Aug 9, 2009

Children with Sexual Behavior Problems

Children with Sexual Behavior Problems

Arthur Becker-Weidman, Ph.D.

Children with sexual behavior problems, a broad category including such diverse behaviors as public masturbation, touching others, and aggressive behaviors, are challenging for the adults in their lives. The most recent issue of Child Maltreatment, Vol. 13, #2, May 2008 is devoted to this topic. The issue describes important material regarding assessment, treatment, policy and stereotypes.

I found the material that countered “common knowledge,” most interesting. Do children who have been sexually abused develop sexual behavior problems? Yes, they do have increased rates of sexual behavior problems (SBP), as do other children with other types of trauma. In fact exposure to violence has a much stronger association with SPB’s than does prior sexual abuse. The material makes clear that SBP’s are complex behaviors with multidimensional elements.

The issue is encouraging and supportive of our work. Several articles make the point that including the family in treatment is an important element of efficacious treatment.

The article by Mark Chaffin on policy is very interesting. The perception that youthful sex-offenders are high risk, unique and require special treatment, are homogeneous, and impossible or very difficult to treat turns out to be false. Research shows that children with SBP’s pose a low long-term risk for future child sexual abuse perpetration and sex crimes. For example, for teenage sex offenders the long-term future sex offense rates are between 5% (for those who received treatment) 15% (for those without treatment). For pre-teen children the range is 2% to 10% at ten year follow-up. At ten year follow-up the rate of sex abuse perpetration among those with SBP’s who received treatment was no different than for those children with ADHD. This and other material supports the argument that the policy issue of putting such children on public lists is simply bad policy. Other material shows that children with SBP’s do not require specialized treatment and that generally effective treatment approaches are effective for these children.

There are several other excellent articles in this issue. One describes the impact of various maltreatment experiences on sexualized behaviors. Another describes predictors of SPB’s among children with complex histories of maltreatment. There are two outcome studies and a very well written meta-analysis of treatment for children with SBP’s. Finally, the issue ends with the Report of the ATSA Task Force on Children with Sexual Behavior Problems which describes best practices for the evaluation and treatment of children with SBP’s and various policy recommendations.

In summary, this is an outstanding journal issue and it should be in every clinician’s library.


Anonymous said...

So I geuess the question doctor is this:

What is the bridge then to sexual offenders that sexually assault another person? My question is, we have been told all along that if you are sexually abused as a child, you will most likley be a sexual offender as an adult.

Obviously, sexual offenders just don't decide to become sexual offenders at say, 23 years old. I just wonder what other factors come into play?

Very interesting read.


Arthur Becker-Weidman, PhD said...

Dear Michael,

Great question and topic, thanks.

The special issue makes clear that children who have sexual behavior problems as children are NOT likely to become adult predators. The incidence is about 15% for untreated children and 5% for those treated with good child therapy approaches. BTW, about 5% of children with ADHD go on to become adult predators.

There are many factors that go into a person becoming an adult offender. Early family experiences, various personality and temperament and disabilities of various sorts can be factors. There is no one set of factors that "usually" lead to a child become an adult predator. The fact is that we cannot predict which children will become predators; even if "after the fact" it seems clear.

Does this help?

RADOnline said...

Dear Dr. Weidman,

Great response! :-) I was just talking to another LISW -S today and we both agreed there is a massive problem.

We are a reactive society and has to act shocked when "Predators" hurt anyone.

Until our society take a proactive approach to this problem (and many others), it's going to continue and get worse.


Arthur Becker-Weidman, PhD said...

Dear Michael,

Thanks for you comment. The special issue is very important, especially for professionals who work with children and, accepting the common wisdom, assume most children with sexual behavior problems will become predators as adults.

This is another reason why good research and practice research is so important.

RADOnline said...

Dear Dr.Weidman,

I really like this conversation. Too bad it can't happen with more R.A.D. Survivors and clinicians to inspire change!

If we have to accept the fact that NOT all children that have been sexually abused will abuse why do we then have to accept that fact that all "Predators" will re-offend?

I like to think that if we are talking about reasserting our positions of child turned predator shouldn't we be doing the same for adult offenders?

I wonder what what would happen if we applied this very proactive logic to treating adult offenders what the outcome of such research wuold be?


Arthur Becker-Weidman, PhD said...

Dear Michael,

The difference is that the research shows that children with sexual behavior problems are not very likely to grow up to be adult perpetrators. However, the research does show that adult sexual offenders are highly likely to re-offend and treatments are not very effective.

It would seem that the etiology and dynamics are quite different when looking at children with sexual behavior problems and adult predators.