Heterogeneity in problematic sexual behaviors among sexually abused children: A cross-sectional study of associated factors

BACKGROUND: Problematic sexual behaviors (PSB) in children reflect multifactorial developmental processes. Although child sexual abuse (SA) is a documented risk factor, its presence alone does not fully explain PSB, highlighting the need to identify additional ecological correlates. OBJECTIVES: This study aimed to identify correlates associated with PSB among SA children, beyond abuse characteristics, using an ecological framework. PARTICIPANTS AND SETTINGS: Participants included 307 caregiver-child dyads recruited from a clinical sample. Children had experienced corroborated SA and were referred for specialized services. METHOD: Bivariate analyses and hierarchical logistic regression models were conducted to examine correlates of PSB. Variables included individual, victimization, trauma-related, and post-disclosure support factors. RESULTS: Overall, 36% of children presented PSB. In the final multivariable model, boys had twice the odds of presenting PSB (OR = 2.10), and each additional interpersonal victimization experience was associated with a 20% increase in the odds of PSB (OR = 1.20). Clinically elevated dissociative symptoms were associated with greater odds of PSB (OR = 2.60), whereas higher perceived post-disclosure support was associated with lower odds (OR = 0.82). CONCLUSIONS: PSB among SA children were more strongly associated with broader developmental, familial, and social factors than with abuse characteristics. Findings suggest that strengthening caregiver and systemic responses following disclosure and addressing cumulative victimization and dissociative symptoms may represent important intervention and prevention targets. While these findings help explain variability in PSB among SA children, they do not address broader etiological pathways across populations.