Reactions of non-abused children aged 3-9 years to the Sexual Knowledge Picture Instrument: An interview-based study

Kirsten Van Ham, Sanne Van Delft, Sonja N. Brilleslijper-Kater, Rick R. Van Rijn, Johannes B. Van Goudoever, Johanna H. Van Der Lee, Arianne H. Teeuw

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1 Citation (Scopus)


Background The Sexual Knowledge Picture Instrument (SKPI) is a child-friendly picture book that was developed as a diagnostic tool for sexual abuse in young children and is currently being validated. The aim of the current study was to explore the verbal and non-verbal reactions of non-abused Dutch children, aged 3-9 years, to the SKPI and to assess differences in reactions between genders and age groups. Methods and analysis Subject recruitment took place at preschools and primary schools. All children underwent a recorded video semi-structured interview with the SKPI. Interview recordings were scored by an independent rater who used scoring lists for verbal and non-verbal reactions. Non-parametric tests were used in statistical analyses. Results Of the 90 children (median age 5 years) participating in the study, most correctly named the genitals and their non-sexual functions. Only 34 showed an understanding of the picture depicting adult sexuality, with just one child describing a sexual function. Girls (n=45) gave more correct answers (median 87%) than boys (n=45, median 78%; p=0.006). Giggling was the most frequently observed non-verbal reaction, with a total of 186 instances in 54 children. Conclusion Non-abused children up to 9 years of age showed only limited knowledge of the sexual function of the genitals and hardly any insight into adult sexuality.

Original languageEnglish
Article numbere001128
JournalBMJ Paediatrics Open
Issue number1
Publication statusPublished - 7 Sept 2021
Externally publishedYes


  • child abuse
  • epidemiology
  • forensic medicine


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