1. Sexual Behavior in Children
Normal and ABnormal
NaNCY Kellogg, M.d.- University of texas health science center

2. Sexual Abuse Trends Since 1995, sexual abuse numbers are trending down
Approximately 70,000 children per year in the U.S. are validated victims of sexual abuse

3. Media Influence
Children spending 6-8 hours a day exposed to some form of media
Television: 8 sexual acts per hour (compared to <2/hr in 1976)
Clothing (e.g. Abercrombie and Fitch): Clothes line for girls 7-14 include thong underwear with “Eye Candy” and “Wink Wink” near the crotch
A larger and younger generation of “sexual savvy” youth

4. Sex and Cell Phones Study of 3477 law enforcement cases (2008-09)
63% of sexual images transmitted by cell phone
An adult was involved in 36%
Telephone survey of 1560 youth ages 10-17
7% had received nude or nearly nude images of others
1% appeared in or created nude images or videos

5. Types Solitary Behaviors Behaviors involving others Purpose:
Gratification
Self-soothing
Curiosity
Imitation
Attention-seeking

6. Normal sexual Behaviors
Developmentally appropriate and expected
No risk factors for abuse are observed
Other terms: “sexualized behavior” or “sexual play”

7. Normal: Ages 6-9 High frequency (14-40%) Touches genitals at home
Tries to look at people when they are nude
Stands/sits too close to others
Touches mother’s breast

8. Normal: Ages 6-9 Low Frequency (8-14%) Very interested in opposite sex
Knows more about sexual topics
Tries to look at pictures of nude people in books or T.V.
Talks about sexual topics
Dresses like opposite sex
Masturbates with hand

9. Normal: Ages 10-12 High Frequency (9-29%)
Very interested in opposite sex
Wants to watch/view nudity on television and other media
Knows more about sexual topics
Touches sex parts at home
Lower Frequency (5-8%)
Stands/sits too close
Tires to look at people when they are nude
Talks about sex acts
Talks flirtatiously
Dresses like opposite sex

10. Sexual Behavior Problems
Children 12 and younger who “Initiate behaviors involving sexual body parts (i.e., genitals, anus, buttocks or breasts) that are developmentally inappropriate or potentially harmful to themselves or others (Association for the Treatment of Sexual Abusers, 2006)
Developmentally Inappropriate
Occur at a greater frequency than seen in normative groups
Occur at a much earlier age than would be expected
Become a preoccupation for the child
Persist/reoccur after adult intervention
Potential Harm
Coercion or cause physical injury or emotional distress

11. Examples of SBP’s in Children
Any sexual behavior that involve children who are 4 or more years apart
A variety of sexual behavior displayed on a daily basis
Sexual behavior that results in emotional distress or physical pain in at least one child
Coercion or threats to another child to participate
Persistent behaviors resistant to adult redirection and child becomes angry if distracted
Explicit repetitive acts involving actual penetration or oral-genital contact
Asking an adult to perform a sexual act
American Academy of Family Physicians, 2010

12. Associated Disorders with SBP’s in Children
One study showed 96% of children with sexual behavior problems had an additional psychiatric diagnosis
76% Conduct Disorder
40% ADHD
27% ODD
Externalizing behavior problems strongly associated in children
Lower self-esteem and peer acceptance

13. Adolescent Sexual Behavior
Adult Response Required
Sexual preoccupation/anxiety that interferes with daily functioning
Pornographic interest
Promiscuity/multiple sexual partners
Sexually aggressive themes or obscenities
Sexual graffiti that is chronic or affects others
Embarrassment of others with sexual themes
Violations of other’s body space, such as pulling down pants, pulling up shirt
Single occurrence of peeping, exposing or frottage (rubbing against others sexually)

14. Adolescent Sexual Behavior
Correction or Professional Intervention
Compulsive masturbation
Degradation/humiliation of self or others with sexual themes
Chronic preoccupation with sexually aggressive pornography
Sexually explicit conversation with significantly younger children
Touching genitals without permission (“goosing” “tapping”)
Sexually explicit threats

15. Adolescent Sexual Behavior
Illegal Behavior requiring immediate intervention
Obscene phone calls, voyeurism, exhibitionism, or frottage
Sexual contact with someone of significant age or power difference
Forced sexual contact
Forced penetration
Sexual contact with animals
Genital injury to others

16. FACT
If children receive a cognitive-behavioral therapy intervention, their risk of becoming a sex offender is no more than that of children with ADHD (Carpenter, Silovsky & Chafin, 2007)

17. Principles of Management for SBP’s
Gather information about the behavior from multiple sources
Focus on what current factors are maintaining current behavior rather than the initial causes or past behavior
Cognitive-behavioral and psycho-educational interventions involving the children, parents, and teachers are very effective (even short term therapy)
Do Not push the sexual abuse agenda if a child does not disclose abuse

18. Reporting Suspected Abuse
If Child gives a history that they have been sexually or physically abused
If Child gives a history that they have had sexual contact with a child 4 or more years older or younger, or contact is otherwise abusive, or
If a child has injuries that are suspicious for sexual or physical abuse
Report neglect if a parent intentionally exposes child to harmful pornographic material or
Parent fails to modify environment to reduce the child’s access to sexually explicit material despite medical or mental health advice

19. FECC Assessment Tools Child Sexual Behavior Inventory –CSBI
Child Sexual Behaviors, 21 Problematic Characteristics –CSB21
Juvenile Sexual Offense Recidivism Risk Assessment Tool, 2nd Edition –JSORRAT-II
Juvenile Culpability Assessment –JCA
Sexual Behavior and Attitude Interview
Trauma Symptoms Checklist for Children -TSCC
Trauma Symptoms Checklist for Young Children TSCYC