Children With Sexual Behavior Problems: Assessment and Treatment.

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Statement of Problem

Children exhibiting sexual behavior problems are increasingly being referred for treatment. Some of these children have a history of sexual abuse; the abuse history, as well as their own inappropriate sexual behaviors, may place them at risk of becoming sexual offenders as they mature. Evidence that sexually aggressive behavior patterns may emerge in pre-adolescent years has been supported by a study conducted in the state of Washington. In this study of 73 sexually aggressive youth, 26% were children between the ages of 6 and 12 (Division of Children, Youth, & Family Services, 1987).

Although the research is minimal at this time, it is apparent that sexual behavior problems in young children exist and that these behaviors are possibly associated with the development of offending behaviors in adolescence and adulthood.

The current published literature refers to these children as child perpetrators (Johnson, 1988), children who molest (Johnson & Berry, 1989), sexually reactive children (Friedrich, 1990), and juvenile sex offenders. The term "children with sexual behavior problems" appears to be more appropriate and descriptive for two reasons. First, current knowledge about these children and the etiology of their sexual behavior is limited, and second, due to their young age, they are typically not charged with a sexual offense.

Sexual behaviors in young children fall along a continuum from age-appropriate exploration to highly aggressive sexual behaviors. Sexually aggressive behaviors in young children include forcing younger children to undress and sexually experiment with siblings and peers (e.g., Pomeroy, Behar, & Stewart, 1981; Smith & Israel, 1987). Johnson (1989) described 13 girls ages 4 to 13, all with a history of sexual abuse whose sexual behaviors involved the use of coercion or force with an average of 3.5 child victims. Two studies on sexually aggressive boys indicated that their behaviors are similar to older sex offenders and that these boys all used coercion to gain the victims' compliance (Friedrich & Luecke, 1988; Johnson, 1988). Inappropriate or aggressive sexual behaviors have been reported more frequently in sexually abused children; the history of sexual abuse discriminates them from normal, physically abused, and psychiatric child populations (Friedrich, Beilke, & Urquiza, 1987; Gale, Thompson, Moran, & Sack, 1988; Goldston, Turnquist, & Knutson, 1989; Kolko, Moser, & Weldy, 1988).

Currently, there is a paucity of information on treatment approaches specifically designed to address sexually aggressive behaviors in young children. Johnson and Berry (1989) described a group treatment program with activities focused on cognitive and affective dimensions, while another approach used the cycle of reoffense model which teaches the children to recognize and avert the cycle (Isaac, 1990). Neither study has treatment outcome data available at this time.

Although the literature focuses on children with significant sexual behavior problems, these behaviors appear to fall along a continuum from normal sexual behavior to inappropriate sexual behavior to sexually aggressive behavior. A classification system for problematic sexual behaviors in children has been proposed which delineates three levels of disturbance: precocious, inappropriate, and coercive sexual behaviors (Berliner, Manaois, & Monastersky, 1986). These three levels are described below:

1. Precocious sexual behavior involves behaviors such as oral-genital contact or intercourse between pre-adolescents with no evidence of force or coercion. This behavior may be a temporary, unsocialized response to victimization or a response to exposure to sexually explicit behavior. It may cease upon disclosure, increased supervision, or therapeutic intervention. These children should have further assessment to determine the necessity and level of appropriate intervention.
2. Inappropriate sexual behavior includes persistent and/or public masturbation, excessive interest or preoccupation with sexual matters, and highly sexualized behavior or play. These children may be in the incipient process of developing a deviant sexual arousal pattern. Intervention for these children would depend on the frequency, persistence, and consequences of the behavior.
3. Coercive sexual behavior refers to sexual acts in which force is used or threatened, or where a significant disparity in development or size exists. These children may engage in sexually aggressive behavior in conjunction with other antisocial activity. The sexual behavior may be more reflective of anger and hostility than a search for gratification. Children with coercive sexual behavior are seen as requiring immediate, intensive intervention.

In summary, the literature on children ages 6 to 12 with sexual behavior problems is quite limited. There have been no studies of large numbers of these children in order to assess the existence of a continuum of inappropriate sexual behavior and few attempts have been made to establish a typology. Additionally, there has been no clear relationship established between early childhood sexual victimization and the development of sexually aggressive behavior in children. Further, there are no empirical studies comparing different approaches to treatment with this population of children.

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