
(2001). Child sexual behavior inventory: Normative, psychiatric, and sexual abuse compar-
isons. Child Maltreatment, 6, 37–49. doi:10.1177/1077559501006001004
Friedrich, W. N., Grambsch, P., Broughton, D., Kuiper, J., & Beilke, R. L. (1991). Normative
sexual behavior in children. Pediatrics, 88, 456–464.
Friedrich, W. N., Grambsch, P., Damon, L., Hewitt, S., Koverola, C., Lang, R. A., . . .
Broughton, D. (1992). Child sexual behavior inventory: normative and clinical compar-
isons. Psychological Assessment, 4, 303–311. doi:10.1037/1040-3590.4.3.303
Friedrich, W. N., Jaworski, T. M., Huxsahl, J. E., & Bengtson, B. S. (1997). Dissociative and
sexual behaviors in children and adolescents with sexual abuse and psychiatric histories.
Journal of Interpersonal Violence, 12, 155–171. doi:10.1177/088626097012002001
Friedrich, W. N., & Luecke, W. J. (1988). Young school-age sexually aggressive children.
Professional Psychology, 19, 155–164. doi:10.1037/0735-7028.19.2.155
Friedrich, W. N., Olafson, E., & Faller, K. C. (2007). Standardized tests and measures. In K. C.
Faller (Ed.), Interviewing children about sexual abuse: Controversies and best practice (pp.
207–225). New York, NY: Oxford University Press.
Friedrich, W. N., Sandfort, T. G., Oostveen, J., & Cohen-Kettenis, P. T. (2000). Cultural
differences in sexual behavior: 2-6 year old Dutch and American children. Journal of
Psychology and Human Sexuality, 12, 117–129. doi:10.1300/J056v12n01_08
Friedrich, W. N., & Trane, S. T. (2002). Sexual behavior in children across multiple settings.
Child Abuse & Neglect, 26, 243–245. doi:10.1016/s0145-2134(01)00322-2
Gordon, B. N., Schroeder, C. S., & Abrams, J. M. (1991). Age differences in children’s
knowledge of sexuality. Journal of Clinical Child Psychology, 19, 33–43. doi:10.1207/
s15374424jccp1901_5
Gray, A., Busconi, A., Houchens, P., & Pithers, W. (1997). Children with sexual behavior
problems and their caregivers: Demographics, functioning, and clinical patterns. Sexual
Abuse: A Journal of Research and Treatment, 9, 267–290. doi:10.1007/BF02674853
Gray, A. S., Pithers, W. D., Busconi, A., & Houchens, P. (1999). Developmental and
etiological characteristics of children with sexual behavior problems: Treatment implica-
tions. Child Abuse & Neglect, 23, 601–621. doi:10.1016/S0145-2134(99)00027-7
Hall, D. K., Mathews, F., & Pearce, J. (2002). Sexual behavior problems in sexually abused
children: A preliminary typology. Child Abuse & Neglect, 26, 289–312. doi:10.1016/S0145-
2134(01)00326-X
Heiman, M. L., Leiblum, S., Cohen Esquilin, S., & Melendez Pallitto, L. (1998). A comparative
survey of beliefs about “normal” childhood sexual behaviors. Child Abuse & Neglect, 22,
289–304. doi:10.1016/S0145-2134(97)00176-2
Hubert, M., Bajos, N., & Sandfort, T. (1998). Sexual behavior and HIV/AIDS in Europe.
London, UK: UCL Press.
Johnson, T. C. (2002). Some considerations about sexual abuse and children with sexual
behavior problems. Journal of Trauma and Dissociation, 3, 83–105. doi:10.1300/
J229v03n04
230 S. MIRAGOLI ET AL.

Johnson, T. C. (2004). Understanding children’s sexual behaviors. What’s natural and healthy.
South Pasadena, CA: Author.
Kellogg, N. D. (2010). Sexual behaviors in children: Evaluation and management. American
Family Physician, 82, 1233–1238.
Kendall-Tackett, K. E., Williams, L., & Finkelhor, D. (1993). The impact of sexual abuse on
children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113,
164–180. doi:10.1037/0033-2909.113.1.164
Larsson, I., & Svedin, C. G. (2002). Teachers’ and parents’ reports on 3- to 6-year-old
children’ s sexual behavior. A comparison. Child Abuse & Neglect, 26, 247–266.
doi:10.1016/S0145-2134(01)00323-4
Letourneau, E. J., Schoenwald, S. K., & Sheidow, A. J. (2004). Children and adolescents with
sexual behavior problems. Child Maltreatment, 9, 49–61. doi:10.1177/1077559503260308
Lindblad, F., Gustafsson, P. A., Larsson, I., & Lundin, B. (1995). Pre-schoolers’ sexual
behavior at day-care centers: An epidemiological study. Child Abuse & Neglect, 19, 569–
577. doi:10.1016/0145-2134(95)00016-2
Lopez Sanchez, F., Del Campo, A., & Guijo, V. (2002). Pre-pubertal sexuality. Sexologies, 11,
49–58.
Pithers, W. D., Gray, A., Busconi, A., & Houchens, P. (1998). Children with sexual behavior
problems: Identification of five distinct child types and related treatment considerations.
Child Maltreatment, 3, 384–406. doi:10.1177/1077559598003004010
Procaccia, R., Miragoli, S., & Di Blasio, P. (2013). L’utilizzo del Blacky Pictures’ Test nella
valutazione dei minori vittime di abuso sessuale (Blacky Pictures’ Test in the evaluation of
child sexual abuse). Maltrattamento e abuso all’infanzia, 15(3):109–130. doi: 10.3280/
MAL2013-003006.
Sandnabba, N. K., & Santtila, P. (2003). Age and gender specific sexual behaviors in children.
Child Abuse & Neglect, 27, 579–605. doi:10.1016/S0145-2134(03)00102-9
Santtila, P., Sandnabba, N. K., Wannäs, M., & Krook, K. (2005). Multivariate structure of
sexual behaviors in children: Associations with age, social competence, life stressors, and
behavioral disorders. Early Child Development and Care, 175, 3–21. doi:10.1080/
0300443042000206246
Schoentjes, E., Deboutte, D., & Friedrich, W. (1999). Child Sexual Behavior Inventory: A
Dutch-speaking normative sample. Pediatrics, 104, 885–893. doi:10.1542/peds.104.4.885
Silovsky, J. F., & Niec, L. (2002). Characteristics of young children with sexual behavior
problems: A pilot study. Child Maltreatment, 7, 187–197. doi:10.1177/
1077559502007003002
Tarren-Sweeney, M. (2008). Predictors of problematic sexual behavior among children with
complex maltreatment histories. Child Maltreatment, 13, 182–198. doi:10.1177/
1077559508316043
Thigpen, J. W., & Fortenberry, J. D. (2009). Understanding variation in normative childhood
sexual behavior: The significance of family context. Social Service Review, 83, 611–631.
doi:10.1086/650401
Tougas, A. M., Boisvert, I., Tourigny, M., Lemieux, A., Tremblay, C., & Gagnon, M. M.
(2016). Psychosocial profile of children having participated in an intervention program for
their sexual behavior problems: The predictor role of maltreatment. Journal of Child Sexual
Abuse, 25, 127–141. doi:10.1080/10538712.2016.1120258
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Appendix A
Simple Endorsement Frequencies of Sexual Behaviors for the Three Male and Female Age
Groups (N = 227).

5–6 years old 7–8 years old 9–10 years old

M F M F M F
Item No. (Abbreviated) (n = 52) (n = 40) (n = 42) (n = 47) (n = 18) (n = 28)
1. Dresses like opposite sex 5.7 7.5 0.0 0.0 0.0 0.0
2. Stand too close 16.7 15.4 4.9 0.0 0.0 0.0
3. Wants to be opposite sex 0.0 2.5 0.0 0.0 0.0 0.0
4. Touches sex parts in public 26.9 2.5 4.8 0.0 0.0 0.0
5. Masturbates with hand 19.3 2.5 0.0 0.0 0.0 0.0
6. Draws sex parts 3.8 0.0 2.7 0.0 0.0 0.0
7. Touches breasts 3.8 0.0 0.0 0.0 0.0 0.0
8. Masturbates with toy or 1.9 0.0 0.0 0.0 0.0 0.0
object
9. Touches other child’s sex 15.3 2.5 7.1 0.0 0.0 0.0
parts
10. Tries to have intercourse 0.0 2.5 0.0 0.0 0.0 0.0
11. Puts mouth on sex parts 0.0 0.0 0.0 0.0 0.0 0.0
13. Touches adult’s sex parts 1.9 0.0 0.0 0.0 0.0 0.0
14. Touches animal’s sex parts 0.0 0.0 0.0 0.0 0.0 0.0
15. Makes sexual sounds 3.8 0.0 0.0 0.0 0.0 0.0
16. Asks others to do sex acts 9.6 2.5 0.0 0.0 0.0 0.0
17. Rubs body against people 7.6 12.5 0.0 0.0 0.0 0.0
18. Puts objects in vagina or 0.0 0.0 0.0 0.0 0.0 0.0
rectum
19. Tries to look at people when 26.4 5.1 2.9 0.0 0.0 0.0
they are nude
20. Pretends toys are having sex 3.8 0.0 0.0 0.0 0.0 0.0
21. Shows sex parts to adults 5.7 0.0 0.0 0.0 0.0 0.0
22. Tries to look at pictures of 34.7 15.0 4.8 0.0 0.0 0.0
nude people
23. Talks about sex acts 17.3 5.0 4.8 0.0 0.0 0.0
24. Kisses adults not known well 0.0 0.0 0.0 0.0 0.0 0.0
25. Gets upset when adults kiss 0,0 5.0 0.0 0.0 0.0 0.0
26. Overly friendly with men 0.0 2.8 3.1 0.0 0.0 0.0
27. Kisses other children 0.0 10.0 3.1 0.0 0.0 0.0
28. Talks flirtatiously 3.8 0.0 7.2 0.0 0.0 0.0
29. Undresses other children 5.7 5.0 4.8 0.0 0.0 0.0
30. Wants to watch TV nudity 5.7 0.0 4.8 0.0 5.6 0.0
31. Puts tongue in mouth when 0.0 0.0 0.0 0.0 0.0 0.0
kissing
32. Hugs adults not known well 0.0 2.5 0.0 0.0 0.0 0.0
33. Shows sex parts to children 23.1 2.5 0.0 0.0 0.0 0.0
34. Undresses adults against 0.0 2.5 0.0 0.0 0.0 0.0
their will
35. Very interested in opposite 10.2 10.5 12.0 11.4 16.8 10.8
sex
36. Puts mouth on breasts 0.0 0.0 0.0 0.0 0.0 0.0
37. Knows more about sex 23.7 6.0 5.6 4.8 0.0 0.0
38. Other sexual behaviors 0.0 0.0 0.0 0.0 0.0 0.0
Mean CSBI Total Score (SD) 3.85 (5.94) 1.85 (3.44) 1.38 (3.87) 0.15 (0.47) 0.78 (1.35) 0.18 (0.61)