SOCW6362WK1Reading2.pdf

Ethical review and reflexivity in research of children’s sexuality

Paul Flanagan*

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

Introduction

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

review processes.

ISSN 1468-1811 print/ISSN 1472-0825 online

q 2012 Taylor & Francis

http://dx.doi.org/10.1080/14681811.2011.627731

http://www.tandfonline.com

*Email: [email protected]

Sex Education

Vol. 12, No. 5, November 2012, 535–544

http://dx.doi.org/10.1080/14681811.2011.627731

http://www.tandfonline.com

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

concerns:

. . . 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 the [one] hand, 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

researchers.

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 …

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