1. Boy Scouts of America Atlanta, GA November 1-2, 2012
Don’t Shoot: We’re Your Children. What We Know about Children and Adolescents with Sexual Behavior Problems
National Youth Protection Symposium
Boy Scouts of America
Atlanta, GA
November 1-2, 2012
Barbara L. Bonner, PhD
Center on Child Abuse and Neglect
University of Oklahoma Health Sciences Center
(405)
National Center on the Sexual Behavior of Youth

2. Terminology and Definition
Sexual behavior problems (SBP) – Developmentally inappropriate and potentially harmful behaviors involving sexual body parts
Illegal sexual behavior (IBP) – Sexual behavior in older youth (13+) that is illegal under state law
Jimmy
Jane F. Silovsky, PhD, CCAN 2010
Jimmy Widdifield, Jr., CCAN 2010

3. Terminology and Definition
Children with sexual behavior problems (CSBP)
Child ages
Intentions and motivations for these behaviors may be unrelated to sexual gratification
This is a definition, not diagnostic criteria in DSM-IV-R

4. Development of the Field-CSBP
First articles published
Children called “mini-perps,” juvenile sex offenders
1990s
NCCAN funded first RCT on treatment
2000s
Few treatment programs established
2010s
Mental health professionals requesting training

5. Incidence and Prevalence of CSBP in the United States
No national figures available on the number of children with SBPs
No government agency oversees all these youth
1990 – 2010 showed increase in the number of children referred to CPS and mental health services for treatment
Jane
Jane F. Silovsky, PhD, CCAN 2008

6. Typical Sexual Development: Sexual Knowledge
Children 6 to 12 years old…
Aware of genital basis of gender
Aware of sexual aspects of pregnancy
Increasing knowledge of sexual behavior: masturbation, intercourse
Knowledge of pubertal changes

7. Typical Sexual Development: Sexual Behavior
Children 6 to 12 years old…
Sex games with peers, siblings
Show modesty, embarrassment: hide
sex games from adults
May fantasize or dream about sex Interested in media sex
Use sexual language with peers
Show video – Prime Time

8. Characteristics of Children with Sexual Behavior Problems
No profile of children with SBP
Diverse in sexual behaviors, gender, race, family factors, socio-economic factors, maltreatment history, and co-morbid problems
More diverse than adolescent and adult sexual offenders

9. Origins of Sexual Behavior Problems
History of sexual abuse
Many children who have been sexually abused do not have sexual behavior problems
Many children with SBP do not have a sexual abuse history
Complex familial, social, developmental, and biological factors

10. Origins of Sexual Behavior Problems
Exposure to sexualized materials
Family practices regarding nudity and privacy
Neglect, lack of supervision
Exposure to physical or emotional violence

11. Levels of Sexual Behavior
Play – young children playing Doctor, pulling pants down
Inappropriate – touching over clothes, telling sexual jokes, touching self in public
Problematic – use of coercion, causing injury, repeated behavior

12. Levels of Physical Behavior
Play – wrestling, pushing, light contact
Inappropriate – kicking, hitting, holding someone down
Problematic – fighting, causing injury, use of force, repeated behavior

13. Sexual Play Exploratory Spontaneous Intermittent By mutual agreement
With child of similar age, size, developmental level
Not accompanied by anger, fear, strong anxiety

14. Inappropriate Sexual Behavior
Not suitable for location,
i.e., school, church, public
Not appropriate for age
Occurs out of sight
Touching over clothing

15. Inappropriate Sexual Behavior
Three 7 year old boys are found in the bathroom chasing each other while exposing themselves. They are giggling and are embarrassed when caught.

16. Inappropriate Sexual Behavior
Two ten year old boys take a six year old boy into a coat room and are telling him sexual jokes. He looks confused and the boys are laughing.

17. Problematic Sexual Behavior in Children
Greater frequency or duration than developmentally expected
Frequency excludes normal childhood activities
Do not decrease with typically effective parenting strategies
Coercive or aggressive
Acts that wouldn’t normally be known to a child (e.g., oral sex, “tongue kissing”)-yes. And how different are these from those for juveniles?

18. Problematic Sexual Behavior in Children
Elicits fear and anxiety in other children
Potentially harmful to child or others
Occurs between children of significantly different ages or developmental abilities
Involves animals

19. Problematic Sexual Behavior
Two 13 year old boys are with a 9 year old in a tent. They talk the 9 year old into touching their private parts and putting it in his mouth.

20. Problematic Sexual Behavior
A 15 year old boy makes a 9 year old have oral and anal sex. He threatens the boy to beat him up if he tells anyone about it.

21. Intervention Play Separate children; go over rules
Discuss incident with parents
Inappropriate
Separate children; ask, w, w, w, w, w about incident; go over rules; report to parents; possibly refer for treatment

22. Intervention
Problematic : Separate children; briefly question children; take notes; contact parents immediately; contact required authorities; refer for treatment.

23. Prevention of SBP in Programs
Teach rules about sexual behavior
Establish clear boundaries
Closely supervise
Intervene immediately
Monitor interactions between children
Close off private space
Check bathrooms frequently

24. Treatment Program for Children
Rules about sexual behavior
Safety plan
Sexual education
Emotional development
Impulse control
Anxiety management
Social skills

25. CSBP: Sexual Behavior Rules
It is not ok to touch other people’s private parts.
It is not ok to show private parts.
It is not ok for other people to touch your private parts.
It is ok to touch your private parts in private.
It’s not ok to make others feel uncomfortable with your sexual language or behavior.
Adapted from Bonner, Walker, & Berliner (1995)

26. Are Children Involved in the Legal System?
US: Juvenile court for delinquent and deprived children
Goal: Rehabilitate abusive parents and delinquent youth
Children under 12: Typically not adjudicated delinquent
Youth 13+: May be adjudicated delinquent

27. Conclusions Not all sexual behavior in children is problematic
Not all sexually abused children have sexual behavior problems
Most children with SBP:
Can live safely in the home and community
Can be treated successfully on an outpatient basis
Do not have future SBP

28. General Definition
Adolescents (13-18 years of age) who engage in an illegal sexual behavior as defined by the sex crime statutes of the jurisdiction in which the offense occurred.

29. Development of the Field
1970s: Boys will be boys – no problem
1980s: Boys treated same as adult sex
offenders – major problem
1990s: Boys recognized as different from
adults – need different treatment
2000s: Boys recognized as having good outcome, low recidivism

30. Incidence and Prevalence
Adolescents account for 17% of arrests for all sex crimes annually
30% of child sexual abuse is committed by adolescents
Females under the age of 18 account for 1% of forcible rapes committed by juveniles and 7% of all juvenile arrests for sex offenses, excluding the category of prostitution

31. Characteristics of Male AISB
Very diverse population—no “profile” or single set of characteristics
Diverse in sexual behaviors, gender, race, family factors, socio-economic factors, maltreatment history, and co-morbid problems

32. Characteristics of Male AISB
Most AISB do not share the central characteristics of adult sex offenders. Compared to adult offenders, most AISBs:
Have fewer victims, fewer behaviors, shorter duration of behavior
Engage in fewer behaviors involving penetrative acts
Have different motivations for their behavior--more experimental or curiosity driven behaviors

33. Characteristics of Male AISB
Less specific, focused sexual behavior
Less evidence of sexual compulsivity, “cycles,” “grooming” or other features more often found in adults
No evidence that most AISBs have a lifelong, incurable sexual disorder or paraphilia
Peer rapists (adolescent-on-adolescent) differ from child molesters who are less delinquent, often immature, etc.

34. Age of Risk
Early adolescence is a high-risk, and to some extent transitory, developmental period for committing illegal sexual behaviors.

35. Current Research on Treatment of AISBs
Limited empirical research on effectiveness of treatment
Multisystemic Therapy (MST) has best empirical data
Randomized clinical trials being currently conducted
Known recidivism rates are 5-14% for boys receiving treatment

36. Treatment Program for Adolescents
Disclosure / Responsibility
Healthy and appropriate sexual behavior
Legal vs. illegal sexual behavior
Prevention of future illegal behavior
Restitution
Focus on behavior at home, school, and in the community
Improving family communication
Cognitive behavioral basis of behavior

37. Can CSBP and AISB live in the community?
Most AISBs can safely remain in the community during treatment.
Some need residential placement.
Professional consensus that most can be treated on an outpatient basis.
Decisions about placement in residential or incarcerated settings should depend on community safety and treatment needs.

38. Can CSBP and AISB attend school safely?
Most can attend public schools and participate in school activities without jeopardizing the safety of other students.
In some cases, school personnel
may need to know information
to ensure safety and protection
of the students.
Jane
Jane F. Silovsky, PhD, CCAN 2010
Jimmy Widdifield, Jr., CCAN 2010

39. Do CSBP and AISB need intensive residential treatment?
Many successfully treated in shorter, less intensive programs.
Many seen in outpatient group treatment programs once a week for 4 to 28 months.
Residential and inpatient treatment should be reserved for most severe cases.
Jane
Jane F. Silovsky, PhD, CCAN 2010
Jimmy Widdifield, Jr., CCAN 2010

40. Will CSBP and AISB grow up to be adult sex offenders?
Current research shows that the sexual re-offense rate for youth who receive treatment is low in most US settings.
Studies suggest that the rates of sexual re-offense (5-14%) are substantially lower than the rates for other delinquent behavior (8-58%).
Jane
Jane F. Silovsky, PhD, CCAN 2010
Jimmy Widdifield, Jr., CCAN 2010

41. Oklahoma Treatment Programs for CSBP and AISB
Oklahoma CSBP program: 10 year follow-up found 2% (CBT) -12% (DPT) recidivism
Oklahoma AISB program: 10 year follow-up found 3% recidivism; national data: 5-12%
Both programs found significant positive effects of strong parental involvement
Major analysis of children’s programs indicates importance of behavioral parent training
Jane
Jane F. Silovsky, PhD, CCAN 2010
Jimmy Widdifield, Jr., CCAN 2010

42. Conclusions
Youth with problematic sexual behavior problems are different from adult sex offenders.
Most youth do not grow up to be adult sex offenders.
Most youth with SBP can:
Live safely in the community.
Be treated on an outpatient basis.
Attend public school
Be involved in activities
With treatment, the future recidivism rate for both groups is quite low.
Jane
Jane F. Silovsky, PhD, CCAN 2010
Jimmy Widdifield, Jr., CCAN 2010