International Journal of Sexual Health, 22:14–19, 2010 Copyright c© Taylor & Francis Group, LLC ISSN: 1931-7611 print / 1931-762X online DOI: 10.1080/19317610903393043
Healthy Sexual Development: A Multidisciplinary Framework for Research
Alan McKee, PhD Kath Albury, PhD
Michael Dunne, PhD Sue Grieshaber, PhD
John Hartley, PhD Catharine Lumby, PhD
Ben Mathews, PhD
ABSTRACT. A group of Australian researchers from a range of disciplines involved in studying children’s sexual development developed a framework for researching healthy sexual development that was acceptable to all disciplines involved. The 15 domains identified were: freedom from unwanted activity; an understanding of consent; education about biological aspects; understanding of safety; relationship skills; agency; lifelong learning; resilience; open communication; sexual development should not be “aggressive, coercive or joyless;” self-acceptance; awareness and acceptance that sex is pleasurable; understanding of parental and societal values; awareness of public/private boundaries; and being competent in mediated sexuality.
KEYWORDS. Sexual development, sexuality education, children’s sexuality, research design
There has been considerable public concern about the sexual development of children in
Alan McKee, PhD, Film and Television, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
Kath Albury, PhD, Journalism and Media Research Centre, University of New South Wales. Michael Dunne, PhD, Faculty of Health, Queensland University of Technology, Brisbane, Queensland,
Australia. Sue Grieshaber, PhD, School of Early Childhood, Queensland University of Technology, Brisbane,
Queensland, Australia. John Hartley, PhD, ARC Center of Excellence for Creative Industries and Innovation, Queensland
University of Technology, Brisbane, Queensland, Australia. Catharine Lumby, PhD, Journalism and Media Research Centre, University of New South Wales. Ben Mathews, PhD, Law School, Queensland University of Technology, Brisbane, Queensland, Australia. This research was funded by a grant from the Institute for Creative Industries and Innovation at Queensland
University of Technology. Address correspondence to: Alan McKee, PhD, Film and Television, Queensland University of Technology,
Creative Industries Precinct, Kelvin Grove, Queensland, QLD 4059, Australia. E-mail: firstname.lastname@example.org
Australia in 2008 and 2009 (see for example, Devine, 2008; Perkin, 2008; Stedman, 2009; Topsfield, 2008). Of particular concern has been the question of whether children are reaching
Alan McKee et al. 15
sexual milestones too young (King, 2008). This public debate has been conducted in vague terms, worrying simply that children are devel- oping too quickly (Hartley, 1998). No attempt has been made to describe what would consti- tute healthy sexual development.
Lagerberg (2001) suggests that this is in part because “the sexual development of normal children is neither fully explored nor under- stood” (p. 368; see also, Haugaard, 1996, p. 81; Okami, Olmstead, & Abramson, 1997, p. 339; Ryan, 2000, p. 34). There does exist a patch- work history of research from earlier decades which allows us to recover some sense of nor- mal sexual development of children over the years (Hattendorf, 1932; Isaacs, 1933; Levy, 1928; Newson & Newson, 1963; Ramsey, 1943; Rutter, 1971; Sears, Maccoby, & Levin, 1957). And recently, a more systematic research ap- proach to this topic has emerged (Fitzpatrick, Deehan, & Jennings, 1995; Friedrich, Gramsb- sch , Broughton, Kuiper, & Beilke, 1991; Gold & Gold, 1991; Haugaard, 1996; Knoth, Boyd, & Singer, 1988; Lamb & Coakley, 1993; Lars- son & Svedin, 2002a, 2002b; Leitenberg, Green- wald, & Tarran, 1989; Okami et al., 1997; Ryan, 2000; Sandnabba, Santtila, Wannäs, & Krook, 2003). There also exist a number of useful guides to healthy sexual development from dis- tinct perspectives: clinical psychology (Sander- son, 2004), early childhood studies (Chrisman & Couchenour, 2002), and family planning (Fam- ily Planning Queensland [FPQ], 2006).
However, across this range of work, there is no agreement about what constitutes healthy sex- ual development. As Haugaard noted when he gathered data from professionals working in a number of different disciplines, there is “consid- erable disagreement” (1996, p. 88) between dif- ferent professional groups about what character- izes acceptable sexual development for children.
HEALTHY SEXUAL DEVELOPMENT: A MULTIDISCIPLINARY
FRAMEWORK FOR RESEARCH
It thus seemed that it would be a useful con- tribution to public debate on this topic to de-
velop a multidisciplinary framework for under- standing healthy sexual development, drawing on the expertise of professionals from a num- ber of related backgrounds. This article does not present the results of a traditional research project. Rather it sits in the field of “research de- sign and methodology.” Work in this field seeks to “introduce, explain, and illustrate designs and methodologies” (Keith, 1998, p. 332). In par- ticular, the current article sits within that subset of such work which aims to “clarify a research topic about which there are misrepresentations or confusion” (Keith, p. 333). It is targeted at researchers interested in healthy sexual develop- ment and presents an exploration of a possible paradigm within which research can take place in healthy sexual development.
A consultative group was gathered consist- ing of seven Australian experts across a number of disciplines relating to children, development, and sexuality. The group included a psychologist specializing in preventing child sexual abuse, an early childhood expert, a legal expert in chil- dren’s rights, a specialist in sexuality education experts on sexual socialization, and experts on the media’s impact on children’s development. The group commissioned literature reviews of the research on children’s sexuality across their disciplines and worked together to develop a consensual definition of healthy sexual devel- opment that drew on the insights of their various disciplines.
The group met and spent a day discussing this topic. One group member acted as a facili- tator; another took notes. The facilitator led dis- cussion, brainstorming all the possible domains which should be included under the definition of healthy sexual development. Each domain was then discussed by the group to ascertain whether it was agreeable to all disciplinary paradigms and if so how it could best be expressed in a way that made sense to all participants.
A draft version of this article was prepared from the notes taken at this meeting and cir- culated to all the contributing experts for dis- cussion. Based on feedback, a second draft was developed and circulated to all participants, who then signed off on it.
One key point emerged early in the discus- sions: This would be a holistic approach to
16 INTERNATIONAL JOURNAL OF SEXUAL HEALTH
healthy sexual development. In much of the literature in this area, the sole concern is the prevention, diagnosis, and treatment of child sexual abuse (see for example, Haugaard & Emery, 1989; Lamb & Coakley, 1993; Ryan, 2000). The group agreed that preventing un- wanted sexual encounters is a key element of healthy sexual development—but it is far from being sufficient for an understanding of the im- portant elements in that development. There is more to healthy sexual development than simply preventing abuse. Important positive skills and understandings must be developed. We identi- fied 15 key domains which provide a multidis- ciplinary framework for understanding healthy sexual development.
Freedom from Unwanted Activity
Healthy sexual development takes place in a context in which children are protected from unwanted sexual activity (Haugaard & Emery, 1989; Sanderson, 2004). This is a fundamen- tal point. Its complexity must also be acknowl- edged. Hence the second point below.
An Understanding of Consent and Ethical Conduct More Generally
Healthy sexuality is not coercive (Chrisman & Couchenour, 2002; FPQ, 2006; Ryan, 2000; Wardle, 1998). And so children need to under- stand the nature and complexity of consent—not just their own but also other people’s—in sexual- ity. They need to learn about the ethics of human relationships and how to treat other people ethi- cally.
Education About Biological Aspects of Sexual Practice
In healthy sexual development, children are provided with accurate information about how their bodies work. Research has shown that “[i]n the absence of adequate and systematic sex ed- ucation, children invent their own explanations for biological and sexual processes often in the form of mythologies” (Goldman & Goldman, 1982, p. 392).
An Understanding of Safety
In healthy sexual development, children learn what is safe sexual practice. This is meant in the widest possible sense, including physical safety, safety from sexually transmitted diseases (STDs; Allen, 2005, p. 2), and safety to experiment.
In healthy sexual development, children learn relationship skills more generally. This includes, but is not limited to, communication and as- sertiveness skills. Children learn to ask for what they want assertively in relationships generally. At an appropriate point, this also includes sex- ual relationships (Impett, Schooler, & Tolman, 2006).
Emerging from the previous point, in healthy sexual development children learn that they are in control of their own sexuality and in control of who can take sexual pleasure from their bodies. They are confident in resisting peer pressure. They understand their rights. They learn to take responsibility for making their own decisions (Sexuality Information and Education Council of the United States [SIECUS], 1995).
Every researcher who has studied the healthy sexual development of children insists that chil- dren are naturally “curious” about their bod- ies and about sex (Sanderson, 2004, p. 62). Studies during many decades have shown that children explore their bodies—including touch- ing and sometimes masturbating their genitals— from birth (Larsson & Svedin, 2002a; Levy, 1928; Ryan, 2000); they ask questions about sex at the same time as they begin to ask ques- tions about other aspects of society (Hatten- dorf, 1932; Larsson & Svedin, 2002b); and they play “sex games” like doctors and nurses with other children from an early age (Chrisman & Couchenour, 2002; Isaacs, 1933; Lamb & Coak- ley, 1993; Larsson & Svedin, 2002a; Sandnabba et al., 2003). Research has shown that this be- havior is not only normal, it is healthy and has no harmful effect on later sexual development
Alan McKee et al. 17
(Greenwald & Leitenberg, 1989; Kilpatrick, 1992; Larsson & Svedin, 2002a; Leitenberg et al., 1989; Okami, Olmstead, Abramson, & Pen- delton, 1998). Similarly, learning about sexual- ity does not stop at the point where sexual in- tercourse begins. Adults continue to learn about their sexuality throughout their lives, improving their knowledge of and attitudes toward their sex lives.
There is a necessary element of risk in all learning. This is also true of sexual learning (Chrisman & Couchenour, 2002, p. 3). In healthy development, children develop agency in order to facilitate resilience so that bad sexual experi- ences are opportunities for learning rather than being destructive.
Healthy sexual development requires open communication between adults and children, in both directions. As noted above, this means that children are provided with age-appropriate in- formation about sex (SIECUS, 1995) and par- ticularly that they are given honest answers to any questions they may ask (Chrisman & Couchenor, 2002). There is absolute agreement in the literature that this is important for prevent- ing sexual abuse (Krafchick & Biringen, 2002, p. 59; Sanderson, 2004, p. 55), development of a healthy attitude toward their own bodies and sex- uality (Chrisman & Couchenour, p. 14; Impett et al., 2006), and preventing unwanted pregnan- cies and STDs when they do become sexually active (Lindberg, Sonfield, & Gemmill, 2008). On the other hand, in healthy situations, children feel comfortable in coming to adults with prob- lems, concerns, or issues they may have about their bodies or what is happening to them.
Sexual Development Should Not Be ‘Aggressive, Coercive, or Joyless’
This is a key distinction between healthy and unhealthy sexual development. Healthy sexual development is “fun,” playful, and light-hearted (Okami et al., 1998, p. 364). Unhealthy sexual
development is aggressive, coercive, or joyless (Sanderson, 2004, p. 79).
In healthy sexual development, children are supported in developing a positive attitude to- ward their own sexual identity (Impett et al., 2006) and a “positive body self-concept” (Okami et al., 1998, p. 363).
Awareness and Acceptance That Sex Is Pleasurable
Children learn to understand that it is accept- able for sexuality to be pleasurable in healthy development (SIECUS, 1995; World Health Or- ganization [WHO], 2002, p. 5). It is not shameful to enjoy it. It is a desirable outcome, and when they become adults, they will have to option of enjoying satisfying and high-quality sexual re- lationships should they choose to do so (Okami et al., 1998, pp. 361, 365).
Understanding of Parental and Societal Values
In healthy development, children learn so- cial and parental values around sexuality to en- able them to make informed decisions about their own sexuality in relation to them. These vary greatly (WHO, 2002). Research shows that parental values around sexuality range from extremely conservative to extremely liberal (Okami et al., 1998) and that judgments about what is appropriate sexual behavior in children differ dramatically in different societies (Ariès, 1962; Higonnet, 1998; Jenkins, 1998).
Awareness of Public/Private Boundaries
As a particular subset of values, children learn how the public/private distinction works in their culture as part of healthy sexual development. This allows them to manage their own privacy, understand public behavior, and understand how to negotiate the boundaries between the two (Larsson & Svedin, 2002b; Sanderson, 2004, p. 60).
18 INTERNATIONAL JOURNAL OF SEXUAL HEALTH
Competence in Mediated Sexuality
In healthy sexual development, children will develop skills in accessing, understanding, cri- tiquing, and creating mediated representations of sexuality in verbal, visual, and performance media (Buckingham & Bragg, 2004; Hartley & Lumby 2003; Higonnet, 1998 ; Lafo, 2008; Mazzarella & Pecora, 2007; Ward, Day, & Epstein, 2006).
This article sits in the field of “research design and methodology” and has sought to “clarify a research topic about which there are misrepre- sentations or confusion” (Keith, 1998, p. 332, 333). It brings together and reconciles the litera- tures from a number of disciplines to produce a coherent framework for understanding healthy sexual development. This framework has the potential to inform any research project which is interested in exploring healthy sexual devel- opment. For example, it will be useful for re- searchers interested in interaction between so- cial variables—such as the effects of exposure to media or new communications technologies— and healthy sexual development. We hope that it proves useful to researchers interested in these issues and functions as a starting point for a range of future research projects.
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