Problematic Sexual Behavior – Cognitive-Behavioral Therapy for Preschool Children

Boys and girls ages 3 to 6 years with sexual behavior problems and their caregivers

For children/adolescents ages: 3 - 6

For parents/caregivers of children ages: 3 - 6

Problematic Sexual Behavior – Cognitive-Behavioral Therapy for Preschool Children is a family-oriented, cognitive-behavioral, psychoeducational, and supportive treatment group designed to reduce or eliminate incidents of problematic sexual behavior in young children:

• Services are provided through an outpatient group treatment program for children ages 3 to 6 years and a parallel group for their parents or other caregivers. Recommended group size is 5-7 children per group.
• The program can be provided to individual families when group is not an appropriate option.
• Group treatment is provided as a closed-ended group.
• The group treatment is 12-14 sessions.
• Collaboration with child protective services, school personnel, and others involved is highly recommended.

Caregivers are taught about sexual development in children, and how to enhance supervision of children, teach and implement rules in the home, communicate about sex education, and reduce behavior problems utilizing behavior parent training strategies. Children are taught private part rules and abuse prevention skills in the context of safety rules, boundaries, emotional regulation, coping skills, and basic impulse—control strategies, all of which are taught and practiced during and between sessions.

Jane F. Silovsky
University of Oklahoma Health Sciences Center

• Email: OU-YPSB@ouhsc.edu
• Phone: (405) 271-8858

The goals of Problematic Sexual Behavior – Cognitive-Behavioral Therapy for Preschool Children are:

• Eliminate or reduce problematic sexual behavior in children
• Improve child behavior via better parental monitoring, supervision, and behavior management skills
• Improve parent-child interaction and communication
• Improve coping, self-control, and social skills in children

The essential components of Problematic Sexual Behavior – Cognitive-Behavioral Therapy for Preschool Children include:

• Modeling, observing, and providing constructive and corrective feedback on skills to children and their parents or caregivers
• Structured treatment program and providers who use a directive approach
• Addressing clinical components with children and caregivers
• Rules about sexual behavior
• Boundaries
• Abuse prevention skills
• Emotional regulation and coping skills
• Impulse-control and problem-solving skills
• Sex education
• Social skills and peer relationships
• Addressing additional clinical components for caregivers, as needed
• Behavior parent training to prevent and respond to problematic sexual behavior, as well as other behavior problems in children
• General child development, including sexual and moral development
• Dispelling misconceptions regarding problematic sexual behavior in children and implications to the child and family
• Support for parents and other caregivers involved

Child/Adolescent Services

Problematic Sexual Behavior – Cognitive-Behavioral Therapy for Preschool Children directly provides services to children and addresses the following:

• Sexual behavior problems, general behavior problems, and internalizing symptoms

Parent/Caregiver Services

Problematic Sexual Behavior – Cognitive-Behavioral Therapy for Preschool Children directly provides services to parents/caregivers and addresses the following:

• Parenting a child with problematic sexual behavior; understanding of sexual development, sexual behavior problems, and parenting strategies that improve boundaries and reduce sexual behavior problems; parental stress

Recommended Intensity

90-minute weekly sessions

Recommended Duration

12-14 sessions

Delivery Settings

This program is typically conducted in a(n):

• Outpatient Clinic

Homework

Each week the child and caregiver are assigned activities in which they apply or practice the skills/information taught in sessions.

Resources Needed to Run Program

The typical resources for implementing the program are:

• Rooms large enough to facilitate groups, including one room large enough to hold all the families for the parent-child group component
• Co-therapists for each child group are recommended; one therapist is needed to facilitate the parent/caregiver group.
• Personnel to conduct intake assessments
• Supervisor/Director of the treatment program
• Therapeutic materials, such as books, puppets, crayons, stickers, etc.

Prerequisite/Minimum Provider Qualifications

Supervisor and lead therapists are recommended to be licensed mental health practitioners with experience treating behavior problems and trauma in young children and their parents/caregivers.

Manual Information

There is not a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

Onsite at agency receiving training or at the University of Oklahoma Health Sciences Center

Number of days/hours:

Depends in part on training and experience of staff to be trained. Training is provided either over the course of four days with a later scheduled booster training, or via three coordinated training sessions of which the first two typically scheduled about one month apart and a third (booster training) following successful implementation of a group treatment program.

Child Welfare Outcome: Child/Family Well-Being

"What is included in the Relevant Published, Peer-Reviewed Research section?"

• Note: The following studies were not included in rating Problematic Sexual Behavior – Cognitive-Behavioral Therapy for Preschool Children on the Scientific Rating Scale.

  Silovsky, J. F., Niec, L., Bard, D., & Hecht, D. (2007). Treatment for preschool children with sexual behavior problems: A pilot study. Journal of Clinical Child and Adolescent Psychology, 36(3), 378–391. https://doi.org/10.1080/15374410701444330

  Type of Study: One group pretest-posttest design

  Number of participants: 85

  Population:

  • Age — Children: 3-7 years; Caregivers: Not specified
  • Race/Ethnicity — Children: Not specified, Caregivers: Not specified
  • Gender — Children: 58% Female; Caregivers: 79 Female and 6 Male
  • Status —

    Participants were children presenting co-occurring trauma symptoms and disruptive sexual behaviors referred from child protective services and other agencies or programs.
    

  Location/Institution: Oklahoma Department of Human Services

  Summary:

  The purpose of the study was to evaluate a 12-week group treatment program for preschool children with interpersonal sexual behavior problems (SBP) [now called Problematic Sexual Behavior – Cognitive-Behavioral Therapy for Preschool Children]. Measures utilized include the Child Sexual Behavior Inventory III (CSBI-III), Child Behavior Checklist (CBCL), Parenting Stress Index – Short Form (PSI-SF), the CSBP Preschool Group Satisfaction, Social Validity Questionnaire (CSBP-PGSQ), the Diagnostic Interview Schedule for Children (DISC-IV), Abuse Dimensions Inventory, Peabody Picture Vocabulary Test – Third Edition (PPVT-III), and the Treatment History Form. Results indicate that a significant linear reduction in SBP due to the number of treatment sessions attended was found. Results also indicate that caregivers reported an increase in knowledge, satisfaction, and usefulness of treatment. Limitations include the lack of a control or comparison group, the small sample size, and the lack of follow-up. Note: This article was not used in the rating process due to the lack of a control group.

  Length of controlled postintervention follow-up: None.

• Silovsky, J. F. (2009). Taking Action: Support for Families of Children with Sexual Behavior Problems. Vermont: Safer Society Press.
  

• Silovsky, J. F. & Niec, L. (1998). Group treatment for preschool children with problematic sexual behavior. Program manual. Unpublished treatment manual.
  

• Silovsky, J. F., Swisher, L. M., Widdifield, Jr., J., & Burris, L. (2011). Clinical considerations when children have problematic sexual behavior. In P. Goodyear-Brown (ed.), Handbook of child sexual abuse: Identification, assessment, and treatment (pp. 399-428). John Wiley & Sons.