National Center on the Sexual Behavior of Youth

WHAT CAUSES A SEXUAL BEHAVIOR PROBLEM?

It is often assumed that all children with problematic sexual behaviors have been sexually abused. Research indicates, however, that many of those children have no history of sexual abuse. For example, between one-third and one-half of the children with problematic sexual behaviorswho were seen at an agency who treat these youth have had no history of sexual abuse.

A wide range of other factors cause problems in children’s sexual behavior, not just sexual abuse. The factors that influence a child’s behavior can come from a variety of experiences. Some children…

• have seen a lot of violence or have been physically abused.
• have experienced other kinds of traumatic or scary events. They may not know positive, healthy ways to cope. For example, these children may not yet know the words to describe their own feelings and thoughts, and they may act out instead.
• have not experienced any trauma or abuse.
• may act before thinking. Such children may look at or touch other children’s private parts without thinking about what they’re doing. have problems following rules and listening to their parents, teachers, or caregivers at home, in school, and in the community. These children break a variety of rules, including privacy rules.
• have seen specific sexual acts performed (such as in a movie or music video) and they then act out what they have seen with their friends or siblings.
• have problems making friends their own age. They may instead play with much younger children. They may become curious about sexual behavior when they start puberty and act out with younger children who are their friends and playmates.
• are left on their own to care for themselves, with poorly monitored television and video games as their primary source of entertainment.
• have not had a regular place to call home.
• have parents who struggle to provide close supervision because of a variety of factors, such as depression, substance use, the need to hold multiple jobs, or simply nervousness or insecurity about parenting.

No single factor causes the development of problematic sexual behavior in children. The graphic shows many of the factors that can influence the problematic sexual behavior and how they can interact with each other.

NCSBY OSB Behavior

NCSBY OSB Behavior (Spanish)

Factors Contributing to
Problematic Sexual Behaviors

What If Sexual Abuse is Suspected?

If your child tells someone that another person has touched his or her private parts, or if you suspect a child has been sexual abused, you need to make a referral to Child Protection Services. Some states require that all citizens report any suspected abuse of a child. Ongoing sexual abuse must be stopped to be able to help a child. If you think sexual abuse might have happened, and it has not been previously investigated by Child Protective Services, then you can report what you suspect so that the appropriate actions can be initiated . Reporting suspected abuse to the authorities can be a scary process for some parents. Parents may be concerned that they will be wrongly accused of abuse themselves. It is critical to stop ongoing abuse if it is occurring, and the first step is to call the authorities. Develop a team approach in working with Child Protective Services, express your desire to protect your child, and make sure the right services are provided. More information about Child Protective Services and legal responses are provided.

Caregivers or authorities may suspect sexual abuse when children display problematic sexual behaviors. Results of an investigation of child sexual abuse at times can indicate that the findings are uncertain, meaning that authorities are not able to confirm that the child has been sexually abused, but they also cannot completely rule it out. Caregivers are understandably concerned about what to do when sexual abuse is suspected. In these situations, we caution caregivers against frequently questioning their child during or after an investigation of possible abuse. Questioning a child repeatedly can actually hinder the official process. In addition, it can cause distress and confusion in the child. If no evidence exists of ongoing sexual abuse or exposure to trauma or sexualized materials, children often can respond to treatment of the problematic sexual behaviors. Further, with education about child-abuse prevention skills, children may later reveal details of past sexual abuse, if it had occurred. Abuse-prevention skills help children understand what behaviors are okay and not okay. Those skills teach children that if someone touches their private parts, that person is breaking a rule. Children can also learn which adults to tell when these situations happen. (Abuse-prevention skills are discussed more thoroughly here) Caregivers are advised to be available to listen, but not to repeatedly question children about possible past sexual abuse.

Supportive and Protective Factors

Protective Factors That Prevent the Onset and Continuation of Problematic Sexual Behaviors

Families and communities have many characteristics that can provide protection for children. Identify those positive factors in your own life and connect with groups that support these messages for your children. Some protective factors include

• the ability of informed adults to talk openly to children about relationships, intimacy, and sexual-education matters;
• close supervision and guidance of children;
• opportunities for children to be involved in age-appropriate activities (for example, sports, boys/girls clubs, after-school activities, and craft activities);
• friends who are caring and who make good decisions;
• warm relationships with caring adults;
• clear, positive messages about modesty, boundaries, and privacy;
• protection for your child from scary or traumatic events, including media coverage of such events as wars, bombings, or shootings; and
• closely observing what your child watches on television and in the movies or is exposed to in music and on the Internet.

Impact of Problematic Sexual Behaviors
on Other Children

How does sexual behavior impact children?

Children who experience sexual behaviors initiated by another child can have a wide range of responses. Some children function have no trauma symptoms, nor any other significant behavioral or emotional concerns. Other times children might experience responses that can include:

• re-enact the experience with peers, dolls or stuffed animals,
• demonstrating sexual knowledge and sexual behaviors that are not typical for the age of the child,
• anxiety (such as difficulty in separating from parents),
• anger, aggression, argumentativeness, and defiance,
• symptoms of prolonged sadness, depression, or abrupt mood changes,
• confusion about relationships with peers,
• difficulty making and keeping friends,
• nightmares and fears,
• startling easily to loud noises or sudden movements, and
• avoiding anything that reminds them of the event.

What factors influence how the children may be impacted?

Sexual behavior among children falls on a continuum ranging from typical, to concerning, to problematic, to harmful Behaviors that fall in the typical end of the continuum, also referred to sex play, do not tend to lead to negative impact. For example, the sons in the first example family in the introduction section of the website were involved in sex play. The boys described feelings of mutual curiosity and responded well to education provided by their parents. No negative impact would be predicted.

However, when a child demonstrates problematic sexual behavior (such as sexual behavior initiated by an older child who was aggressive), the experience can have a detrimental effect on the child. For example, the girl who was held down by Jerry in the last example of the introduction may have a variety of trauma symptoms in response. She may have bad dreams, fears, clinginess or other symptoms after that abusive experience.

Factors that influence a child’s response to experiencing sexual behavior problems include:

• the response and support by the parents and other caregivers following the incident(s)
• the length of time in which the sexual behaviors take place (sexual behaviors that occur over a longer period of time are more harmful);
• how many times the problematic sexual behavior happened (sexual behaviors that happen on multiple occasions);
• the type and closeness of the relationship among the children (such as, whether they were siblings, close friends, acquaintances, or strangers);
• how scary the situation was for the child. Fear and worry may be related to age/size difference of the children, and the use of threats, coercion, aggression, or force;
• the type of sexual behavior, such as whether genital contact and penetration was involved;
• the child’s recent functioning (for example, children who were already struggling with depression, anxiety, or other concerns will have a more negative impact to the problematic sexual behavior than children who were happy, had friends, and were otherwise doing well);
• the response and supports by the professionals who may become involved after the incident is discovered. Professionals may be from child protective services, law enforcement, school personnel, and behavioral health specialists. (Whether or not the assessment, investigation, safety planning, and treatment was provided in a child-friendly, calm, and supportive manner can impact child response).

How do I know how best to support my child?

Research indicates that parental responses play a key role in a child’s response to experiencing problematic sexual behavior initiated by another youth. Specifically, remaining calm, and nurturing makes a difference for the children. Clearly communicating the belief in the disclosure along with developing and implementing a safety plan are key elements in a response that will be supportive to your child. Children who show symptoms of distress can be evaluated by a licensed behavioral health specialist (such as a psychologist, social worker, psychiatrist, or licensed professional counselor) with experience in child trauma to determine what supports and help would be best.

What type of treatment may be helpful?

Short-term community-based treatment may be recommended to provide therapy and support to the child and caregivers. If the child is demonstrating trauma symptoms, Trauma-Focused Cognitive- Behavioral Therapy (TF-CBT) may be recommended. TF-CBT is a type of therapy for children who experienced a traumatic event, including problematic sexual behavior from other children. TF- CBT has been identified by multiple federal and state agencies as a “best/model practice” and is considered to be the gold standard treatment for these children. TF-CBT is an out-patient therapy for the child and their caregiver(s) that is typically completed in 12-24 sessions. Some of the things covered in sessions includes teaching children skills for relaxation, emotional expression, coping, problem-solving, and safety planning. In addition, directly addressing the trauma gradually is utilized to reduce anxiety and distress related to trauma memories. Caregivers learn methods for assisting their children with healthy coping and techniques for managing challenging child behaviors. Caregivers also participate in the sessions where the trauma is addressed to learn ways to communicate with their child about the traumatic experience and to enhance the parent-child relationship.

Information about providers trained in TF-CBT can be found here. Information about other evidence based treatments are available through the California Evidence-Based Clearinghouse at www.cebc.com. Local Child Advocacy Centers may be able to provide services directly or facilitate guiding caregivers to treatment options in their community (www.nationalcac.org/locator.html).

Children respond best when their caregiver is calm, supportive, caring, and resourceful. It is important to note that caregivers have a range of responses themselves and may struggle with remaining calm and knowing how to be supportive. Seeking support through friends, family, professionals and resources helps to maintain the strength and patience needed to assist children with coping.

How do I support all the children involved when the sexual behavior occurs within the family?

Caregivers of children who act out sexually with siblings (or other family members such as cousins, niece, etc.) often feel divided and unsure how to provide the right support to all their children. All of the children who are involved will need someone to listen to them and help them cope. Child victims need to know they are believed, they are not at fault, and they are safe. Children who initiated the problematic sexual behavior will need help understanding how their behavior was a bad choice, they are not inherently bad, and they can make respectful choices in the future. It is important that all children are safe and receive caring support for healing to take place.

The specific types of supports provided will differ widely depending on the circumstances, needs, resources, and responses. A variety of professionals, such as from child protective services, law enforcement, medicine, and behavior health, may become involved with the family. The process can be confusing and stressful for the caregivers. It is important for needs, wishes, and resources of all the family members are considered and that services be coordinated, preferably within a single or few agencies.

It is essential that all the children feel and are safe. How this occurs will differ by family and circumstances. Sometimes the children can remain in the same home with safety measures including close supervision in place. Sometimes children will need to live in separate homes while they receive therapeutic services. See Safety planning and Living together, separation, and reunification sections of the website for more information. When family members have to be temporarily separated, planning for safe reunification should start early. Often family therapy prior to reunification facilitates the transition home.

How many children have
problematic sexual behavior?

No one knows how many children have had problematic sexual behaviors during their lives. No specific entity or agency is in charge of these youths or tracks their behavior. Sometimes, Child Protective Services are involved with children with problematic sexual behaviors, especially when the children have been abused or neglected. At times, juvenile or family court could also be involved, especially with older children. Over the last two decades, child protective service systems and juvenile services have had more referrals of children with problematic sexual behaviors. We don’t know if these referrals represent a true increase in the number of children with problematic sexual behaviors, or if they represent a greater public recognition of and response to the problem, or a combination of both.