Children With Sexual Behavior Problems: Assessment and Treatment.

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Discussion

Examination of the demographic data for the children in this project reveals some interesting and provocative findings. The first finding has to do with the composition of the sample. As the project began, it was somewhat difficult to locate suitable subjects for the investigation. However, as word about the project got out to the community, the number of referrals steadily increased. Thus, sexual behavioral problems in children are not rare, in fact, they may be much more common than is generally recognized.

The children that participated in this research, in general, reflected the demographics in the communities (Oklahoma City and Seattle) in terms of racial composition. There was also good representation of children across the age range from 6 to 12. Cases involving children with sexual behavior problems were found at all socioeconomic levels, but as might be expected, there was an over-representation of lower socioeconomic patients in the current project. Additional findings indicated that children with sexual behavior problems tend to experience more stress in their lives than in those in the comparison group. A significantly higher number of them had parents who were divorced, experienced a death in the immediate family, witnessed human sexual behavior, and behavior problems at school.

One interesting and remarkable finding in the demographic data has to do with the male/female ratio. At the younger ages, males and females are equally represented. As age increased, there was a tendency for males to outnumber females. The fact that females were well represented in the sample of subjects is striking in that sexual offenses are rare among adolescent and adult females. However, it should be noted that as the level of aggressiveness increased, the number of females involved decreased. An interesting area of research might be to determine why it is that at younger ages there are numerous occurrences of sexual behavior problems in females, but by puberty and later, sexual occurrences are more uncommon.

The demographic data on the children's history of child maltreatment are equally interesting. Overall, there were no significant differences between the children with sexual behavior problems and the comparison group on history of physical abuse, neglect, or emotional abuse. This is due to the fact that the comparison group was chosen to be as close to the experimental group as possible, except for the presence of inappropriate sexual behavior. Thus, many of the children in the comparison group had been identified by the Department of Human Services or other clinical agencies as in need of services and the abuse rate was correspondingly high. However, the children with sexual behavior problems did have a significantly higher rate of sexual abuse than the control group (p =.001). Before this research project, the limited literature on this population indicated that the children would have high levels of abuse in their history, and particularly high levels of sexual abuse (e.g., Johnson, 1988; 1989). However, in studying this larger sample, it was found that 52% of the children with sexual behavior problems did not have a reported history of sexual abuse and 41% did not have an abuse report of any type. The present data would support the idea that child maltreatment might increase the probability of children behaving inappropriately sexually; however, it is not a necessary or sufficient variable in accounting for such behavior.

The data obtained from the children's and the parents' answers on standard psychological instruments indicate numerous significant differences between the children with sexual behavior problems and the comparison group, with virtually all the differences being in the direction of the children with sexual behavior problems being more disturbed and more pathological. This was particularly true for inappropriate and aggressive sexual behavior, externalizing behaviors, and conduct problems.

The failure to identify subgroups within the data by means of cluster analyses was at first surprising. However, on further reflection it became apparent that none of the measures employed in the current study adequately assessed the main variables of sexually inappropriate and aggressive behavior in children. The inadequate assessment of these crucial variables made it impossible for clinically useful clusters to be derived. It should be noted that the best measures available in the research were utilized. Therefore, the development of more adequate measures for sexual behavior in children would, no doubt, be an area for future research.

An examination and classification of the referral sexual behaviors by expert judges was successful in classifying the children into three subgroups: Sexually Inappropriate, Sexually Intrusive, and Sexually Aggressive. There were few significant differences on the assessment measures for these three groups, undoubtedly due to the same reason that these assessment instruments did not initially classify the subjects. While standardized instruments were not useful in grouping the children, the expert clinicians' ratings of inappropriate and aggressiveness were significantly different for the three groups with inappropriateness and aggressiveness increasing from Group I to Group II, and from Group II to Group III. Thus, the three group classification appears to have merit and warrants further investigation. The most important need for future investigation is more adequate instruments and techniques to assess inappropriate sexual behavior and sexual behavior problems of children, especially those involving aggressiveness.

Examination of the outcome data indicates a significant improvement on test scores from pre-treatment to post-treatment. Thus, the children were much healthier in terms of standard psychological assessment measures at the end of the treatment than they were at the beginning. This was true for both forms of group treatment (cognitive-behavioral and dynamic play). There were no interactions between forms of treatment and test scores, indicating that neither treatment was significantly more effective than the other. Since this project used a comparison group rather than a true control group, it is not possible to attribute the change with certainty to the treatments employed. It should be noted that the decision not to employ a true control group was made due to ethical considerations.

The changes in scores could result from a variety of other factors, including developmental changes, behavior changes induced by parental reactions and other factors outside of the treatment, statistical regression of their scores toward the mean, as well as others. Nevertheless, it is significant to note that following treatment the children were functioning better than prior to treatment. In addition, for most children, the inappropriate sexual behavior was no longer present.

In summary, data from this project indicate that sexual behavior problems in young children are by no means a rare phenomenon. In fact, we have probably just touched the tip of the iceberg in the present investigation. Females at this age level are much more likely to be identified as having sexual behavior problems than are females at any other age. Standard psychological assessment measures indicate high levels of behavioral and affective disturbances among these children, in addition to their sexual behavior problems. The project further documented that it is possible to identify subgroups of children with sexual behavior problems. The crude typology developed in this project warrants further investigation and refinement. However, accomplishment of this would depend on the development of more sophisticated and precise measurement instruments for use with this population.

This project had other heuristic results. Several programs have been established nationally based on the treatment models utilized in the study. At the conclusion of the research project, clinical services for children with sexual behavior problems were continued at the University of Oklahoma Health Sciences Center (OUHSC) through a service grant from the Oklahoma Department of Human Services. This is currently an ongoing project involving 10-15 children in two groups and there is always a waiting list for the groups. In addition, as a result of this project, an additional research project for children ages 5 and younger was conducted and continues as an ongoing service at OUHSC.

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