When working with children it is important to understand the phases of development, including sexual development. What is normal development to one culture may differ in another culture. As a helping professional, understanding your own biases is critical, especially if you are a parent or a primary caregiver of a child.
Post by Day 3 an explanation of how you would counsel parents on the topic of children’s sexuality. Explain when it is developmentally appropriate for children to display sexual behaviors and how to respond to a child’s sexual behaviors. Describe how you would identify developmentally normal sexual expression and sexual expression that is not developmentally appropriate. Include supportive research from the week’s resources.
Ethical review and reflexivity in research of children’s sexuality
Department of Human Development and Counselling, University of Waikato, Hamilton, New Zealand
Research in the area of children’s sexuality is largely based on observational and retrospective studies. Childhood studies literature increasingly calls upon the inclusion of children’s voices, yet with sensitive topics ethical positions often close research possibilities in the territories of children’s worlds. Children are perceived as a vulnerable group, especially when the investigation focuses on their sexual development and activity – and it is perceived that this research area is too sensitive and potentially harmful to children. Within the context of beginning a qualitative study on children’s sexuality in New Zealand (including interviews with children), this paper reviews a number of studies of childhood research. These studies provide a glimpse at how research focusing on children has been conducted, and explores ethical issues arising in such research. The significance of researcher reflexivity is acknowledged for ethical research practice. The paper concludes that in research on children’s sexuality a process of ethical review is limited, and that researcher competence in sensitive investigations is required. Among other difficulties for this researcher (with a professional background in child and family therapy) is the vulnerability of being a man choosing to research children.
Keywords: child sexuality; research ethics; reflexivity; sensitive topics
This paper explores the work of selected authors about their research of children’s lives
and worlds, and the effects of that research for those involved – including the researcher.
These ideas are explored in the light of studying children’s sexuality, and the ethical
implications of such sensitive research.
Ethical review of qualitative research offers possibilities for researchers to engage in a
reflexive process. I support a sense of ethics permeating the total process of the research,
and not simply ticking a box on a checklist. The process of ethical review should not be,
and is not, simply one delegated to a committee. It is a way of thinking to be part of the
research ideas from germination through development of the proposal, including review
by ethics committee, but it neither begins nor ends there. The committee’s sign off is
simply for the explanation of the process at that point in time. These ideas are developed in
this paper, with particular focus on a current research project: exploring discourses on
children’s sexuality in New Zealand, which is to include interviews with children. 1
This article reports about a reflexive process for researchers – including dialogues on
ethics: with the self; professional practice as a therapist; an ethics committee; and the
literature. After reviewing three studies of research with children, I give a brief introduction
to the project I am undertaking and how reflexivity permeates the research and ethical
ISSN 1468-1811 print/ISSN 1472-0825 online
q 2012 Taylor & Francis
*Email: [email protected]
Vol. 12, No. 5, November 2012, 535–544
Why engage in research with children?
Research with children is necessary. Regardless of the sensitivity or the nature of the
research topic, research that is focused on children should not be avoided or shut down
because of its difficulty or charged environment. Children’s sexuality is one such area
because of how this speaks to understandings of sexuality generally.
When exploring some of the sexuality research involving children, there is a clear
distinction between literature that researches about children and that which is research of
children. Lucia O’Sullivan records a range of studies on childhood sexuality, and that the
. . . often center on beliefs that involving children in studies of sexual behaviour will cause distress or spur sexual curiosity and experimentation. . . . there is no obvious empirical evidence to support these concerns. Instead, researchers tend to limit their inquiry to more socially condoned topics of sexual science, such as variations in pubertal development . . . , child sexual abuse . . . , or the development of ‘problem behaviours’ . . . These studies frequently employ clinic populations, or describe atypical experiences or outcomes, and as such, they may ultimately serve to perpetuate the perspective that children’s sexual behaviour is essentially aberrant. (O’Sullivan 2003, 23)
O’Sullivan then decries the record of Institutional Review Boards (IRBs), also known
elsewhere as research ethics committees. She cites one study where: ‘ . . . proposals addressing
“socially sensitive topics,” such as child sexuality, were twice as likely to be rejected by
institutional review boards as those involving less sensitive topics (Ceci, Peters, & Plotkin,
1985)’ (O’Sullivan 2003, 23). In another study: ‘IRB decisions . . . were based more on
institutional risk aversion or precedent than a consistent assessment of participants’ risk or
level of adherence to a standard of protection (Rogers et al., 1999)’ (O’Sullivan 2003, 23).
Further to this, the late Bill Friedrich wrote about moving to work at the Mayo Clinic,
and being faced with a new IRB:
The topic of sexual behaviour was viewed as quite sensitive, and my proposal to obtain a large normative sample with the revised, 35-item Child Sexual Behavior Inventory required fairly constant shepherding through the IRB. I was required to keep an account of complaints received, and was asked to stop the study in response to any major protest. (Friedrich 2003, 110)
Friedrich received four ‘mild’ complaints from the 1231 ‘subjects’ who were approached.
This result is indicative of a wider issue for the processes of ethical review for both
researchers and reviewers involved. It is clear that institutional ethical review processes
should focus more on researcher capability and experience, assessing their competency to
engage in sensitive research. Such an accountability of the researcher, particularly by the
researcher in the first instance, is more productive than a blanket caution related to risk
aversion or perceived notions of participant protection. While questions about a project’s
value and usefulness must be considered together with design and methodological rigour,
a researcher’s account of their understanding, experience and ideas of responding to
ethical issues within the process of sensitive research will provide a much more robust
rationale for approving or declining such research projects. Any anxiety and fear the
committee may have due to risk can then be productively located in the researcher
relationship and process, and not the research question or topic.
Emma Uprichard (2010) proposes that many of the issues considered in childhood
research are really issues that affect all research: ideas of exploitation and vulnerability,
for example. She claims:
On thehand, we need to involve children in social research that goes beyond childhood experiences precisely because they may be able to tell us something about the social world and how it works. On the other hand, we need to maintain good ethical practice such that children
536 P. Flanagan
are involved in social research only if it is viable and worthwhile for them to be included in the overall research sample of any particular study. The paradox, of course, is that we cannot know beforehand whether what children say about the social world will necessarily help us to learn more about it. However, this is a paradox that researchers must necessarily wrestle with in all research, not just in research with children. Therefore, excluding children for this reason alone raises ethical issues in itself, since the counter implications of doing so suggest that there are no ethical considerations in sampling adult participants or that only child participants are viewed as ‘vulnerable’ participants, both of which are wrong. (Uprichard 2010, 9 – 10)
Uprichard strongly challenges the idea of limiting research with children that ‘tends to
focus on areas of social life that are predominantly child-centred’; that is, the ‘accumulation
of knowledge about children’s life-worlds’. She calls for including children in ‘research
that explores children’s views in order to contribute to fields other than “childhood”’
(Uprichard 2010, 6).
Furthermore, Uprichard calls on the work of Mayall (2002, cited in Uprichard 2010),
who speaks of the ‘relational processes’ of the ‘generational approach’ – that is, ‘that
children are necessarily involved in constructing childhood, which itself is in turn also
relationally constructed through other structural categories (e.g. ‘adulthood’, ‘parenthood’
etc.)’ (Uprichard 2010, 4). So while children and their cultures are embedded in social
systems and practices, they are not outside the wider social systems and practices that
adults may perceive as adult business, and take up a position where children are
overlooked and not taken into account. Uprichard is but one of many researchers who
explore, describe and encourage understandings of children, the constructions of
childhood, and children’s positioning or positionality within research. Children should not
be excluded from research of sensitive topics simply because they are children.
Sexuality research with children is an important area for study. My focus will be
narratives about children’s sexuality. These narratives will speak not only of ‘children’s
life-worlds’, but also to broader ideas and contexts of sexuality that adults very often choose
to ignore or assume are not possible, permissible, or question as abnormal or perverted.
If complex, difficult and sensitive, possibly highly emotional and politically thorny
research with children should occur, what ethical concerns are to be considered?
Ethical research and ethical review of research with children
Ethics is now seen as a practice which bridges the gap between anticipation and reflection . . . In this sense our qualitative research can be ethical right through the research. (Parker 2005, 19)
Each of us in our own professions will identify with specific codes of ethics or codes of
practice. My own counselling professional association includes a section related to research
within the code of ethics (New Zealand Association of Counsellors 2002, Section 11), and
my academic institution also has its own regulations regarding ethical conduct in human
research and related activities (University of Waikato 2008). These also inform my ideas
about my work, and form something of the body of ethics knowledge that accompanies me.
It is useful to survey the experiences of researchers and the pragmatics of ethics when
engaging in research focused on children.
John Horton (2008) has written about a ‘sense of failure’. Horton is forthright about:
‘the realisation that the “excess” and “messiness” of (too-easily and too-often overlooked)
everyday events, geographies and experiences ought to have far-reaching conceptual and
methodological implications’ (2008, 363). He writes about the reality of research
situations with children: the comments they make; the questions they ask; the accusations
that can fly – all in the face of a well-designed methodology that has had rigorous ethical
review. Horton reflects that the literature on ethical complexities of research with children,
Sex Education 537
‘ . . . is a succession of attempts to come to terms with uncertainties, anxieties and the
possibility of “failure” in/of research’ (2008, 364).
Identifying the vast literature on ethics, Horton refers to a ‘guidelines mentality’ that is
often reduced to the idea of Good Practice – ‘in the form of a checklist, code of conduct or
contract of obligations’ (2008, 366). Guillemin and Gillam (2004) refer to practices
around these sources as procedural ethics – attending to the processes of ethical review of
an application, its design and methodology. Procedural ethics then, attends to what Horton
outlines as ‘Good Practice’, consisting of five key sets of obligations; namely that research
must be: legal; consensual; confidential; respectful; and demonstrably pay attention to
these four obligations.
Horton also speaks of researchers who foster an ‘ethic of care’, and: ‘Therefore ethics,
and the need to act ethically, becomes recast as a personal, everyday, ever-present
responsibility which we cannot “get out of ” by recourse to some higher notion of Research
Ethics’ (2008, 367; original emphasis). Perhaps the distinction made by Guillemin and
Gillam (2004) between procedural ethics and ‘ethics in practice’ can be useful here.
Guillemin and Gillam’s ‘ethics in practice’ connects with Horton’s ‘ethic of care’ – and
each of these suggests ‘reflexivity’ in research:
Although reflexivity is a familiar concept in the qualitative tradition, we suggest that it has not previously been seen as an ethical notion. We propose that reflexivity is a helpful conceptual tool for understanding both the nature of ethics in qualitative research and how ethical practice in research can be achieved. (Guillemin and Gillam 2004, 262 – 3)
In qualitative research with children, ethics must necessarily be viewed and engaged
with as a process from the genesis of a research idea, ongoing as a continual reflexive
practice until its completion in written report and presentation forms. Research with
children connects with the everydayness and messiness of human relational activity – a real
and human engagement. When consideration of ‘ethics’ is limited or reduced to procedural
tasks (the recruitment of participants, generation and collection of data, analysis and
report), then a sense of a ‘relational process’ is kept at bay:
. . . we argue that there is considerable continuity between ethical concerns at the procedural and practical levels and moreover, there would be something drastically wrong if this were not the case. . . . we suggest that at the level of ‘ethics in practice,’ the ‘homegrown’ notion of reflexivity actually encapsulates and extends the concerns of procedural ethics. When the responsibility for ethical conduct falls, as it must, on the researcher and not on the research ethics committee, there is still a framework for thinking about ethical conduct that is not utterly divorced from procedural ethics and yet is already integral to the good practice of qualitative research. (Guillemin and Gillam 2004, 269)
Lovisa Skånfors (2009) speaks of ethnography researchers needing to use, ‘“ethical radar”
in order to distinguish children’s ways of expressing acceptance and withdrawal’. As with
Horton, Skånfors acknowledges that ethical problems can surface while actually doing the
research with children and encourages documenting and discussing these ethical challenges to
learn to minimise occasions that could immediately violate the rights of the child.
How can ideas of ‘ethical radar’, ‘ethics in practice’ and ‘a personal, everyday, ever-
present responsibility’ be encouraged for consideration by researchers? And can ethics
committees contribute to such reflexivity within research projects? I believe that any
ethical review process should support researcher reflexivity both in its own processes
(including the procedural documents that are required, e.g. the application) as well as in its
relationship with the researcher (whether via paper or e-communications). In other words,
ethical review committees or boards should themselves be reflexive in their working with
538 P. Flanagan
Examples of childhood sexuality research – and questions of ethics
Two different approaches to research about the sensitive area of children’s sexuality are
now presented: each using different designs and methodologies. Each is explored for the
possibilities for ethical issues arising that were not considered during formal review.
Research interviews with children about sexual behaviour
O’Sullivan (2003) describes a study of 98 boys aged 7 – 13 years who completed
interviewer-administered questionnaires about gender, heterosexual experience, and
AIDS (O’Sullivan et al. 2000, cited in O’Sullivan 2003). The interviewers noticed lengthy
pauses from the boys when asked about sexual knowledge, although they were assured no
repercussions would follow from their answers. Their reluctance was reported as a lack of
information and a lack of vocabulary for the sexual anatomy. O’Sullivan writes that ‘a
number of techniques were used to facilitate boys’ responses in this study’ (2003, 25).
These included: the boys were told they could say anything without repercussion; all
responses were kept confidential, stressing that nothing would be reported to their
mothers; interviewers acknowledged the boys’ difficulty, explaining that other boys had
overcome this difficulty in answering questions; sometimes boys were instructed to write
or draw the word rather than say it aloud, spell the word instead of saying it, or whisper the
word into a tape recorder after the interviewer left the room; and boys were rewarded for
their cooperation with candy and access to games throughout the interview.
O’Sullivan reports that:
. . . almost all the boys reported feeling positively about their participation in the study despite obvious discomfort in talking about sexual matters. In particular, they reported liking the rewards that they received for participation and interacting with the staff. (2003, 25)
The boys who expressed some dislike or discomfort focused on both the sex questions and
the length of duration of the study. The majority of boys indicated they would be willing to
participate again, while only one indicated reluctance due to the sex questions. Others
expressed reluctance due to the duration of the interview. It is reported that ‘no strong
adverse emotional reactions were noted’, there was ‘no need for on-the-spot counseling for
emotional problems’, and there were no ‘interview-related referrals to mental health
services’. None of the mothers made contact about any adverse reactions. A finding was
that, ‘we do not have any reason to assume that the sex knowledge interview exposes
children to significant emotional risk’ (O’Sullivan 2003, 25).
When reading of this study I held questions and concerns related to ideas of ‘coercion’.
While researchers may present a design that includes ‘child-centred’ and child-friendly
approaches, to what degree could these enact relations of power between researcher –
child(ren) that unethically draw forth responses by using lengthy periods of time, a range
of ‘fun’ rewards, and an outcome of relief – something akin to ‘you can leave when we’ve
finished!’? The child’s consent does not appear relevant here, perhaps because his mother
has consented for him.
O’Sullivan then proceeds to explore research that uses direct methods of assessment,
as distinct from indirect methods (retrospective reports from adults and adolescents;
surveys of parents). She claims:
Researchers need to be creative in their direct approach to the study of child sexual behaviour. Questions must be age-appropriate, in language familiar to the children, and tailored in ways that are most likely to facilitate children’s disclosure. (O’Sullivan 2003, 27)
Sex Education 539
O’Sullivan encourages piloting of measures for acceptability, interpretability and appro-
priateness. ‘Incentives should be chosen that children like and can understand’ (2003, 27):
Little is known about the best means of asking sensitive questions of children, or about the impact of the data collection mode, question formats, or contexts. Moreover, there is little information available about the types of protocols that have worked best with children . . . (O’Sullivan 2003, 28)
I think this last point of O’Sullivan’s is her most useful – the development of a protocol
specifically for this kind of research. However, there are concerns for much of how this
research was conducted. Particular questions for me include (this is not an exhaustive list):
what a researcher would do in response to a disclosure of abuse (whether aggressive, sexual
or emotional); or how researchers might explain to a mother their boy’s ‘emotional reaction
or problem’ given the blanket confidentiality promised; or how long would a researcher
‘wait’ if a boy chose not to speak, whisper, write or draw a response; and what effect do
researchers think that ‘incentives’ have on the quality of the data? My hope is that a current
ethical review of this research would have questioned the possibilities for coercion and
invited the researchers to consider other possible alternatives.
The next study develops a sense of children as having a role of authority within the
research – both as participant sharing information, but also, and especially, as an agentic
participant with ability to dissent.
Research with children who have been sexually abused
Mudaly and Goddard (2006, 2009) write about research with children who have been
sexually abused, and their paper intends to contribute to ‘an emerging tendency to report on
how ethical dilemmas encountered in research are addressed’ (2009, 262). They identified
two ethical dilemmas to address in their research: children’s welfare and children’s rights.
De Luca (2004/2006) notes that dissonance frequently occurs between ideals of child rights
and actual practices of consent, particularly as children’s research debates occur about child
welfare and protection, and in relation to children’s rights and agency. Mudaly and Goddard
identified critical ethical questions for their research, such as: the possibility of re-
traumatising children involved in the research who had been abused; balancing meeting
research objectives with these children’s particular vulnerabilities; questioning the rights of
children who have been abused to provide informed and voluntary consent; how much
information about the study and about child abuse should be provided for these children to
decide about their participation; and these children’s rights to confidentiality when concerns
about their protection and safety arise (Mudaly and Goddard 2009, 265).
They believe that particular issues must be considered carefully in any research on
child abuse that involves children who have been abused, namely: reflecting on the
ethical issues as essential to the research design since ethical issues can arise at any stage
of the research process; setting clear criteria about safety for sample selection; that
child-centred techniques are utilised throughout the research; utilising a scientifically
sound research design and qualified researchers who are careful and reflective about
methodological issues; utilising ethical principles (in the absence of guidelines for
conducting research with children who have been abused) such as veracity (re autonomy,
limitations to confidentiality), fidelity and justice; and a full moral analysis by the
researcher explaining and justifying the researcher’s choices throughout the research
(Mudaly and Goddard 2009, 276 – 7).
When considering what could be done differently, they suggest the following (Mudaly
and Goddard 2009, 277 – 8):
540 P. Flanagan
. The development of a research protocol that should specify the research approach, the reason for the research, the possible impact on children, how consent will be
sought, how the data will be used, how children will benefit from the research, and
how confidentiality and child protection issues will be handled.
. Dissenting process – practising with children how to dissent, ‘to empower them to be able to dissent’ and possibly addressing ‘vulnerabilities’ and ‘susceptibility to
coercion and manipulation’.
. Participant information – child-friendly techniques to convey information on the research: newsletters with ‘photos of the researchers and their expertise to conduct
the research; the use of drawings, spidergrams, speech bubbles, large print’.
. Child’s counsellor – where a child counsellor approves of the research, whether ‘the child could feel coerced to consent’ due to their counsellor’s approval.
. Planning for researchers to debrief – the effects for researchers of ‘listening to sensitive and emotionally distressing information’ repeatedly, such as during the
interview, transcriptions, analysing, coding, writing up and disseminating results.
Mudaly and Goddard’s work is pioneering in its developing attention to the care and
sensitivity of ‘in-the-moment’ ethics in research with children. The emphasis on
‘exposing’ to child participants (and almost encouraging through practising) a dissenting
process, and the innovation in this area of a research protocol, both contribute to ensuring
that children’s sexuality research can be more ethical, safe and useful.
I now examine how these ideas for research with children on sensitive topics sit
alongside my research, and how this has been shaped by my own clinical practice and
ethics in practice.
Locating my research with children (my epistemological framework)
Over the past 15 years I have practiced professionally as a counsellor, in family therapy
and counselling supervision. My theoretical approach has been informed by ideas of
narrative therapy, developed by the late Michael White of Adelaide, South Australia and
David Epston of Auckland, New Zealand (White and Epston 1990). These two individuals
(David from an anthropology background, and Michael from mental health social work)
met and connected over their ideas of working with clients – ideas that drew enormous
variance of thinking and practice from mainstream and systemic family therapies. Their
major concerns in the work with clients were the ethics of the relationship and the ethics of
the process of therapy. Their ideas were informed by (among others) Foucault’s writings
about discourse, power/knowledge, and the relations of power. Also connected to their
thinking and practice was the notion of ‘Just Therapy’ developed by the Family Centre of
Lower Hutt, New Zealand. This approach specifically names the social and economic
contexts of problems, and works towards a therapy that attends to the discourses of power
within culture and gender (Waldegrave et al. 2003).
The ethics of the therapy process relates to the work engaged: that therapy is a political
action, located within socio-cultural contexts, and necessarily attentive to discourse,
positioning, agency and deconstruction. Any assessment within this process focuses on
assessing and pathologising the problem – not the person (White 2007).
These ethical positions are shaped within narrative approaches to therapy, where a
client may come with a problem-dominated story (Monk et al. 1997). This story usually
takes on a life of its own that attempts to totalise the identity of the client. Narrative
approaches to therapy invite clients to tell this story, describe the effects of the problem,
Sex Education 541
and tell of their responses to the problem in their life. However, within the storying of the
problem’s life, the client invariably shares pieces or snippets of information through which
submerged or hidden stories come to light that speak of different experience, different
identities, different skills and relationships where the problem has not had traction or
where its influence has been minimised or shrunken. This process is what David Epston
calls ‘co-research’ (Epston 1999).
Together with the client, a narrative therapist then co-authors narratives that tell other
‘true’ stories about the client that are in contradistinction to the dominant problem story,
according to the client’s expertise about their own life and what others know of these
‘alternative’ storylines. These preferred stories are shared with an audience that is
significant to the client, evidenced often with documents or recordings. Frequently …
&enavore> That StillChaWen^e ChWdren and A d u l t s
"You Want Me to Talk to Children about What?"
Responding to the Subject of Sexuality Development in Young Children
Mary Sciaraffa and The
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