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Sexual Behavior Problems Treatment (Children)

Scientific Ratings in this Topic
  • 1 Well-Supported by Research Evidence
  • 2 Supported by Research Evidence
  • 3 Promising Research Evidence
  • 4 Evidence Fails to Demonstrate Effect
  • 5 Concerning Practice
  • NR Not able to be Rated

Topic Areas

Topic Areas

Definition

Sexual Behavior Problems Treatment (Children) is defined by the CEBC as the treatment of behaviors involving sexual body parts that are developmentally inappropriate or potentially harmful to themselves or others initiated by children ages 12 and younger. Sexual behavior problems may range from problematic self-stimulation (such that it causes physical harm or damage) to nonintrusive behaviors (such as preoccupation with nudity, looking at others) to sexual interactions with other children that include more explicit behaviors than sex play (such as intercourse) to coercive or aggressive sexual behaviors, with the latter behavior being of most concern, particularly when paired with large age differences between children. When sexual behavior problems appear to be trauma-related symptoms that originate from sexual abuse the child has experienced, the behavior may be termed "sexually reactive."

It should be noted that although the term "sexual" is used, the reasons for engaging in such behavior vary and are rarely related to sexual gratification or stimulation. Instead, these behaviors tend to be related to other factors, such as curiosity, impulsivity, anxiety, trauma-related symptoms (e.g., re-experiencing symptoms of post-traumatic stress disorder), and attention-seeking.

Interventions for sexual behavior problems that have been systematically evaluated predominately fall in one of two categories: (a) treatments targeting sexual behavior problems and (b) treatments targeting the effects of child sexual abuse including sexual behavior problems.

  • Target population: Children ages 12 and younger who demonstrate behaviors involving sexual body parts that are developmentally inappropriate or potentially harmful
  • Services/types that fit: Outpatient, day treatment, and residential services in individual or group formats
  • Delivered by: Mental health professionals
  • In order to be included: Program must specifically target sexual behavior problems, either on their own or as a component of treatment for child sexual abuse
  • In order to be rated: There must be research evidence (as specified by the Scientific Rating Scale) that examines outcomes related to sexual behavior for the child, such as changes in the child"s behavior, symptom levels, and/or functioning

Definition

Sexual Behavior Problems Treatment (Children) is defined by the CEBC as the treatment of behaviors involving sexual body parts that are developmentally inappropriate or potentially harmful to themselves or others initiated by children ages 12 and younger. Sexual behavior problems may range from problematic self-stimulation (such that it causes physical harm or damage) to nonintrusive behaviors (such as preoccupation with nudity, looking at others) to sexual interactions with other children that include more explicit behaviors than sex play (such as intercourse) to coercive or aggressive sexual behaviors, with the latter behavior being of most concern, particularly when paired with large age differences between children. When sexual behavior problems appear to be trauma-related symptoms that originate from sexual abuse the child has experienced, the behavior may be termed "sexually reactive."

It should be noted that although the term "sexual" is used, the reasons for engaging in such behavior vary and are rarely related to sexual gratification or stimulation. Instead, these behaviors tend to be related to other factors, such as curiosity, impulsivity, anxiety, trauma-related symptoms (e.g., re-experiencing symptoms of post-traumatic stress disorder), and attention-seeking.

Interventions for sexual behavior problems that have been systematically evaluated predominately fall in one of two categories: (a) treatments targeting sexual behavior problems and (b) treatments targeting the effects of child sexual abuse including sexual behavior problems.

  • Target population: Children ages 12 and younger who demonstrate behaviors involving sexual body parts that are developmentally inappropriate or potentially harmful
  • Services/types that fit: Outpatient, day treatment, and residential services in individual or group formats
  • Delivered by: Mental health professionals
  • In order to be included: Program must specifically target sexual behavior problems, either on their own or as a component of treatment for child sexual abuse
  • In order to be rated: There must be research evidence (as specified by the Scientific Rating Scale) that examines outcomes related to sexual behavior for the child, such as changes in the child"s behavior, symptom levels, and/or functioning

Why was this topic chosen by the Advisory Committee?

The Sexual Behavior Problems Treatment (Children) topic area is relevant to child welfare because there are children in the child welfare systems who exhibit sexual behavior problems and who would benefit from treatment to help manage these behaviors. Children may exhibit age-inappropriate sexual behavior, including inappropriate sexual contact with another child. These children can benefit from treatment that promotes learning and maintaining appropriate boundaries, and managing their inappropriate behavior. This treatment acknowledges the child's own abuse history (if present) and how the abuse has impacted their relationships with others.

Debra Zanders-Willis, Director
Child Welfare Services
County of San Diego
San Diego, CA

Why was this topic chosen by the Advisory Committee?

The Sexual Behavior Problems Treatment (Children) topic area is relevant to child welfare because there are children in the child welfare systems who exhibit sexual behavior problems and who would benefit from treatment to help manage these behaviors. Children may exhibit age-inappropriate sexual behavior, including inappropriate sexual contact with another child. These children can benefit from treatment that promotes learning and maintaining appropriate boundaries, and managing their inappropriate behavior. This treatment acknowledges the child's own abuse history (if present) and how the abuse has impacted their relationships with others.

Debra Zanders-Willis, Director
Child Welfare Services
County of San Diego
San Diego, CA

Topic Expert

The Sexual Behavior Problems Treatment (Children) topic area was added in 2011. Jane F. Silovsky, PhD was the topic expert and was involved in identifying and rating any of the programs with an original load date in 2011 (as found on the bottom of the program's page on the CEBC) or others loaded earlier and added to this topic area when it launched. The topic area has grown over the years and any programs added since 2011 were identified by CEBC staff, the Scientific Panel, and/or the Advisory Committee. For these programs, Dr. Silovsky was not involved in identifying or rating them.

Topic Expert

The Sexual Behavior Problems Treatment (Children) topic area was added in 2011. Jane F. Silovsky, PhD was the topic expert and was involved in identifying and rating any of the programs with an original load date in 2011 (as found on the bottom of the program's page on the CEBC) or others loaded earlier and added to this topic area when it launched. The topic area has grown over the years and any programs added since 2011 were identified by CEBC staff, the Scientific Panel, and/or the Advisory Committee. For these programs, Dr. Silovsky was not involved in identifying or rating them.

Programs

Children with Problematic Sexual Behavior Cognitive-Behavioral Treatment Program: School-age Program

Children with Sexual Behavior Problems Cognitive-Behavioral Treatment Program: School-Age Group is a family-oriented, cognitive-behavioral, psychoeducational, and supportive treatment group designed to reduce or eliminate incidents of sexual behavior problems:

  • The program is an outpatient group treatment program for children ages 6 to 12 years and their parents or other caregivers.
  • Program can be provided to individual families when group is not an option.
  • The treatment is provided as an open-ended group, with children able to graduate in 4-5 months.
  • Collaboration with child protective services, juvenile court personnel, school personnel, and others involved is highly recommended.

The children acknowledge the previous breaking of sexual behavior rules, learn coping and self-control strategies, and develop a plan of how they were going to keep these rules in the future. Caregivers were taught how to supervise the children, teach and implement rules in the home, communicate about sex education, and reduce behavior problems utilizing behavior parent training strategies.

Scientific Rating 2

Trauma-Focused Cognitive-Behavioral Therapy

TF-CBT is a conjoint child and parent psychotherapy model for children who are experiencing significant emotional and behavioral difficulties related to traumatic life events. It is a components-based hybrid treatment model that incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles.

Scientific Rating 2

Interventions for Children with Sexual Behavior Problems: Research, Theory and Treatment

This program is designed especially for professionals who work with school-age children exhibiting sexual behaviors problems. The program provides insights and intervention strategies. Interventions for Children with Sexual Behavior Problems: Research, Theory and Treatment is designed to help and heal child and family using a full array of activities to help foster key life skills such as safety planning, relationship skills, emotional expressive skills and empathy, cognitive coping, and self-regulation.

Scientific Rating NR

Problematic Sexual Behavior – Cognitive-Behavioral Therapy for Preschool Children

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.

Scientific Rating NR

Safety, Mentoring, Advocacy, Recovery, and Treatment

The SMART Model is an innovative, structured, phase-based, abuse-focused treatment approach to address the emotional and behavioral needs of young children with a history of child sexual abuse (CSA) exhibiting problematic sexual behavior (PSB). A major premise of the model is that the PSB stems from emotional responses to the prior CSA causing the child to form cognitive distortions about themselves, others, and the world around them. The family unit is a major target of treatment. Important aspects of family values and beliefs are integrated into the model including examining the family power structure, perceptions regarding sexuality, gender roles and identity, stigmatization of mental health, and spirituality. Unique to the model is the formation of parallel narratives of the child's experiences as a victim and as one who victimizes others and the development of a family narrative that addresses the impact and difficulties associated with caring for a child with a history of CSA and PSB.

Scientific Rating NR

Trauma Outcome Process Assessment Model

The TOPA program is designed to help sexually abused and sexually abusive children/youths: (a) recognize how self-destructive and/or sexually abusive behaviors connect to past sexual abuse and other traumatic experiences (e.g., physical abuse, exposure to domestic violence); (b) take responsibility for maladaptive behaviors; and (c) make adaptive choices when current stressors trigger feelings or memories related to past traumas. Therapists take a directive role by creating a safe therapeutic environment, then implementing cognitive-behavioral interventions through experiential methods (art therapy, play therapy, sand tray, bibliotherapy, role play, drama, relaxation). Therapist also works with parents or caregivers to ensure that the home environment supports and maintains the child's treatment gains.

Scientific Rating NR

When Children Abuse

When Children Abuse is a structured, cognitive behavioral program that addresses the dynamics and behavior of children with sexual behavior problems. The types of sexual behavior addressed include a broad spectrum, ranging from socially inappropriate behavior to aggressive sexual assault involving force or coercion. It was developed with issue-related modules that can be tailored to address the child, the behavior and the circumstances presented at intake and as treatment progresses. Its guidelines include intake criteria, client assessment, and two types of progress and evaluation tools which can be applied during and following treatment. It is a "Parallel" treatment program because it includes simultaneous educational/ treatment groups for the caretakers of its child clients, due to the degree of dysfunction, unresolved personal issues and/or emotional reactions of the parents.The program is based on the belief that a child, regardless of the specificity of the referral or severity of the behavior, must be seen and addressed as a whole child. If there are multiple diagnoses or abuse issues, cognitive/developmental issues, complex family circumstances, etc., these should be addressed as part of treatment.

Scientific Rating NR

Programs

Children with Problematic Sexual Behavior Cognitive-Behavioral Treatment Program: School-age Program

Children with Sexual Behavior Problems Cognitive-Behavioral Treatment Program: School-Age Group is a family-oriented, cognitive-behavioral, psychoeducational, and supportive treatment group designed to reduce or eliminate incidents of sexual behavior problems:

  • The program is an outpatient group treatment program for children ages 6 to 12 years and their parents or other caregivers.
  • Program can be provided to individual families when group is not an option.
  • The treatment is provided as an open-ended group, with children able to graduate in 4-5 months.
  • Collaboration with child protective services, juvenile court personnel, school personnel, and others involved is highly recommended.

The children acknowledge the previous breaking of sexual behavior rules, learn coping and self-control strategies, and develop a plan of how they were going to keep these rules in the future. Caregivers were taught how to supervise the children, teach and implement rules in the home, communicate about sex education, and reduce behavior problems utilizing behavior parent training strategies.

Scientific Rating 2

Trauma-Focused Cognitive-Behavioral Therapy

TF-CBT is a conjoint child and parent psychotherapy model for children who are experiencing significant emotional and behavioral difficulties related to traumatic life events. It is a components-based hybrid treatment model that incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles.

Scientific Rating 2

Interventions for Children with Sexual Behavior Problems: Research, Theory and Treatment

This program is designed especially for professionals who work with school-age children exhibiting sexual behaviors problems. The program provides insights and intervention strategies. Interventions for Children with Sexual Behavior Problems: Research, Theory and Treatment is designed to help and heal child and family using a full array of activities to help foster key life skills such as safety planning, relationship skills, emotional expressive skills and empathy, cognitive coping, and self-regulation.

Scientific Rating NR

Problematic Sexual Behavior – Cognitive-Behavioral Therapy for Preschool Children

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.

Scientific Rating NR

Safety, Mentoring, Advocacy, Recovery, and Treatment

The SMART Model is an innovative, structured, phase-based, abuse-focused treatment approach to address the emotional and behavioral needs of young children with a history of child sexual abuse (CSA) exhibiting problematic sexual behavior (PSB). A major premise of the model is that the PSB stems from emotional responses to the prior CSA causing the child to form cognitive distortions about themselves, others, and the world around them. The family unit is a major target of treatment. Important aspects of family values and beliefs are integrated into the model including examining the family power structure, perceptions regarding sexuality, gender roles and identity, stigmatization of mental health, and spirituality. Unique to the model is the formation of parallel narratives of the child's experiences as a victim and as one who victimizes others and the development of a family narrative that addresses the impact and difficulties associated with caring for a child with a history of CSA and PSB.

Scientific Rating NR

Trauma Outcome Process Assessment Model

The TOPA program is designed to help sexually abused and sexually abusive children/youths: (a) recognize how self-destructive and/or sexually abusive behaviors connect to past sexual abuse and other traumatic experiences (e.g., physical abuse, exposure to domestic violence); (b) take responsibility for maladaptive behaviors; and (c) make adaptive choices when current stressors trigger feelings or memories related to past traumas. Therapists take a directive role by creating a safe therapeutic environment, then implementing cognitive-behavioral interventions through experiential methods (art therapy, play therapy, sand tray, bibliotherapy, role play, drama, relaxation). Therapist also works with parents or caregivers to ensure that the home environment supports and maintains the child's treatment gains.

Scientific Rating NR

When Children Abuse

When Children Abuse is a structured, cognitive behavioral program that addresses the dynamics and behavior of children with sexual behavior problems. The types of sexual behavior addressed include a broad spectrum, ranging from socially inappropriate behavior to aggressive sexual assault involving force or coercion. It was developed with issue-related modules that can be tailored to address the child, the behavior and the circumstances presented at intake and as treatment progresses. Its guidelines include intake criteria, client assessment, and two types of progress and evaluation tools which can be applied during and following treatment. It is a "Parallel" treatment program because it includes simultaneous educational/ treatment groups for the caretakers of its child clients, due to the degree of dysfunction, unresolved personal issues and/or emotional reactions of the parents.The program is based on the belief that a child, regardless of the specificity of the referral or severity of the behavior, must be seen and addressed as a whole child. If there are multiple diagnoses or abuse issues, cognitive/developmental issues, complex family circumstances, etc., these should be addressed as part of treatment.

Scientific Rating NR