Problematic Sexual Behavior – Cognitive-Behavioral Therapy for Preschool Children

About This Program

Target Population: 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

Program Overview

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.

Program Goals

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

Logic Model

The program representative did not provide information about a Logic Model for Problematic Sexual Behavior – Cognitive-Behavioral Therapy for Preschool Children.

Essential Components

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

Program Delivery

Child/Adolescent Services

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

  • Sexual behavior problems, general behavior problems, and internalizing symptoms
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: This program involves the family or other support systems in the individual's treatment: The treatment requires weekly parent/caregiver attendance and active participation, monitoring and supporting child application of skills between sessions, and ongoing assessment of child progress in treatment.

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 Setting

This program is typically conducted in a(n):

  • Outpatient Clinic


Problematic Sexual Behavior – Cognitive-Behavioral Therapy for Preschool Children includes a homework component:

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.

Manuals and Training

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 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.

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Silovsky, J. F., Niec, L., Bard, D., & Hecht, D. (2007). Treatment for preschool children with sexual behavior problems: Pilot Study. Journal of Clinical Child and Adolescent Psychology, 36, 378-391.

Type of Study: One group pretest-posttest design
Number of Participants: 85


  • 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: (To include basic study design, measures, results, and notable limitations)
The study evaluated a 12-session group treatment program for preschool children with interpersonal problematic sexual behaviors (PSB) [now called Problematic Sexual Behavior – Cognitive-Behavioral Therapy Program 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 PSB due to number of treatment sessions attended was found. Results also indicated that caregivers reported increase in knowledge, satisfaction, and usefulness of treatment. Limitations included the lack of a control or comparison group, small sample size, and lack of follow-up..

Length of controlled postintervention follow-up: None.

Additional References

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.

Contact Information

Jane F. Silovsky, PhD
Agency/Affiliation: University of Oklahoma Health Sciences Center
Phone: (405) 271-8858
Fax: (405) 271-2931

Date Research Evidence Last Reviewed by CEBC: February 2018

Date Program Content Last Reviewed by Program Staff: July 2017

Date Program Originally Loaded onto CEBC: April 2011