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    Objectives
    • Familiarize yourself with examples of cautionary and problematic sexual behavior.
    • Understand how sexual behavior communicates messages.
    • Know the risk factors for sexual behavior challenges.
    • Use the appropriate terms for children and youth with sexual behavior challenges.

    Learn

    Learn

    Before we delve into exploring sexual behavior challenges, keep in mind that you should always think of children from a whole-child point of view. This means that children’s behavior and development, no matter how disruptive or delayed, are only parts of who they are. It can be easy, given the sensitive nature of sexual development and behavior, to focus in on children’s problems rather than thinking more openly about their uniqueness and strengths. Remember that children’s behavior communicates messages, and an important part of your work as a caregiver is to interpret these messages so you develop a deep understanding of children’s lives, how they relate to the world around them, and the best ways to support their learning and growth.

    Know

    Sexual Behavior Challenges: Cautionary and Problematic

    Now that you have a base of knowledge for normative sexual development and behavior in children and youth, you may be wondering about development and behavior that is not normative. Perhaps you have observed sexual behavior in your work in child care that doesn’t seem to fit into the normative category or wasn’t easily redirected. Let’s start by defining sexual behavior problems, which we will refer to throughout the course as sexual behavior challenges.

    Sexual Behavior Challenges —

    “Children ages 12 and younger who initiate behaviors involving sexual body parts (i.e., genitals, anus, buttocks, or breasts) that are developmentally inappropriate or potentially harmful to themselves or others” (Chaffin, et al., 2006).

    Remember that sexual behavior in children and youth occurs on a continuum, and what is cautionary for one child may be normative for another child and context. Review the table from Lesson One to remind yourself of the general characteristics of each type of sexual behavior.

    As you learn more about sexual behavior challenges, the lines can become even more blurry, especially when considering factors such as children’s intent. Review the table below for examples of cautionary and problematic sexual behavior arranged by developmental stage. Keep in mind that these examples are guidelines, not hard rules. What is normative sexual behavior versus a sexual behavior challenge may vary depending on various factors (culture and family, development, intention, frequency and participation, environment, effect on others, and ability for redirection).

    Sexual Behavior Challenges

     
    Cautionary
    • Rubbing body against others in a sexually stimulating way
    • Trying to insert tongue when kissing
    • Touching others’ genitals
    • Imitating what appears to be sexual acts
    • Continues to masturbate or touch genitals of self or others after adult redirection and beyond developmental expectations
    Problematic
    • Frequent repeated pattern of a variety of sexual behaviors
    • Requesting others to engage in specific sex acts
    • Sexual behaviors that cause emotional or physical pain
    • Advanced sexual knowledge
    • Inserting objects or fingers into genitals
    • Imitating sexual intercourse
    • Touching animals’ genitals
    • Planned and intrusive sexual behavior
    • Mouth to genital contact
    • Pretending toys are having sex
    • Attempting intercourse with others
    • Penetration of self or others with an object to genitals or rectum
    • Coercing others to engage in sexual behavior
    • Engaging in sexual behavior with children 2 or more years younger
    Cautionary
    • More than typical preoccupation with sexual ideas or topics
    • Sexually advanced conversations with peers
    • Preoccupation with masturbation
    • Masturbates, touches/rubs, or exposes genitalia in public
    • Sexually suggestive behavior with toys or peers (clothed)
    • Group masturbation
    • Single occurrences of obscenities, peeping, exposing, nudity, rubbing clothed body against others
    • Greater than typical interest in or attempts to see others' private parts
    • Drawing sexual images
    • Advanced sexual knowledge for age and development
    • Frequently uses sexual language that makes other children uncomfortable
    Problematic
    • Sexually advanced conversations with peers and children of different ages
    • Touching others private parts
    • Rubbing others’ bodies
    • Initiating unclothed intercourse with peers
    • Demeaning of own or others genitals
    • Forcing others to expose themselves or to touch private parts
    • Use of threats, force, or aggression to engage in sexual behavior
    • Genital injury or bleeding not explained by accident
    • Repeated pattern of obscenities, peeping, or exposure
    • Interest in pornography
    • Masturbation that affects participation in other activities
    • Masturbation that involves penetration and/or use of objects
    • Penetration of any kind with children or animals
    • Mimicking intercourse with toys, peers, or animals
    • Sexually exploratory behavior with children 2 or more years younger
    Cautionary
    • Preoccupation with masturbation
    • Masturbates, touches/rubs, or exposes genitilia in public
    • Advanced sexual knowledge for age and environment or culture
    • Attempting to expose the genitals of others
    • Occasional incidents of looking at others private parts, exposing their own private parts after adult redirection and beyond developmental expectations
    Problematic
    • Compulsive masturbation or touching private parts in public
    • Masturbation with an object
    • Inserting objects into vagina or anal cavity
    • Touching or trying to touch adult’s private parts
    • Putting mouth on mother's or other woman’s breasts
    • Putting mouth on another individual's genitals (child or adult)
    • Touching another child’s private parts
    • Touching animal genitalia
    • Exposing private parts to adults or other children
    • Asking others to engage in sexual behaviors
    • Sexually explicit threats--written or verbal
    • Intrusive, aggressive, or coercive mimicking of adult sexual behaviors
    • Attempting to have sexual intercourse with another child or adult
    • Intercourse
    • Attempting to undress other children against their will
    • Forcing exposure of other's genitals
    • Rape
    • Chronic pornographic interest or use
    • Interest or use of child pornography
    • Engaging in sexual behaviors with another child who is 2 or more years younger

    What are your initial feelings about the behaviors described? Perhaps you’ve observed some of these behaviors in your work, or you may feel shocked or upset. While it is upsetting to think of children in some of the circumstances described, knowledge builds understanding and awareness. It is difficult to give an estimate for how common sexual behavior problems are in children and youth because there are not definite descriptions for what is normative versus a sexual behavior challenge. Some research suggests 2 to 3 percent of children will demonstrate sexual behaviors problems (Carpentier et al., 2006; Chaffin et al., 2008); whereas, the majority of children display some normative behaviors at some point during childhood (Kellogg, 2009). It is likely that you will encounter children with sexual behavior challenges at some point during your work in child care. The more informed you are about these behaviors, their complex nature, and how to respond, the more supportive you can be to these children and their families.

    Behavior Communicates Messages

    Take some time to think about sexual behavior challenges from the perspective of children, and remember that behavior communicates messages. When children and youth have sexual behavior challenges, what messages do you think they are trying to communicate? As you explore this question, it may be helpful to think generally about challenging behavior. “Acting out,” “disobeying,” and “inappropriate behavior” are often the result of children lacking the developmental and relationship-building skills needed to meet the expectations of the adults around them. When children have sexual behavior challenges, they are often trying to communicate the following messages:

    • “I don’t understand what I’m supposed to do.”
    • “This is how I know to communicate, get attention, and interact with others.”
    •  “I don’t have the skills to do what you want me to do.”
    •  “I cannot cope with the demands you place on me.”
    • “I’m confused by the different expectations of the people in my life.”

    As you reflect on the statements above, how do these messages influence your thoughts on children with sexual behavior challenges? Do you see cautionary and problematic sexual behaviors as “acting out,” “disobeying,” and “inappropriate?” Or do you suspect children with sexual behavior challenges feel confused, scared, and unsure of themselves? If you have observed sexual behavior challenges in your program, think back on those experiences and the messages those children may have been trying to communicate. Though we do not view sexual behavior challenges as ideal for children’s development and well-being, some children may have had experiences where these behaviors are adaptive for them or provide them something they need. For example, some children engage in sexual behaviors to cope with trauma or to gain relational closeness with others (Gilgum, 2006).

    Risk Factors for Sexual Behavior Challenges

    Sexual behavior problems occur in children for a variety of reasons, and there are often multiple factors that contribute to children and youth having these behaviors. Review the risk factors that increase the likelihood of sexual behavior problems in children and youth.

    • Lack of understanding about personal space (very common in children)
    • Observed more in girls during the preschool years and boys during the school-age years
    • Family adversity (poverty, minimal family support, limited educational opportunities, trauma)
    • Increased family sexuality (attitudes towards sex, nudity, and privacy; modeling of sexualized behavior)
    • Exposure to violence (domestic, community, war)
    • Placement in foster care (especially frequent home changes )
    • Increased number of stressful life events (family separation, incarceration, divorce, parental death, parental illness with hospitalization, child illness with hospitalization)
    • Emotional, behavioral, or developmental challenges or delays
    • Increased parental stress
    • Physical abuse
    • Exposure to sexualized media
    • Strained parent-child relationship
    • Limited supervision and monitoring
    • Coercive parenting and harsh discipline
    • If sexual abuse has occurred, multiple abusers
    • If sexual abuse has occurred, penetration
    • If sexual abuse has occurred, preschool-age children are more likely to display sexual behavior challenges than children of other developmental ages

    Children with sexual behavior challenges often exhibit other challenging behaviors and social difficulties such as a lack of impulse control, difficulty following the rules, difficulty making friends or initiating play with others, and limited self-regulations skills. Learn more about challenging behaviors including prevention strategies and how to provide appropriate supports to children experiencing behavior challenges in the VLS Focused Topics Course Supporting Children with Challenging Behaviors.

    When Sexual Behavior in Children and Youth May be a Sign of Abuse

    If you recall the information you’ve learned elsewhere on the Virtual Lab School, there are some shared risk factors for sexual behavior challenges and child abuse and neglect. Nevertheless, it is important not to assume that children with sexual behavior problems have also been abused. There are many instances where children with no history of abuse or neglect have sexual behavior challenges. Review the Child Abuse: Identification & Reporting course if you need support in determining whether an observed sexual behavior may be a sign of abuse and warrants a mandated report. This can be very difficult to do, and these situations are often stressful and upsetting for child care professionals. If you are unsure whether you should make a report or if you feel you need support after making a report, speak with a coach, trainer, or administrator. Remember that it is not your role to determine if abuse has actually occurred, but you have fulfilled your duty as a mandated reporter and possibly stopped child abuse from further occurring when you report suspected and definitive child abuse and neglect.

    See

    Children with sexual behavior challenges benefit most when adults recognize they have these challenges early. Listen as experts describe sexual behavior challenges, risk factors that may make children more susceptible, and protective factors or conditions that help children overcome sexual behavior challenges. Protective factors support children through adversity. Can you think of other circumstances when protective factors minimize risk to children’s well-being?

    Sexual Behavior Challenges

    Listen to experts speak about sexual behavior challenges.

    Do

    Language Matters: Speaking about Children and Youth with Sexual Behavior Challenges

    Think back to the reflective opportunities in Lesson One of this course when you thought about your own experiences and beliefs on sexual development and behavior in children and youth. You learned that there are a wide range of cultural and personal beliefs around this topic that influence one’s comfort level and also frame reactions to sexual behavior in children. Keep this in mind when you communicate with coworkers and families about children and youth with sexual behavior challenges. Similar to when you speak about children with disabilities, use person-first language. For example, “Lora has a history of sexual behavior challenges” is preferred over, “Lora is a problem child,” “sex offender,” “abuser,” or “sexual predator.” These terms stigmatize children and are inaccurate, given that the vast majority of children with sexual behavior challenges who receive research-based intervention do not continue these behaviors into adolescence and adulthood (Silovsky, Swisher, Widdifield, & Burris, 2012). The language used to describe children with sexual behavior challenges can affect how your program’s community and other systems of support, such as child welfare and law enforcement, make decisions. A term such as “sex offender” can have specific meaning to someone in law enforcement who may have little or no training on child development. A sex offender is a legal term for someone who has been convicted of a sexual offense.  Also, what messages do we send children when we label them in this way? How do you think children and youth feel when they are called terms such as “deviant”? Children, their families, and the community may interpret some terms to mean that these children are bad, rather than guiding them to understand that what they did was wrong, but it does not mean they are bad children. Shaming children can deeply affect their social-emotional well-being and future behaviors, and it is important to use a whole-child point of view when supporting children with sexual behavior challenges. Review the examples below for appropriate versus inappropriate terms for children with sexual behavior challenges. 

    Appropriate Terms

    • Sexual behavior problems
    • Sexual behavior challenges
    • Non-normative sexual behavior
    • Atypical sexual behavior
    • Objective statement of the specific behavior (e.g., “Miles mimics intercourse-like behavior”)

    Inappropriate Terms

    • Sex offender
    • Child abuser
    • Sexual predator
    • Pervert
    • Deviant
    • Perpetrator

    Preventing Sexual Behavior Challenges through Community-Wide Safe Media and Technology Use

    Think about the ever-present role of media and technology in our lives. As it becomes more common for families to have various electronic devices in their homes and for children and youth to spend increasing amounts of time on them, many children’s access to sexually explicit content occurs earlier and through more mediums (TV, social media, internet search, print). Even in family environments where there is close supervision of children and their media use, it is impossible to control everything children are exposed to.

    Peers can heavily influence the sexual knowledge of other children. Children from families who closely follow the American Academy of Pediatrics recommendations (Infants, Toddlers, & Preschoolers; School-Age Children) attend programs with children from families who may have devices on throughout the day with limited supervision. Most families’ practices may be somewhere in the middle, but know that the children in your program have diverse experiences with media at home. Children with more knowledge and exposure to sexual content through media may talk about what they’ve seen and heard with peers, and the sexual knowledge of one child in your program can influence the sexual knowledge of many other children.

    Let’s consider how media use affects the severity or type of sexual behavior. Two 7-year-old children might engage in, “show me yours, and I’ll show you mine” behavior and expose their private parts to each other. This on its own is a normative sexual behavior driven by curiosity and is likely harmless. If one of the children in this situation used a tablet and began to take pictures of child’s genitals, this becomes a much more serious concern and under some laws may be considered child pornography. While you cannot control what happens in families’ homes, family life experiences affect children’s knowledge and behavior while in your program. Building community awareness of the effects media exposure may have on sexual behavior creates a community that is more knowledgeable on how to prevent sexual behavior challenges.

    Explore

    Explore

    Choose at least one Case Study below from the following age groups: infant and toddler, preschool, or school-age, and complete the coordinating activity. Use the Sexual Behavior Reflection Tool to guide your thinking on how to respond to these behaviors. In Lesson Five, you will have the opportunity to revisit these case studies to brainstorm further action steps and support.

    Apply

    Apply

    Through your relationships with families, think about how you can build a community that knows how to prevent sexual behavior challenges. In addition to information on Normative Sexual Development and Behavior (in the Apply section of Lesson Two), consider sharing this Safe Media & Technology Use for Children, Youth, and Families handout with the families in your program.

    Glossary

    TermDescription
    Adaptive BehaviorBehavior that is to one’s benefit in a particular environment
    Continuum Series of steps where the steps directly next to each other may not be that different but the extremes are very different
    PenetrationPlacing a part of one’s body or an object into a bodily opening related to sex
    StigmatizeAttribute a belief of shame or disgrace

    Demonstrate

    Demonstrate
    Assessment

    Q1

    True or false? Children who display sexual behavior challenges have been sexually abused.

    Q2

    Two-year-old Lucy displays a sexual behavior challenge in her preschool program. Select which message is not likely to explain Lucy’s behavior:

    Q3

    Select which example illustrates risk factors for sexual behavior challenges.

    References & Resources

    AAP Council on Communication and Media. (2016). Media use in school-age children and adolescents. Pediatrics, 138(5).

    AAP Council on Communication and Media. (2016). Media and young minds. Pediatrics, 138(5).

    American Academy of Pediatrics. (2020). Media and children communication toolkit https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/Media-and-Children.aspx

    Carpentier, M. Y., Silovsky, J.F., Chaffin, M. (2006). Randomized trial of treatment for children with sexual behavior problems: Ten-year follow-up. Journal of Consulting Clinical Psychology, 74(3).

    Chaffin, M., Berliner, L., Block, R., Cavanaugh Johnson, T., Friedrich, W., Garza Louis, D., . . Silovsky, J.F. (2006). Report on the task force on children with sexual behavior problems. Findings from the Association for the Treatment of Sexual Abusers. Retrieved from https://www.atsa.com/pdfs/Report-TFCSBP.pdf

    Friedrich, W.N. (1993). Sexual victimization and sexual behavior in children: A review of recent literature. Child Abuse & Neglect, 17(1).

    Gilgun, J. F. (2006). Children and adolescents with problematic sexual behaviors: Lessons from research on resilience. In D. Prescott, & R. Lango (Eds.), Current perspectives on working with sexually aggressive youth and youth with sexual behavior problems. (pp. 383-394). Holyoke, MA: Neari Press.

    Healey, A., Mendelsohn, A., AAP Council on Early Childhood. (2019). Selecting appropriate toys for young children in the digital era. Pediatrics, 143(1).

    Horner, G. (2004). Sexual behavior in children. Journal of Pediatric Health Care, 18(2).

    Silovksy, J. F. & Niec, L. (2002). Characteristics of young children with sexual behavior problems: A pilot study. Child Maltreatment, 7(3).

    Silovsky, J. F., Swisher, L., Widdifield, Jr., J., & Burris, L. (2011). Clinical considerations when children have problematic sexual behavior. In P. Goodyear-Brown (Ed.). The handbook of child sexual abuse: Prevention, assessment and treatment (pp. 401-429). Hoboken, NJ: Wiley.

    St. Amand, A., Bard, D. E., Silovsky, J. F. (2008). Meta-analysis of treatment for child sexual behavior problems: Practice elements and outcomes. Child Maltreatment, 13(2).