Understanding Sexual Behavior Problems In Children and Youth

Childhood sexual play and exploration can throw parents into a panic, especially if your child has been fostered or adopted. We immediately wonder if the child has a history of sexual abuse and if, somehow, the seeds of deviance have been planted.

In most cases, we needn’t worry. Sexual exploration and play are normal behaviors. Children are naturally curious about body parts; their own and others. If the sex play is between children of roughly the same age who know each other well, doesn’t involve coercion or threats, is painless and doesn’t cause emotional distress, there’s probably nothing to stress about. The play is bound to be infrequent and will disappear on it’s own.

In some cases, however, behavior can go beyond natural curiosity and becomes cause for concern. If the child continues to engage in the following behaviors after being told to stop, we need to pay more attention.

• Inappropriate for the child’s age. For example, a 4 year old rubbing sexual parts against an adult. Suspected sexual re-enactments.
• Using objects in a dangerous way, such as inserting objects into another child’s rectum.
• Asking a child to keep quiet “secrets” about the activity by using threats orintimidation.
• The activity involves children of widely different ages. For example, an 11year old and a 6 yr. old.
• The activity causes physical or emotional harm to the recipient. For example,the child might avoid the perpetrator, have bad dreams, anxiety, etc.
• The activity has been repeated.
• Interferes with normal child development.
• The child becomes obsessed with on-line pornography.

The number of children and youth involved in chronic sexual behavior is unknown but it does cross ages, socio-economic status, and sexual orientation. There seems to have been an increase, but that may be due to factors such as better reporting and increased awareness.

There are some factors which can increase the odds of sexually acting out in children with attachment difficulties and histories of trauma. Risk is increased if the child has been a victim of sexual abuse or has witnessed adult sexual behavior, including the media, or has been left without adequate adult supervision because of work schedules, neglect, or parental substance abuse. We don’t know exactly why children who have been abused or are the victims of other trauma have an increased risk, but it could be because initially, sexual self-stimulation could have been soothing or self-comforting. Or it was the only way to get affection from an adult. We do know that chronic developmental trauma can cause serious delays in impulse control and inability to judge cause and effect or consequences. Many have not, as yet, developed empathy skills. None of these factors make it inevitable that the child will become an adult sexual offender.

Myth: All children with sexual behavior problems grow up to be sex offenders. It’s also a myth that all child sex offenders were themselves victims of abuse.

Fact: Children who receive treatment for their sexual behavior problems rarely commit sexual abuse or offenses as adults. One study followed a group of children for 10 years after they were treated. The vast majority (98%) did not commit sexual offenses of any kind, and the group as a whole was no more likely to commit sexual offenses than children with a past of only nonsexual behavior problems.*(* National Child Traumatic Stress Network: See (ASTA) Report of the Task Force on Children with Sexual Behavior Problems)

More good news is that most children can be successfully treated at home, if the child can be consistently supervised. Surprisingly, many have not been taught that the behavior is inappropriate! What they’ve witnessed other adults do or have seen on media seems normal to them. Outpatient treatment has the advantages of not having to remove the child from his community, school, friends and activities,
though they will need to be monitored until the behavior ceases. Treatment usually lasts from 3-6 months and involves the family. A small number of children will need to be in more intensive residential care, particularly if they have concurrent severe psychiatric disorders, or threaten or have a plan to harm themselves or others. If the child is highly aggressive or can’t be adequately supervised and continues the
behavior, other options must be considered.

If you discover that your child has sexually misbehaved, check your reaction. You will, no doubt, feel overwhelmed, in shock, and angry. Feelings of great shame and disappointment, in yourself and your child, are typical reactions, but don’t shame the child. If you were the victim of sexual abuse or other traumatic events in childhood, you may  experience overwhelming flashbacks and physiological responses. It’s
natural to want to isolate yourself and avoid the child. But however you feel, understand that you are not alone in this. Many other parents have been in your situation, and with support and treatment both you and your child can get through this! Sexual behavior behaviors are highly treatable in children and youth both because of the age of the offenders, and the reasons they offend. Adults offend because of a need to control and harm their victims, children do not. This is why a
child or teen should never be put in an adult perpetrator treatment program. Remember that child offenders are first and foremost, children. This is absolutely essential!

The most common intervention to date used with juvenile sexual  offenders is CBTRP, or cognitive behavioral therapy-relapse prevention. It’s a long term group therapy developed for adult men. But it can be harmful for children and youth. The reasons youth offend are because of environmental factors; lack of friends and social skills, lack of warmth and closeness to parents, difficulties in school, past trauma, harmful neighborhood influences and more. Relapse prevention does nothing to address these factors. Also, putting youth in adult programs and/or adult settings only offers them a “school for deviance.” The same is true for residential treatment for youth sexual offenders, which can make a less deviant youth more deviant. That should be reserved for only the most dangerous children; those who have acted violently or plan to hurt themselves or others.

Interventions that directly address the environmental influences, which make it more likely for a child to offend, are best addressed in  community and family settings. Longitudinal studies to date suggest that:

• Developmental pathways to sexual misbehaviors are similar to those for juvenile non-sexual offending.
• Juvenile sexual offending is multi-determined in nature. Therefore, treatment approaches must be flexible enough to match the correlates of the offenses.
• Since juvenile sexual offenders are so similar to juvenile non-sexual offenders, it stands to reason that the same types of interventions would work for both. Juvenile offenders, sexual or otherwise, have much more in common with each other than they do with adult sexual offenders. Three intervention models have been identified which have proven effective with juvenile non-sexual offenders, and hold promise for those who commit sexual offenses:
• Functional Family Therapy (FFT)
• Multidimensional Treatment Foster Care (MTFC)
• Multisystemic Therapy (MST)
  All are family and community based, use behavioral interventions, and are geared to individual juvenile, family, peer, and community issues. Several studies already indicate the effectiveness of MST in treating juvenile sexual offenders.*

Although more research is needed into the reasons for sexual  misbehaviors in children and youth needs to be done, we are making strides in finding effective interventions. We need to take heart that our children will, in almost all cases, not going to become adult offenders. But the real facts of the situation need our awareness and advocacy. Too many children and youth are being mistreated by interventions such as CBT-RP, which can greatly harm them. Just as troubling is the
fact that teenagers are being put on adult sex offender registries when almost all (98%) will not re-offend as adults. We need to be aware of and advocate for proper and effective treatments for these youth, and take heart that they will, in all likelihood, grow up to be law-abiding adults.