From being withdrawn and anxious to trying to kiss other kids at school, some youngsters may have a search history that will shock you
It’s the early 2000s at a primary school disco, the music is blaring, and the children are in semi-darkness bopping up and down to the rhythm. It’s a picture of childhood innocence.
But Dr Lesley-Anne Ey (PhD), who was a primary school teacher at the time, was watching the children when she noticed something happening out of the ordinary.
There were some children on the dancefloor, who despite being pre-pubescent, were grinding and gyrating their bodies to the music.
“I realised the children were trying to imitate what they had seen in popular music videos and re-enacting how popular music artists were acting, which was very sexualised,” Dr Ey tells The Medical Republic.
Fast forward to the present and educators are no longer worried about children dancing like their favourite pop artist. Instead, every child with access to an electronic device is at risk of viewing graphic sexual images or videos.
For some children this will include sharing the pornography they see with other children or participating by taking and sharing photographs of themselves or their peers.
Research from the Australian Institute of Family Studies reported that just under half of Australian children aged nine to 16 years who participated in a survey of 400 children and their families had viewed sexual images in the last month alone.
Young males were more likely than females to deliberately and frequently seek out pornography.
Concerningly, a majority of children aged nine to 12 years reported that they felt stressed or upset by viewing pornography.
GPs may be the first point of contact for concerned parents, especially if they notice their child is acting differently or expressing sexual knowledge beyond their years.
Other early signs a child might be viewing pornography included deleting their internet search history or isolating themselves to be able to use the internet away from adult supervision.
In more extreme cases, children may develop compulsive or addictive behaviours where they will avoid sleeping so they can increase the frequency of viewing pornography.
Some children may even attempt to perform sexual acts on themselves or their peers at school, sporting clubs or social gatherings.
Dr Ey says the most important thing when assessing the harm of pornography is to remember the role it plays within a broader sociocultural context in which stereotypes about gender, sexism, sexual objectification and violence-supportive attitudes are also in play.
“Sexual content continues to rise in media and we have known for a long time that sex sells, but we have observed that it is becoming more frequent and more explicit,” she says.
One trend Dr Ey noticed in her own research was that as general media, such as television programs, advertising and music becomes more sexualised, the pornography industry differentiates itself by becoming more violent.
The Australian Institute of Health and Welfare says in the longer-term, exposure to sexualised media can shape a child’s view of sexual practices and can be associated with unsafe sexual health practices such as not using condoms and unsafe anal and vaginal sex.
It says pornography also strengthens attitudes which are supportive of sexual violence and violence against women.
A PROBLEM IN THE SCHOOLYARD
These socio-developmental impacts are one reason parents and caregivers who suspect their child has viewed graphic sexual content should be encouraged to start open communication, discussion and critical thinking with their children.
But to encourage this type of intervention, Dr Ey says frontline health professionals also need to educate themselves of the behaviours of a child who may be viewing content that is distressing to them.
Anecdotally, Dr Ey says educators are more frequently having to deal with instances of children who are acting differently in the classroom and towards peers because of being exposed, either accidentally or intentionally, to graphic sexual content.
But to be able to recognise what sexual behaviour is abnormal, it’s first important to identify what is considered to be age-appropriate sexual curiosity.
Dr Ey says in children under the age of 10 “normal” sexual behaviour is considered to be general sexual curiosity.
“In kindergarten-aged children this might be explored in playing games of doctors and nurses or revealing their genitals to one another with an attitude of ‘I’ll show you mine, if you show me yours’,” she says.
And it’s not until around 10 years of age that children start to become aware of developing sexual attraction, which is expressed through actions of minimal flirting, hand holding and calling other children “boyfriend” or “girlfriend”.
But Dr Ey says educators are now seeing children under the age of 10 trying to re-enact sexual behaviours they’ve seen in graphic sexual content with their peers.
“If young children are trying to be secretive and engage in sexual activity or trying to touch other children under their clothes is absolutely considered to be non-typical development for that age group,” Dr Ey says.
This includes sharing pornographic material with other children, attempting to perform oral sex on other children and even attempting penetrative sex.
These types of sexual advances by children are known as problem sexual behaviours and often, both the perpetrating child, and any children who have been victims of the behaviour, will need help from a GP and counselling service.
DEALING WIYTH PROBLEM BEHAVIOUR
The Australian Institute of Criminology identifies over 136 clinical risk factors which contribute to sexually abusive behaviours in young people, but none are considered causal.
Of these, the four most dominant risk factors include:
- Being directly exposed, or witness to family violence
- Chronic, long-term neglect
- Being a victim of sexual abuse
- Inappropriately witnessing sexual activity
In addition, a majority of children who were treated for problem sexual behaviour in Australia in 2015 had pre-existing condition such as anxiety (37%), ADHD (26%) or PTSD (10%).
Mr John Blomfield, team leader at The Sexual Assault and Family Violence Centre in Victoria which delivers problem sexual behaviours counselling and sexually abusive behaviours treatment services, says while none of these conditions are causal to problem sexual behaviour, they are commonly present in the children who are treated.
Mr Blomfield, who has written education resources for the RACGP on problem sexual behaviour, says many GPs may be surprised by how common problem sexual behaviour is.
“When we’re professionals and come in contact with families and young children, it may not be obvious they are having any difficulties and disclosures in an office are not very common,” he says.
“It’s more likely when a GP is attuned to the possibility of problem sexual behaviours that they will be more likely to notice they could be a problem for that child.”
Sexual knowledge and sexual behaviours are not necessarily an indicator of sexual abuse, but it is a possibility that should be considered by health professionals.
In a majority of cases, sexual abuse is not present, particularly in an era of such ready exposure to adult material over the internet, Mr Blomfield says.
“Many parents immediately jump to the conclusion that their child may have experienced sexual abuse, and allaying those fears, while holding in mind the possibility, is much more helpful.”
Mr Blomfield says disclosures about problem sexual behaviour may occur during a physical examination.
“Children might become very shut down or withdrawn when asked to be examined, or being asked about bathing or their genital area,” he says.
This type of behaviour indicates there could be something very uncomfortable or distressing for the child when they think about nudity or being touched.
But in other cases, children being examined might verbally disclose to the treating doctor by saying “my brother hurts me there”, or “my brother tickles me there”.
Children are often scared to disclose to parents and doctors out of fear of not being believed, or experiencing parental or sibling displeasure, anger or rejection.
Mr Blomfield says health professionals should remain calm and ask questions to the children that sound curious, rather than judgemental such as: “Can you tell me a little bit more?” or “Could you tell me where this happens?”
WHEN TO MAKE A MANDATORY REPORT
While children under 10 years who perform sexual acts with other children are not breaking the law, children older than 10 can be criminally charged depending on the severity of their behaviour.
Sometimes, despite the age of the children involved, doctors may consider making a mandatory report because they are worried that siblings or other children may be at risk from further sexual behaviours.
And any parent or guardian who either has shown or allowed their child to view pornography should also be reported to the relevant authority in each state and territory.
And if there is reasonable suspicion that any form of abuse has happened, health professionals need to protect the integrity of any disclosure by only listening and not suggesting language to the child to help them describe their experiences.
Mr Blomfield admits this is difficult when children are young and not yet cognisant about what happened or if it is wrong.
An article in Australian Family Physician found some GPs have reservations about reporting in these cases out of fear of breaking doctor/patient confidentiality, a breakdown of the doctor/patient relationship, the family knowing the GP provided the report, professionally implications if they “got it wrong” and, knowing the notification could make the situation worse for the patient and their family.
Mr Blomfield says health professionals could be reassured that any involvement of child protection agencies will want to ensure that the parent or guardian has capacity and is willing to act protectively of the children involved and that all children in the household can be kept safe.
Where this is the case, protective services will be unlikely to take the matter any further other than to make a referral for appropriate counselling support.
However, some pre-existing factors which are likely to launch further investigation include a record of past investigations, a history of drug or substance abuse, history of transience or homelessness, overcrowding in the home and, homes with multiple children sharing bedrooms.
For those seeking immediate help in more severe cases, GPs can direct parents to call the 1800RESPECT hotline and children can receive immediate free counselling through the Kids Helpline.
For ongoing assistance, children can be referred to a private psychologist or counsellor who has experience in problem sexual behaviour or can get help through sexual assault crisis centre which can be found in each state and territory.
Ms Fiona Williams, a psychologist and senior counsellor at the Kids Helpline, tells The Medical Republic that when children are able to share their experiences of watching graphic sexual content, and felt listened to without judgement, it relieves their distress and anxiety around what they have seen.
“They know they aren’t alone in dealing with how they are feeling about viewing pornography,” she says. “We also know counselling can increase children’s confidence which will help them to better deal with exposure to sexual content.”
But in the best-case scenario, a GP will be able to intervene at an early stage with these paediatric patients to encourage parents to set boundaries in the household around internet use and secrecy when using devices.
Sexual assault councillors also recommend that parents start to bathe and toilet older and younger children separately, and if necessary, reconsider sleeping arrangements if more than one child is sharing a bedroom.
TAMING THE TECHNOLOGY
Parents seeking advice on how to protect their children online can be guided to the eSafety Commissioner which offers free resources for parents to start conversations with their children about pornography and keeping safe when using the internet.
The eSafety Commissioner recommends parents use parental control on children’s devices, only allow children to access technology in common spaces and to limit the time children spend on electronic devices.
But it warns that no parental control settings are 100% effective and having frequent open conversations about internet safety with children who are using devices was more effective.
Ms Williams says sex education also plays an important role in providing children with a factual and balanced approach to sexuality, so children aren’t turning to pornography as an educational tool.
“Good sex education allows children room to discuss ideas about sex and ask questions about it.
“We also need to educate children and young people about understanding respectful relationships, the role of consent, as well as things like using contraception and the risks around sexually transmitted infections,” she says.
For younger children, parents should be encouraged to talk to their children about rules around appropriate sexual conduct, who can have sex, and at what age.
One trap to avoid when discussing access to pornography with children is concentrating on blaming the technology, rather than how sex is being displayed problematically through the device.
Dr Antonia Quadara (PhD), a research fellow at the Australian Institute of Family Studies, says while in past decades there were more obstacles to accessing and viewing pornography, the technology isn’t going away.
“Concentrating on the harms of technology creates a binary rather than recognising this is now the empirical reality of our young people and it’s time to move on from trying to diagnose what is particular about the technological or digital domain – as though that’s the problem,” Dr Quadara says.
A more radical idea would be to think about what the alternative to pornography would be, Dr Quadara suggests.
“How do you create spaces where it is safe for women to be sexual agents and not get punished for it?” she says.
“In the future we need to have a counter narrative, so the conversation becomes a strength-based discussion, rather than pornography at the moment which is often a deficit discussion.”
In the meantime, one thing we know for certain is even if the technology continues to change, young children will continue to be exposed to graphic sexual content.
It’s up to adults to either bring the reality check, or risk the fantasy in children’s minds to continue, untamed.
