Children With Sexual Behavior Problems: Assessment and Treatment.

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Goals and Objectives

This study was designed to (a) assess a large number of children ages 6 to 12 with sexual behavior problems in order to develop a continuum of problematic sexual behaviors in this age group, (b) suggest a typology for children with sexual behavior problems, and (c) compare the efficacy of two approaches to treatment for children with sexual behavior problems through a controlled treatment outcome study. The study was conducted at two sites to increase the generalizability of the findings:

1. Center on Child Abuse and Neglect, Department of Pediatrics, University of Oklahoma Health Sciences Center in Oklahoma City, Oklahoma (OUHSC), and
2. The Sexual Assault Center, Harborview Medical Center, University of Washington in Seattle, Washington (UW).

The project was designed in three phases. Phase one (1991-92) encompassed the first year of the project. During this time, the following activities were accomplished: (a) the grant was established within the OUHSC and the UW systems; (b) the Institutional Review Board requirements for recruiting and testing subjects and obtaining informed consent from the participants were met at OUHSC and UW; (c) the Project Coordinator was hired and trained in the testing protocol; (d) therapists were hired for the children's and parents' groups; (e) individual test packets were created in which the tests were administered in random order; (f) the Principal Investigators met with professionals at various agencies and organizations to establish the referral process; (g) children and caregivers were recruited and assessed; (h) the manuals for two approaches to group treatment were developed for pilot testing; and (i) the two treatment protocols were pilot tested.

The assessment of subjects for the typology and of comparison subjects was conducted at OUHSC and UW in order to assess a broader range of children. All treatment groups for children and the caregivers were conducted only at OUHSC to ensure standardization of the treatment approaches.

Phase two (1993-95) included years two through four of the study. During this period, the following activities were accomplished: (a) based on the pilot groups, the treatment manuals were revised; (b) 16 groups of children and their caregivers were assessed and randomly assigned to one of the two treatment groups (8 groups per treatment approach); (c) 52 comparison subjects and their caregivers were assessed at OUHSC and UW; (d) the treatment manuals for replication of the twelve treatment sessions were finalized; (e) data entry files were established and preliminary data analyses were conducted; (f) immediate, one-year, and two-year follow-up evaluations of the children completing at least 9 of 12 sessions were conducted; and (g) preliminary findings were presented at 6 local, 17 national, and 4 international conferences.

During the final phase of the project (1996-98), the following activities were accomplished: a) follow-up assessments of children attending 9 of 12 treatment sessions were completed; b) data entries were verified and final analyses were computed; c) news releases were prepared and submitted for publication; d) the treatment manuals were readied for distribution; e) presentations were conducted at 12 local, 14 national, and 7 international conferences; f) a book contract on the project was finalized with Sage Publications; g) the initial drafts were developed for three articles on the project to be submitted for publication; and h) the final report was submitted to the National Center on Child Abuse and Neglect.

The results of this research project will have significant benefits for children with sexual behavior problems, their potential victims, parents/caregivers of children and their victims, and mental health professionals who provide treatment for these children. By assessing a large number of children with and without sexual behavior problems, a greater understanding of the children's problems has been obtained, a continuum of their inappropriate or aggressive sexual behaviors has been documented, and the efficacy of two different treatment approaches has been established.

Benefits for the children and parents involved in the study included: reducing the children's inappropriate sexual behaviors, increasing their self-esteem, and improving the parent-child relationships. These benefits should generalize to the child's school environment and to the child's relationships with peers and other family members. The project will have significant benefits for the mental health, child welfare, and possibly the juvenile justice systems who deal with these children.

The development of a typology of children with sexual behavior problems will be useful in determining the level of intervention necessary for a particular child. Conducting a carefully controlled study that compares two approaches to treatment, as well as the development of treatment manuals that outline and explain the rationale for procedures used in the group programs, will have long-term benefits for mental health professionals in planning effective treatment programs for these children. The treatment manuals are specific and non-technical so that replication can be easily implemented. All materials developed by this project are prepared in a format that will ensure maximal distribution and utilization.

This project addressed the following hypotheses:

1. Three specific categories of childhood sexual behavior (precocious, inappropriate, and coercive) will be derived by applying a cluster analysis to data obtained from the psychological assessment. Additionally, assessment techniques will distinguish between children who demonstrate aggressive sexual behavior and children who exhibit other types of aggressive behavior.
2. Children who receive highly-structured cognitive behavioral group therapy will show greater movement toward more normal, positive behaviors. Those behaviors include an increase in self-esteem and a decrease in the frequency of inappropriate sexual behaviors. Children who receive the dynamically-oriented group therapy will show less, but some, movement toward normal behavior.
3. Children who receive highly-structured cognitive behavioral group therapy will show a greater reduction in inappropriate sexual behaviors than those receiving dynamically-oriented group therapy.
4. Children who receive highly-structured cognitive behavioral treatment group therapy will show a lower rate of repeated inappropriate or aggressive sexual behavior than those receiving dynamically-oriented group therapy.
5. The cognitive behavior therapy will maintain more positive changes in outcome measures over a 24-month follow-up period.

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