1. Ana Saldivar- Schlosser, MS, LPC, NBCC, R. Psych (p) atschlosser@g mail.com SEXUAL BEHAVIOR PROBLEMS: IN CHILDREN & TEENS

2.  I have no financial relationships with a commercial entity producing health-care related products and or services. DISCLOSURE

3.  Sexual responses are present from birth  40-85% of children will engage in sexual behavior before 13  Sexual development and behavior are influenced by social, familial and cultural factors, as well as genetics and biology.  Wide range of sexual behavior in children is normal and non-problematic  More children are being identified with inappropriate sexual behavior  Treatments such as cognitive behavioral therapy are proving effective in reducing problem sexual behavior  *1* FACTS OF SEXUAL DEVELOPMENT

4. Sexual acts between children are normal and not harmful Children with SBP should not live with other kids Children with Sexual Behavior Problems (SBP) have been sexually abused Children with SBP should be placed in specialized inpatient/residential tx Children with SBP should not attend public school Children who have been sexually abused act out later sexually with other kids Without long term intensive tx they will continue to have sexual behavior problems Girls rarely have sexual behavior problems Children with SBP grow up to be adult sex offenders HANDS UP: TRUE OR FALSE? 12 AND UNDER

5. Some sexual behavior between children is not appropriate With intervention and treatment, most children with SBP can live safely with other children Sexual acts between children can be significantly harmful Outpatient treatment can be successful for most children with SBP Many children with SBP have not been sexually abused Most children with SBP can safely attend any school Most children who have been sexually abused DO NOT have SBP’s Most treated children do not continue to have SBP. “short term” 12-32 weeks of treatment. 15% recidivism after 2 yrs As many as 1/3 children with SBP are girls. Up to 65% in preschool age Most children with SBP do not demonstrate continued SBP into adolescence and adulthood *14* FACTS OF 12 AND UNDER

6. Sexual PlayProblem Sexual Behavior Exploratory and spontaneousFrequent, repeated, compulsive Intermittently and mutual agreementAggressive, forced or coerced, causing harm Similar age, size, development level No fear, anger or anxiety present Varying sizes, ages, developmental level Decreases when told to stopDo not decrease when told to stop Controlled by increase of supervision Often occurs between siblings, cousins, peers Occurs between children who do not know each other well. Becomes more sneaky if supervised more PLAY VS. PROBLEM BEHAVIOR 12 AND UNDER

7. SEXUAL BEHAVIOR CHARTS FOR CHILDREN

8.  Child’s age  Level of stress in the family  Family violence  Family sexuality  Time spent in daycare  Size of family living space  Neighborhood in which they live  Age of siblings  Exposure to sexuality  Level of sexual interest  Parental, religious, societal, cultural norms, values and attitudes regarding sex and sexuality FACTORS EFFECTING NORMAL CSB

9.  Confusion regarding what they see in media  Lack of adequate supervision  Neighborhood, single parents, rejection by mother, poverty  Homes with sexualized environment  Homes with little or no physical, sexual or emotional privacy  Child meeting parents emotional needs which may be sexualized-substitute partner role  Adults in home become sexualized after drugs/alcohol  Pairing of sex and aggression in home  Sex used for exchange in the home  Physically, emotionally abused or neglected  Sexual abuse-direct or indirect  Physically or hormonally different from other children WHAT PUSHES KIDS BEYOND CSB

10.  Sexually reactive children (largest group)  Can be distracted from engaging  Self directed and directed towards others  No coercion or force used  Respond to no  Fear, anxiety, confusion is the basis  Children who engage in extensive mutual sexual behavior  Full spectrum adult behaviors  Distrustful, hurt and abandoned by adults  Connect with other kids to cope with abandonment loss and fear  Difficult to stop bc don’t se anything wrong with it  Children who molest other children  Sexuality and aggression closely linked, target specific selection  Frequent and pervasive, use coercion, have problems in all areas CONTINUUM FROM NATURAL TO ABUSE

11.  Sexually explicit conversation with peers  Obscenities and jokes within cultural norm  Flirting, innuendo, courting, “sexting”?  Interest in erotica  Solitary and or mutual masturbation  Foreplay (making out, fondling)  Monogamist intercourse (stable or serial)  *6* NORMAL TYPICAL ADOLESCENT SEXUALITY

12.  Preoccupation/Anxiety regarding sex  Pornographic interest  Promiscuity/Polygamist Behavior/Indiscriminant Contact  Sexually Aggressive Themes/Obscenities  Violating others body/personal space  Pulling skirts up or pants down  Single occerance peeping, exposing, frottage, with KNOWN peers  Mooning and Obscene gestures  *6* YELLOW FLAGS

13.  Compulsive masturbation (especially chronic or public)  Degredation/Humiliation of others using sexual themes  Attempting to expose OTHERS genitals  Sexually Aggressive Pornography  Sexual conversation with significantly younger children  Touching and grabbing others genitals without permission  Verbal or written sexually explicit threats  Sadistic acts (cutting/mutilation)  *6* RED FLAGS

14.  Sexual abuse, molestation, harassment  Obscene phone calls, chat, texts etc  Voyeurism  Exhibitionism  Frottage  Child sexual abuse  Rape  Bestiality  Penetration including using weapon or foreign object  *6* ILLEGAL BEHAVIORS

15.  Exploration/curiosity  What’s this all about? Self/others  Imitation/learning  See/do/practice/teach  Sensation seeking arousing when bored/ calming when stressed  Reinforcement: feels good  Arousal, orgasm, tension reducing  Pleasure: self/others  Relationship, intimacy, friendship, love  Compensation/improvement  Feel better, do better, regain self image or control  Anger/retaliation get back at others, make others feel hurt, angry MOTIVATION FOR SEXUAL BEHAVIOR

16.  PTSD 60% male/40% female  Sexually Reactive, unresolved grief/trauma, repeatedly violate boundaries  Repetition compulsion to regain control over own abuse, use relapse prevention  CBT, DBT etc, respond well to therapy, gravitate to victims at their “stuckness”  DEVELOPMENTAL DELAYS-FASD  Require structure and supervision, No Cognitive Behavioral, Concrete  MENTAL HEALTH  OCD, RAD, ADHD, Bipolar, PDD, concurrent disorder treatment  *2* OFFENDER UMBRELLA

17. FEMALESMALES Same gender offences typicallyOpposite gender offences Sibling targets typicallyMore offending towards non- immediate Romance, love, fantasy elementSee child as object/means to an end Mostly contact offencescommit non-contact offenses more Tend to take more responsibilityBlame victim more Longer offendingMore impulsive shorter term offenses More empathetic towards victimLess offenders-fluid with physical abuse Not usually arousedAre aroused during Abused by male figure (father)Absent or inconsis. male figure (father) DIFFERENCES IN FEMALE VS MALE ASO

18.  1. Motivation to offend  A. Emotional needs  B. Sexual needs  C. Blockage 2. Internal Barriers 3. External Barriers 4. Victims Resistance *7* HOW DOES THE OFFENSE OCCUR?

19. FOUR PRECONDITIONS MODEL *7*

20.  Consent vs Compliance/Cooperation  Coercion  Equality Rules of Consent: Same level emotionally Appropriate age (2 years) Honesty about what’s to occur Both Say “Yes” Permission to say “no” at any time Both understand what is going to happen No impaired thinking Both clean and sober Equal intelligence Affection/existing relationship *12* EVALUATING SEXUAL INTERACTIONS

21.  Understanding Lapses vs Relapses  Grooming, Maintenance, and Gateway Behaviors  Thinking errors  Warning signs  Prevention/coping steps  IMPULSE CONTROL METHODS:  Thought stopping  Urge or impulse charting  Thought switching  AROUSAL CONTROL METHODS:  Masturbatory reconditioning  Boredom tapes  Vicarious Sentitization  Empathy Covert Sensitization  Offending fantasy, empathy scene, positive scene  Covert sensitization  Offending fantasy, negative scene, positive scene  *12* RELAPSE PREVENTION PLANNING

22. DEVIANT CYCLE-THINKING ERRORS *12*

23.  Address physical boundaries in all areas of offenders home/school/work etc  Knock when door closed, no locks on inside of door, no shared bed  Children of opposite sex should not share room after 5 years of age  Children should not share bedroom with parent after age one  Sexually abused children may not cuddle in bed with parents One person in a room/bathroom at at time Rules around play Touching between offender-victim SAFETY PLANNING

24. Clothing- noone should be in underwear only Touching- always ask permission, no viewing others privates Being alone with others-have a “witness”, never allow babysitting Horseplay/wrestling/tickling-limited-clarify hugs, kisses affection etc Feelings-emotional boundaries One on one time with parents Technology-monitor ALL means of access to internet, cell phone, chat  no Sexual talk or innuendo with media  No drugs or alcohol  Never put child in charge of discipline and caretaking  No gift giving between offender-victim SAFETY PLANNING CONTINUED… * 8*

25.  Physical pleasure  Peer pressure  Proving man or woman hood  Parental pressure  Curiosity-new experiences  Love and affection  Risk taking  Wanting to get pregnant  Wanting to be an adult  Rebelling against parents  Public opinion  Wanting to hold on to boyfriend or girlfriend REASONS YOUTH HAVE SEX

26.  Am I feeling pressured to have sex?  Will having sex fit my moral or religious beliefs?  Will I feel guilty if I have sex?  Do I want to have sex to get love, affection or attention?  Do I want to have sex to prove that I am sexually attractive?  Am I afraid that my reputation will be hurt if I have sex?  Do I think sex will bring my partner and me closer together, both emotionally and physically?  Do my partner and I both want the same things from sex?  Can I talk to my partner about birth control and can we share the responsibility for birth control?  Can I talk to my partner about sexually transmitted diseases?  If birth control fails, are we ready to deal with an unplanned pregnancy?  YES to 1,3,4,5,6 or 7 or NO to 2,8,9,10, or 11 use caution  *9* AM I READY FOR SEX?

27.  Never force  Respect ‘no’  Avoid potentially difficult situations  Be prepared  There is a shared responsibility in sexual relationship  Communicate openly about contraception  Sexual privacy should be respected  Be considerate of others  Sexual harassment is not a joke  *10* SEXUAL ETIQUETTE

28.  Make sure you are aware of your own level of comfort talking about sexual issues  Sit at 90 degrees from the child  If you are asking about negative or embarrassing issues, assume there’s more  If you are asking about normally expected issues, assume there is none  Be careful not to supply the answer-be willing to sit in silence  Use concrete materials (family trees, maps, floor plans, timelines, pictures, charts)  Areas: social, school/vocational, Non-sexual Delinquency, Emotional Expression (non-sexual), Self esteem, sexual development, masturbation, sexual victimization, sexual offense, denial, minimization, sexual attitudes, non-offensive sexual relationships, family issues, living environment  *11* ASSESSMENT INTERVIEWING AND INTAKE

29.  Do not overreact as most sexual behaviors in children are within the typical or expected range  Inappropriate or problematic sexual behavior in children is not a clear indicator that a child has been sexually abused  Most children will stop the behavior if they are told the rules, mildly restricted, well supervised and praised for appropriate behavior  If the sexual behavior is problematic as described above-refer to treatment  If behavior extends to other environments-seek treatment  *1* REMEMBER:

30.  1 National Center on Sexual Behavior for Youth-(NCSBY) Sexual Development  2 Mike Boniello- Sexual Offending Youth  3 PHASE Typology of Adolescent Sex Offenders- Michael O’Brien and Walter H. Bera, MA  4 Typologies of Juveniles Who have Committed Sexual Offenses- Tom Leversee, LCSW  5 Female Perpetrators Typology and Treatment issues-Susan Peddie, MSW, RSW  6 Range of Adolescent Sexual Behavior-Ryan  7 Theory of “Four Preconditions: A Model” Finkelhor, D (1984) Child Sexual Abuse: New Theory and Research (pg. 53-68) New York: Free Press.  8 Childhood Sexuality: It’s Perfectly Normal- Wayne Duehn, Ph.D.  9 Am I Ready For Sex? HIV/AIDS network of Southeastern AB  10 Sexual Etiquette- Contraceptive Technology Update  11 Interviewing Adolescents who have sexually offended-Worling, 2009  12 Pathways : A Guided workbook for Youth completing treatment- 3 rd  13 NCSBY Fact Sheet- Adolescent Sex Offenders  14 NCSBY Fact Sheet-Children with Sexual Behavior Problems REFERENCES

31. EXTENDED REFERENCES *1*

32. EXTENDED REFERENCES *13*

33. EXTENDED REFERENCES *13* CONT.

34.  Please feel free to contact me:  Ana Saldivar-Schlosser, MS, LPC, NBCC, R. Psych (p)  atschlosser@gmail.com atschlosser@gmail.com  918-508-1567 THANK YOU!!