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Don’t Shoot: We’re Your Children. What We Know about Children and Adolescents with Sexual Behavior Problems

Don’t Shoot: We’re Your Children. What We Know about Children and Adolescents with Sexual Behavior Problems. Barbara L. Bonner, PhD Center on Child Abuse and Neglect University of Oklahoma Health Sciences Center (405) 271-8858. National Youth Protection Symposium Boy Scouts of America

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Don’t Shoot: We’re Your Children. What We Know about Children and Adolescents with Sexual Behavior Problems

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  1. Don’t Shoot: We’re Your Children. What We Know about Children and Adolescents with Sexual Behavior Problems Barbara L. Bonner, PhD Center on Child Abuse and Neglect University of Oklahoma Health Sciences Center (405) 271-8858 National Youth Protection Symposium Boy Scouts of America Atlanta, GA November 1-2, 2012 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

  3. Terminology and Definition • Children with sexual behavior problems (CSBP) • Child ages 6 - 12 • 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 • 1980s • 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

  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

  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

  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.

  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.

  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%).

  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

  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.

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