Problematic Sexual Behavior

Do you worry about what is normal in your child’s sexual development? Join us to talk with Roy Van Tassell, a Licensed Professional Counselor in Oklahoma and Director of Trauma and Evidence-based Interventions for Centene Health. He co-chairs the National Child Traumatic Stress Networks’ subcommittee on children with problem sexual behaviors.

Warning: We will be using anatomically correct words and talking about sex, so if this offends you or triggers you, you may want to skip this podcast.

In this episode, we discuss:

• Typical Sexual Development / Play
  • What is typical sexual development in children as they age?
  • What type of sexual play is considered “normal?”
  • How should parents manage a child’s natural sexual development?
• Problematic Sexual Behavior
  • What are Problem Sexual Behaviors in Children?
  • What causes kids and youth to act in socially unacceptable or destructive sexual ways? What factors influence the development of these behaviors?
• Child vulnerabilities
  • Behavior problems
  • Emotional difficulties
  • Developmental delays
  • Low impulse control
• Family vulnerabilities
  • Poor supervision
  • Single caregiver
• Modeling of coercion
  • Harsh parenting practices
  • Physical abuse
  • Domestic violence
• Modeling of sexuality
  • Sexual abuse
  • Modeling/exposure
  • Nudity or poor family boundaries
• How common are problematic sexual behaviors?
• Suggestions for professionals and parents and how to respond to behaviors.
• What should parents and caregivers do?
• Rules for younger kids
• How effective is therapy?
• How to find a therapist?
  • What training have they had in this area?
  • Child development expertise (including sexual development)
• Resources
  • Taking Action booklets (two booklets) – for children with problematic sexual behaviors (age 12 and younger) and one for 13+
  • Resources at the National Center on Sexual Behavior of Youth – really good resources for caregivers and parents.
  • National Center for Exploited Children—for kids to understand safety—teaching them safety skills to protect their own body
  • Amaze.org—videos for children
  • National Child Traumatic Stress Network
    • A.J.’s Story— A Book About Not OK Touches

Transcript

Please pardon any errors, this is an automated transcript.

Welcome to Creating a Family, talk about adoption, foster care, and kinship care. I'm Tracy Whitney, the content director for creatingafamily.org and the host for today's conversation. Creatingafamily.org is the national nonprofit that exists to support and strengthen adoptive, foster, and relative caregiving families and the professionals who serve them.
Today, we're sharing a classic interview from our archives, featuring our founding executive director, Dawn Davenport. She spoke at length with Roy Van Tassel, a licensed professional counselor in Oklahoma and director of trauma and evidence-based interventions for Centene Health. He also co-chairs the National Trial Traumatic Stress Network's subcommittee on children with problem sexual behaviors.
I want to give a bit of a warning. This interview uses anatomically correct words and they talk frankly about sex and sexual behaviors. If you have little ones in the room while you're listening, you might want to consider redirecting them to other activities or popping in some earbuds while you listen. And if these topics are triggering or offensive to you,
Please take care of yourself. And we invite you to join us again next week to listen to another interview that will support and strengthen your family. And so now let's get to the interview. Welcome, Roy, to Creating a Family. I am looking forward to this discussion. Thank you, Dawn. I appreciate the opportunity to be here. Looking forward to it as well. So we're going to be talking about problematic sexual behaviors in children and youth. But I think before we begin to talk about...
problematic behaviors, I think it is helpful to understand typical sexual development in a normal child. So let's walk through typical sexual development in children and what are some of the behaviors that you would see that are just a healthy part of growing up?
Sure. And this is a question that comes up a lot, Dawn. And amazingly, a lot of medical professionals are often not comfortable in even addressing some of these issues with caregivers. You're so right. You know, don't know what to ask. And that comes from not just my own speculation. We have members of our problematic sexual behavior work group who are physicians or pediatricians, and one of them who trains residents. And she said, you know, my residents are incredibly uncomfortable with having these conversations with caregivers.
Not sure what information to address. And caregivers are equally as, not only are they, I think they are naive and perhaps have amnesia about their own, or maybe just don't remember. I keep thinking, do you not remember being a kid and being curious? But nonetheless, I think it's across the board. So go ahead. I agree. And, you know, my point there was just that if we have professionals who are uncomfortable with this, or, you know, at least the medical professionals we know have the right biological information, but if there's discomfort around talking about that.
You know, it's no surprise that the caregivers can feel that way. And often mental health professionals that are consulted really don't have the information about typical child development, especially when it comes to sexual development. So to kind of launch in, you know, that typical sexual development is part of the child's overall development. It's part of that natural curiosity, kind of how we learn about the world. You know, young children learn by observing, closely observing, mimicking others.
Form of flattery. Well, what if your child imitates something that they've seen at home that they shouldn't demonstrate in public or somewhere else? So it's kind of how we learn about the world. But it's also very much shaped by the family's individual values and beliefs, their comforts within their family about conversations, about understanding certain things. Some cultures, for example, you know, very much celebrate and have rituals to kind of as children move into puberty.
And others don't. You know, there's a lot of variation in terms of how that's addressed. But children are very curious. They want to know the differences between how their body compares to a sibling who may be of a different gender or to an adult, even of the same gender. They may be curious about, you know, how daddy's body looks different than my body or mommy's body looks different than mine. But it's also more complex than that. We all develop psychologically, emotionally, socially in the context of relationships.
So all of this fits together. Our physical development, our emotional development, and our sexual development are part of how we view ourselves, how we understand our relationship with others. But it's also the first lens through which we really see intimacy or experience intimacy.
When there's a hug or contact, you know, it's, we may be very comfortable and familiar with giving hugs within our family. And then a cousin shows up who's maybe the opposite gender and a similar age. And they want us to hug that person. And it's all of a sudden, you know, the child's aware of those differences. And does this feel comfortable or not? Does this feel naughty? Does this feel, you know, it can be a very turbulent time for children to sort of understand what are the rules here and how do I express my curiosity and get my questions answered?
typical sexual play for children, it's generally speaking, very exploratory. They're trying to figure out how things work, how they differ, how they feel, because like other parts of our body, like our lips and our fingertips, genital areas are full of a lot of nerve endings. They're very sensitive. We learned pretty early on touching those is a good feeling. We want to repeat that. Anybody who's parented young children know that they, particularly little boys, they enjoy touching their penis. It feels good.
Absolutely. And they can have spontaneous erections at a very young age. You can have a child changing a diaper and a boy who's, you know, very young, you know, can have a response. Yeah. So, you know, parents often construe that to maybe mean something and their body is physically reactive and it's growing and it does what bodies does. So when the play begins, generally speaking, it's usually between, well, it makes sense that it's going to be.
connected to people who are in the closest proximity with you. So usually your family or cousins or friends that you're close to, you spend time with. Younger boys tend to spend time with boys. Younger girls tend to spend time with younger girls. So not surprisingly, any kind of sexual play is going to start.
with who's in your neighborhood, who's close to you. And it tends to be spontaneous and very much intermittent and very much based on the circumstances. They're changing after they've been swimming or having some other activity or getting ready for bed or they're having a blanket tent camp out in the bedroom or whatever. It tends to be very opportunistic.
Some studies have found is one of the things we should probably say in our conversation today about studies is that it was very difficult and perhaps very unethical to do certain kinds of studying on children related to sexual behavior and other kinds of things. So a lot of the data.
is inferential, particularly when it comes to problem sexual behavior, how much they use online, media, those kinds of things. It's just obviously clear sensitivity to do research on children around some of these top areas. Yeah, as there should be. As there should be. However, when it comes to sexual development and typical development, we know a lot about that. And it's a lot of just observational.
So typical sexual play when it begins between children is usually sort of by mutual agreement. That kind of that old, I'll show you mine if you show me yours. Or, you know, those little moments when they step closer to each other in terms of contact or questions or curiosity or whatever, usually is by mutual agreement. And typically, children of similar age and development, when it gets out of that boundary, like very different, you know, age differences, that's a different concern. But we'll get to that.
shortly. But importantly, when children begin their sexual play and exploration, it's more accompanied by curiosity and interest and really trying to
find things out. And yeah, maybe there's a pleasurable aspect to that. But importantly, it's not accompanied by feeling weirded out and very anxious or fearful or afraid about what's going to happen. When it falls in that realm, it's kind of typical sexual play. It tends to be mimicking and curious and driven from that direction. You've said mimicking, and yet it seems to me that adult sexual behavior...
should not be something that children have ever witnessed. I mean, yes, as you get older, you may have walked in on mom and dad, but that wouldn't be the typical. So what do you mean by mimicking?
Well, mimicking starts with, you know, how people touch and children often observe people in public, whether it's in their family or, you know, in some public place where, you know, there may be cuddling, there's kissing, there may be touching body parts externally, you know, hand. I mean, you watch a football game and see guys with hands on butts. So children, not surprisingly, are going to mimic some of these things and don't always understand the social context in which they occurred. And depending on what sort of they've been exposed to.
their family. So many families internally have very different boundaries around touching. And parents may assume, or the adults, I should say, maybe it may assume that, of course, they have permission to do these behaviors and may assume that, oh, well, kids know that these are not for kids, these behaviors that we're doing.
Kids don't necessarily know that. And they may demonstrate a behavior that they've seen someone else do. So think here along the lines of things like always in school, beginning to snap a girl's bra strap or make sexual comments or do other kinds of touching that might involve trying to embarrass or get the other person's attention. It may be easily over the line, but it's something that may have witnessed in their own home or among other peers.
What about family nudity? Because I think that there is a huge variety in what adults are comfortable in from the range of families that don't allow any, your children would never have seen even the same-sex parent undressed or even in their underwear, to families who, I'm sure there are families who are very, when they're changing bathing suits.
all mixed ages are allowed to be in and mixed ages and mixed genders so yeah what about the comfort level of families
That is a huge piece, Don. And it's one of those things that often kind of can get kids into some difficulty because what might be typical in your family may not be elsewhere. Some families are buttoned up from, you know, neckline to the top of your shoes and other families very, very uncomfortable. I've known families over the years that I grew up with in my neighborhood, kids that I knew, families, you know, it wouldn't be unusual to come in in the middle of the afternoon to find dad sitting in his underwear in his lounge chair watching TV and watching a football game. And many families like that would never.
happen. So it depends on those family boundaries and what kids are sort of used to with that. Again, sometimes for families, there are those very permissive boundaries where certain levels of nudity may be sort of typical within the family. But sometimes those children learn that there's nothing unusual about that. That's not a nasty or a sexual thing. It's just a thing. And then you could have children who...
That's not typical for them who are exposed to that, you know, the family. And all of a sudden they're just freaked out by that. They just have never seen anything like that. So you make a good point that the family boundaries around this are very, very fluid and different greatly based on culture, based on a whole variety of different things. But those are very early places where often the child's curiosity gets stimulated and sometimes moved a little bit of the hyperdrive.
But it can absolutely have an effect on whether they see this as stimulating or typical or naughty or bad. I mean, the violence they put on that has a lot to do with their own individual feeling about that. Also, the way their family treats it. If it's just everybody's getting dressed for the pool and certain cultures certainly have. I was a foreign student in Germany and children even up to the age of.
10 or 11 would change poolside into their bathing suits whereas here in the u.s that would not be typical we would go into a dressing room and do that so absolutely well you know even the dressing rooms you know when i was growing up when boys had gym class and this wasn't until middle school i went to a school that didn't actually have a gym but it was in elementary but
all the boys shower together, which when you think about it for that age is really a horrible thing to do to kids. You know, put them in a mass room with like 15 shower heads sticking out of the wall and not expect something weird to happen or someone being teased or whatever. So I would think less weird and more somebody's going to be teased. Yeah. Because development is so different at that point. Exactly. Exactly. You know, some kids are much more comfortable. You know, most children when they hit an age of about seven, eight or nine.
begin to shift into being a little bit modest. They don't want things pointed out. They don't want their bodies being referred to like by parents in front of other people. You know, they're modest about the bathing and the toileting and all those kinds of things. Younger children, two, three, four or younger, you know, if clothing feels uncomfortable, two-year-old may just...
peel it all off and just run around with no clothes on so you know that that sexual development does shift as they go through and not all children hit those social development points at the same time which is why some exposures might be more alarming to you know one child versus another because it's just so foreign to them or they may feel very very private about their bodies right some kids not so much yeah
So how should parents manage a child's natural sexual curiosity, sexual play, sexual development? And let's say to the outset, some of it doesn't need to be managed at all. It's just natural and it's a healthy sign of development. And so there is no managing. However, there are some behaviors, particularly when they're happening in public. We haven't necessarily talked about masturbation, but that would be an example as children get older. There are certain rules associated about it, certain societal.
rules that we would want to make sure if our child is not picked up on them. So how should parents manage those, not the natural curiosity, but things that are exceeding where that you're comfortable at that point as a parent having them do in public? Yeah, that's a great question, Donna. There's so much variation on how adults...
feel about this. Some parents may be embarrassed by a child's behavior. They may think it means there's something concerning going on. Exactly. Or they may go, oh, boys will be boys or girls will be girls. And they may even ignore or downplay something that they maybe should pay more attention to. So it really does kind of vary. We want to encourage caregivers not to be angry or blaming of children, especially younger children when they're showing that normal curiosity, where there doesn't seem to be
anything about that that's harmful or aggressive or anything along those lines. And it's more true, particularly for younger children. When children reach the age of seven, eight, they were in school, they begin to know those social boundaries and begin to understand what's okay and what's not okay. But again, we all can probably remember kids in school whose boundaries were different than ours on a variety of different things. Again, it might've been the typical norm in their family was a little bit different.
I'm going to actually back up for a second. You know, we really hope that all caregivers will begin to think about this. And I'm hoping that maybe that's one of the messages that comes across through this conversation is that, especially for those who have very young children, be thinking about what your values and what you're comfortable with. What would make you uncomfortable seeing a child express in terms of their behavior? How comfortable are you talking about? How comfortable are you using the words like?
breast, penis, vulva, vagina, anus, that's uncomfortable for you. And if it may feel uncomfortable thinking, gosh, could I ever use those as a child? That's a place to start.
be thinking about how do I want to language this? How do I want to address this? How do I want to discuss this with my child in a way that matches our family values, et cetera. And, you know, parents should be kids first teachers and they are, and we want them to also be in a place of helping their children to be comfortable and safe.
as they kind of go out into the larger world. And an example of what I mean, it's not uncommon for us, for example, to suggest to caregivers that they be the ones to use the right names for body parts with their children. You know, that they are the ones who teach the right names for body parts, using that language correctly, et cetera, rather than a child to hear that first from someone else.
And then not be so shocked or sort of surprised by that when we hear it. So it's really important that the language kind of be thought about sort of early on. So when a caregiver sees a child touching their own private parts, whether they walk into the bathroom, the child's doing that or during bath time or changing after swimming or something like that. Think about these as a window of opportunity and an opportunity to have that conversation and to set those personal boundaries within the family.
but do so in educational frame, children still want to please parents. They still want parents to be proud of them and for them to get the positive attention that they want to get from adults and caregivers. So they generally will respond to that very well when they're given the right names and they're told, well, these are things that we don't do in public, things that we do in private.
And to validate that they would have natural curiosity. And then if you have questions, you can come to me at any time and ask those questions rather than trying to explore that information from some other child on the school bus. You know, unimpeachable source, we all agree. So, you know, not to have negative feelings because kids are going to pick up pretty quickly. If you're making this a topic that I feel afraid to bring up with you, I might get in trouble for.
talking about this or for demonstrating some behavior, whether it's touching my private parts or being curious about a nude picture that I come across in a magazine or something like that, if I feel like I'm going to get in trouble, that begins to put a little valence on that for kids that this stuff is off limits in some way or is not okay or gets you in trouble or gets a reaction out of caregivers that you don't want. Well, you're going to tend to not.
show much of that you're not going to tend to express that very much so if there's an open communication around that if there's an opportunity to say just to normalize that yeah everybody's curious about how their body works or about other people's bodies but these are how we handle that in our family or this is how we would handle that in a public place
Then we can help children feel more armed with good information. That curiosity is not a dangerous thing, but we're still at the same time putting some of those guardrails in, those boundaries in. I don't know if that makes sense. Especially if we do this in private or if it's involving touching or looking at someone else's, that's something that we don't do because that's private for them.
Exactly. So I appreciate you bringing up that point, because one of the other important things here is we're learning to help children begin to not just respect their own bodies, but to respect other people and their boundaries around that. And just because something's comfortable for you or is a typical thing in your family doesn't mean it is for everybody. Also, kids respond really well when you can kind of put things in frames that are familiar to them. So just like they may have a hard time understanding that there may be rules about that we don't touch certain parts of our.
own bodies, you know, publicly. But in the same way, if you start with something that sort of kids get, it's like, well, you know, you might pick your nose at home because you're having trouble breathing or you have allergies and, you know, you're having a little itchy going on there, but you might be conscious of not doing that in public. You know, what's considered sort of rude or might be considered sort of, you know, disgusting or whatever. You know, we're teaching kids about those kinds of rules all over the place.
Don't scratch your butt in public. Yeah. You go to the bathroom when your bottom itches. Yes. So it's a nice natural way of saying, well, these are some of the other things that we don't do in public. You know, we don't pick our nose and we don't floss our teeth around other people. And these are all the things that we don't do in public.
You might notice that this classic interview is audio only. Since this was originally recorded, we have added video to our weekly interviews and you can catch us over on YouTube. Our channel is Creating a Family. Listening while watching can be a real boost to the way that you take in this kind of excellent expert-based information and we're privileged to offer it to you every week now in YouTube format. However you take us in, we're glad you're here. So let's go back.
to the interview now. Okay, so we've talked about typical, normal, healthy sexual development, sexual curiosity, and sexual play in young and children as they age as well. Now let's talk about problematic sexual behavior. So how do we make the distinction between normal, healthy, typical development or behaviors that showing healthy development and problematic sexual behaviors?
There's some helpful guidelines to determining that. So we like to kind of see this as a continuum. You know, there's a continuum of typical, continues the word typical because I know normal is a town in Illinois. I used to have a dryer with a normal setting on it. I didn't have a normal setting. So normal is shifting. We have to imagine that normal is shifting. You know, when I was growing up, the only guys who had tattoos were probably my dad's sailor friends. Now, people use body art as a typical expression and it's a normative thing now.
Norms do change as well. And that's true around sexual development to a point. And that's really important that we help kids and especially caregivers understand what we're talking about when we talk about what would not be typical or problematic behavior. So one of the things we really want to emphasize is helping caregivers to understand that what a child does express.
some sexual behavior whether it's of touching or another kind that's different from what they would be comfortable with it doesn't immediately mean that my child is damaged or deviant or broken or bad or something like that we very easily and unfortunately the mental health field the juvenile justice field has collaborated with this over the years but we've used terminology
that gets identified with children. We're talking about deviant behavior. We've heard children be referred to as mini perpetrators or those kinds of things, and nothing could be more inaccurate. There's a distinct difference between children who exhibit problematic sexual behaviors and maybe an adult pedophile, for example. There's no comparison there. So I really want to help caregivers to not be over-alarmed.
and not immediately think there's something bad going on here. All of our development is kind of finding the boundaries, you know, in relationships, in how we use words, learning how much humor is funny, gets people laughing. And when people go, oh, whoa, okay, that was over the line or that was too much. We're always learning those guardrails and it's not any less true around sexual behavior.
We're talking about behaviors that involve the same body parts of typical sexual development. So considered private parts, the parts covered by bathing suits are usually the easiest terms to use with younger children. Your private parts are the ones that are covered by your bathing suit. So genitals, anus, buttocks, penis, vagina, etc., breasts.
But when you think about it, also mouth and hands are sexual tools or sexual objects, you know, at certain points in how intimacy is expressed. So we're talking here about behaviors that would be developmentally not.
matching a child at a certain age. So for a child up to maybe age seven or younger, probably doesn't know much about how intercourse happens. Or they may have some general ideas about that from maybe something they've seen in a movie or television or glanced at a magazine article or it was magazine basket in mom's bathroom or... Best friend's older sister. Oh, absolutely. All those kinds of exposures. So they're learning.
about these behaviors, but if they're showing something that we would not expect a young child to have knowledge about yet, especially if you know within your own family that we don't really can't think of anything in our family that would have this exposure, that would be a red flag. And certainly any behaviors that could be potentially harmful to the child who's exhibiting them with a child, if it is a child on the receiving end of that. And certainly if a child demonstrates interest in touching behavior towards an adult.
That would really be not what we would expect of a child reaching for, you know, I'm not talking about a toddler or a very young child, let's say, reaching for a mom's breast. That would not be all that uncommon, depending on the family, the age, the child was weaned, all those kinds of things. But for a seven to eight, nine year old child, that's not what we would expect. So there's a wide range. And I like parents to think or caregivers to think about this from being, OK, what's typical?
What's like, okay, that's different. That's concerning. I've not seen that before too. That to me seems invasive. That seems intrusive to other people. That seems even harmful to what could even cross the line into illegal behavior. So three areas that we really encourage carriers to look at in determining whether this is a problematic behavior. How frequent is it happening? How outside of typical development?
is this and then is this something that could be potentially harmful so is this behavior happening at high frequency so is my child now touching their private parts you know
Quite a bit where they're sitting and watching TV, you know, absentmindedly and they're touching their private parts or something they are no longer doing in the privacy of their room or their bathroom. They're doing it out around the rest of the family members and isn't occurring at a high frequency. Do they seem preoccupied with this behavior such that they would rather be in the room touching the private parts than outside living and playing Legos with their sibling? That's not typical. So that would be a concerning kind of thing.
And then when a parent tries to respond to that, saying, no, honey, we don't touch our private parts when we're around other people, whatever the direction might be, but the child doesn't respond to that gentle parent correction, that's something to pay attention to. So this behavior has an energy to it that they're kind of ignoring the limits that I'm setting with this. And then developmentally, is this something that a child should know about? Particularly, children don't usually...
think about private parts that may not typically be thought of as going together, if you know what I mean. So it may be that child's beginning to learn that a penis goes in the vagina. That age understanding of that varies across cultures and across individual families about how much a child may know about that. But a child doesn't typically think about a penis going in an anus.
or a mouth going on a vagina. So where did that information come from? That wouldn't be, for many children in younger ages, something that would be part of their typical sexual knowledge and development. So parents should dial in and be curious about that. Are they exploring, you know, kind of like with the frequency? So frequency and duration, is it happening a lot?
And when they're doing it, are they doing it for a longer period of time than we expect? And certainly if a child is doing anything to stimulate their own genitals in a way that creates any reddening or pain or discomfort, that kind of thing, that's another concerning flag.
This is now problematic. That's not typical. And when it's in any way interfering with their social development, they're fracturing boundaries in relationships with others. And they're doing that with some frequency or some regularity with friends, kids that are coming over, those kinds of things. Touching behavior despite being addressed by a caregiver continues. And then certainly if the needle moves it at all down into the harming category, are they intruding on other children to where they feel?
fearful, anxious, or upset about that. It's unwanted. They're saying, no, stop that. And it's not stopping. Anytime it includes force.
or they're trying to coerce the other child into that. And that coercion can be like, I'll give you a knuckle sandwich if you don't do this, to I'll give you my Xbox. There could be some bribery going on there. Any of that would not be typical and would say that there's a driver behind this behavior that we're more concerned about. And certainly...
If the child who is on the receiving end of any exploratory behaviors, that they feel uncomfortable in any way, they're anxious, they're afraid, they're afraid that they're doing something wrong or they're being bad. Those are other concerns. And then for the child who's exhibiting these behaviors, if there is an element of satisfaction that comes in.
doing that to someone else, even though the other person doesn't want it, and then they're ignoring those boundaries, or they're doing it when they're angry, or they're doing it when they're stimulated. Those would be some very concerning.
Immediately, when a child or youth is doing something, as you say, sexual behavior that's more frequent or outside of typical sexual development or something that they would not normally know about or something that's harmful, the first thing that parents and caregivers often think about is that the child has been sexually abused themselves and they're acting out what they have seen and trying to process. What percentage of children with problematic sexual behavior
have been sexually abused. Do we know that? We have some pretty good data around that. Less than half, somewhere between, you know, a third to a half. Now, that's not nothing. That's still something. Children, you know, experience a high level of sexual abuse. But among the types of abusive exposures that children could experience, it tends to be the smallest category, you know, sexual abuse compared to neglect or physical exposure to physical abuse or emotional abuse, etc.
So it's not nothing. It's still a substantial number, about a third to a half. But that leaves a whole other half or more that is due to something else. And most times there's no single particular causative factor for a child experiencing sexual abuse. So that's important that maybe we talk about that for a minute. So there's sort of a constellation of factors. And like with many things, the more factors that sort of add up, the more possibility you could have a problem.
The individual child's personal vulnerabilities have a lot to do with this. So if you have a child who already has a lot of impulse kind of issues in their behavior, they may more likely exhibit over-the-bounds behaviors in a whole variety of categories.
Impulsivity knows no boundaries. The logical boundaries, an impulsive child is going to be impulsive across the board. Absolutely. So we shouldn't construe this behavior as necessarily worse than any other impulsive behaviors. It's just one of those categories that it might show up with. You know, some children have much more difficulty emotionally expressing themselves or being on the receiving end of other people's emotional expressions. You know, children who have some developmental...
abnormalities may have more vulnerability. They may be at more risk. They may not understand or pick up social cues, but they also may fracture boundaries and not really realize that they're doing it or doing something wrong when they do it. So that's another category to be concerned about. But you're mentioning impulse control things. That ends up being a real driver. And it's one that we watch a lot clinically for children that have a lot of impulse control issues. So you add...
A child with impulsivity, for example, or who tends to push the boundaries on behaviors in general, and then they may have some stressful factors within their family.
You know, maybe as a single parent family where the caregiver is just really maxed and not having a lot of individual time with kids, not a lot of close supervision time, a lot of outside stressors going on, maybe needing to use substitute caregivers a lot, meaning now children are exposed to lots of different people and their behaviors and interests and curiosities and all those kinds of things.
Certainly when families experience substance use disorder or they have a high level of law enforcement involvement, criminal behavior. So often children who come into care.
whether it's in foster care or maybe who've been eligible for adoption, have come from families that have failed in some of these areas. They have substance use issues. They have violence in the family. They have behaviors and boundaries that just don't respect other people's physical space or their needs or any of those kinds of things. So children may have had those family adversity kind of exposures or a caregiver with severe mental illness or something else that has really exposed them to some pretty untypical kind of behaviors.
So that's a whole set of influences. And then there are the influences we've talked about about those values. Does a family have very porous boundaries around nudity or, you know, parents or adults watching graphic content on the television when children may pass through the room or adults expressing very, you know, a lot of physical intimacy in front of children that many of us would be uncomfortable for children to see. And then when it.
The needle tips even further towards physical abuse or violence in the family, violence between partners or when people are disempowered verbally, emotionally, physically in front of children. Or parents use very, very harsh parenting practices. So when a child exhibits something that they're curious about at a young age, the parents come down like a ton of bricks. That's not wrong. You're being bad and you're dirty. And where did you learn that? You know, that's a pretty.
a stark and overwhelming response for a child. So that's another set of influential factors. But the top of the heap influential factors would be if the child's exposed to real violence, such as physical abuse to themselves or having to witness that.
to someone else, particularly a child witnessing a mother being treated violently, including sexual violence, especially sexual violence, or if the child themselves has been sexually abused. And again, that's a whole continuum in and of itself. Everything from kind of grooming behaviors, showing a child sexual images, to touching or showing private parts, to touching, to moving into intrusive, invasive penetration kinds of things. So there's a real gradient.
sort of scale there. And the more of these concerning factors add up, the greater the risk possibility that these behaviors might occur. But it's interesting to know that children who exhibit problematic sexual behaviors often exhibit other kinds of boundary breaking behavior. And that's particularly true for boys, but girls as well, if that makes sense. So if they're out of bounds on problematic sexual behavior, they may be out of bounds on a whole bunch of other.
behavior as well in terms of taking things that don't belong to them and being you know aggressive to other people or bending the truth to keep themselves safe and protect those you know all those kinds of boundary breaking behaviors would be sort of typical okay how common are problematic sexual behaviors what does the research show because one thing honestly parents and caregivers who are facing it feel very alone so
How common is this in what mental health professionals see? It's actually fairly common. I'll put that in a little frame, though. For us as mental health professionals, someone is coming to seek treatment or seek consultation for a reason. So we're already sort of narrowing the pool of people. There's been something of concern that's occurred, whether that's behavior on the child's part or something the child may have been exposed to.
you know, within their family. The data is always shifting and changing a little bit around this, but some of the early studies around this said that about 6% of children who come in for some sort of mental health treatment display some form of serious sexual behavior problems. So there's that subset of kids who come in for treatment.
which is not the whole population. That's a subset of people. And then of that subset, about 6%. But that's still a lot of children. One of the other things we do know is that a child can develop problematic sexual behavior with something that really started as curiosity and was not handled very well.
or was not provided any educational responses or boundaries by caregivers, and the behavior became replicated, and it began to feel good, and it got a big rise out of people, and it felt good, and it got replicated, and it goes on and it starts to grow. So something that didn't start as a problematic sexual behavior can become one. But these are concerning behaviors. We can't ignore them because not only are they harmful for the child who exhibits them, they're incredibly harmful and potentially extraordinarily damaging for a child who may be on the receiving end of it. So they absolutely do.
need a response. So of the children who receive treatment, will they continue to have problematic sexual behavior in the future? Are these the kids who are going to become perpetrators in the future? Are these the kids who are going to be the whatever? What percentage of these kids, if treated and handled correctly by parents?
are going on to have a future that is doomed to be distraught with all sorts of sexual behavior problems. That's a great question, Don, and we get that as a lot as professionals. The good news is many times these are headed off at the past very early on and no one ever thought about it because the parent responded with,
This is not okay. These are the rules in our house. These are the boundaries that we have. And we have specific rules for children on touching behavior rules, that kind of thing that we want all caregivers to teach children. So the good news is most children who exhibit some maybe early on behavior, if they're responded to in a very natural and educating way, the behavior just finds its natural path and it doesn't ever get out of bounds.
For those children who have exhibited problematic sexual behavior to the point where it is intrusive and it's interfering with their development a little bit and causing some behavior problems, if they get treatment, and importantly, if that treatment involves education around sexual behaviors, if it has education around boundaries, the rules about touching and looking at other people's private parts, those kinds of things. We're talking here about younger children for the most part. And the caregivers are involved in that and they take an active role.
in being the ones to set the boundaries and limits they continue to supervise children they're open to answering questions and continuing education the good news is the chance of that being repeated is three percent or lower and that's been replicated in more than one study and some of these are studies that have 10 and 20 year follow-ups so they follow these children and families for a number of years
and there was no further incidence of behavior. If there were additional behavior problems, they would probably be, you know, they broke the window of an abandoned house in the neighborhood with a rock, or they stole someone out of someone's car, or they stole something from the store. It's other kinds of sort of that spectrum of behavior, but typically these behaviors don't reoccur when there's been appropriate treatment. But I really want to underscore the crucial element here is the caregiver involvement. That is the...
really quintessential piece. When adults are involved and really help children understand the boundaries, they provide appropriate supervision, you know, and they do education when it's necessary. When education's been done, but the behavior persists, then it needs to start responding with consequences and some real limits to the behavior like we would with any kind of child behavior.
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Okay, so you have said that what is important is caregiver involvement, which that leads us into what should parents and caregivers do? We're talking about when the behavior has become problematic and they need to do something, because as you say, this is not okay. We have to step in.
What should parents and caregivers do when they see their child engaging in problematic sexual behaviors? Great question. A couple pieces of that. First of all, we would encourage parents to not wait until some behavior occurs that they don't know how to respond to. So just like we would learn how to do.
anything to raise our children in healthy ways, learning about their diet and all those kinds of things, caregivers should begin to educate themselves about typical sexual development. And I know we can recommend some resources around that. But when a caregiver encounters this behavior, there's an expression that we use sometimes in mental health. And when emotions are high, when things are escalated, the first person you need to regulate in the room is yourself. So that's true for caregivers. They've got to go, okay, take a deep breath.
Let me not overreact to this. Let me not drive a tack with a sledgehammer here. Is this typical exploratory kind of behavior, curiosity among children? Or is there something else going on here? Or have I responded to this behavior before? Or am I seeing something immediately that says, whoa, this is a behavior that's way out of line for what I would expect. They're trying to insert things into each other's private parts or something. Then, okay, their exploratory thing has kind of gone to a deeper level here.
For the caregiver to remain calm, if there's more than one child involved, this is not self-stimulating behavior, separate the children if possible. If it's a single parent, sometimes that's hard to do if you're responding alone. You may have to kind of take them one at a time. You sit here, I'm going to need to go talk to your brother for a little bit or whatever it might be. And you explain what's not okay about that, that this behavior is inappropriate. If you've discussed it before with a child and they're pushing beyond those boundaries, even though you've set them, then maybe this is a time for consequences to land.
You need to make that decision. Is this an education situation or is this a consequence situation? Precisely. Yeah. And a good rule of thumb on that is this, you know, is this the first time I've encountered this? And I'm not going to land like a ton of bricks. I'm going to say, okay, well, you know, this isn't appropriate and this is why.
So part of that explanation helps them to understand how the other person might feel uncomfortable with this and why it's not OK. And that violates boundaries in that way. But also for them, this is not behavior that children do. Sometimes that includes an explanation of sex is for grownups and not for children. You may have to move forward your education earlier than you thought you would have to to talk about this. So we're setting rules here about social interaction, but also behaviors about modesty, about privacy, et cetera.
But also we're educating about relationships and how this can kind of violate that. And it's a great place to insert information about being respectful of your body and respectful of other people's. And generally, you know, when that information is delivered calmly and reassuring with younger children, you know, they tend to respond to that very well. But if, you know, it's been addressed before and the child's still pushing those boundaries, maybe now it's time to move into consequence land here. Supervision has to be really, really now dialed up.
So if we've seen children expressing these behaviors, particularly siblings, where they're going to be in the same house and around each other a lot, caregivers may be going to need to now have some behavior management plans that they don't play in the room with the door closed anymore, or they don't play in the room.
at all anymore maybe their play needs to be out in a place where i can observe it those kinds of things and it also involves educating other caregivers so if there are substitute caregivers that step in grandma babysits the kids on monday wednesday and friday she may need some education look the kids have had some of this behavior these are the boundaries these are the rules we put in place and this is what they so don't let them do an end run around you on this one
It can be uncomfortable for parents. And as you mentioned, parents can feel very isolated with these behaviors. So do you allow your child to go on overnights to other children's homes if they've exhibited this behavior? There's a lot of questions around that. That's a great place to get an outside help from a professional to discuss this with someone, to get an understanding of the context in which it's happening within the family, and to get some ideas and to determine whether treatment is really necessary.
You know, you've talked about supervision, and I will say that one of the things that we hear frequently is, from a caregiver standpoint, how wearying and isolating, if you have a child who has exhibited...
problematic sexual behavior it's not something you can talk about with others it's not can't talk about with other families because other parents because it looks bad on you even if you can think well this child you know is new to my home or whatever it looks bad on you it looks bad on whether the other children in your family could even go over to other people's houses so we tend to isolate and to be constantly on guard is just overwhelmingly exhausting
It is. And parents feel embarrassed. They feel it reflects on them as a parent. If they've had their own maltreatment or abuse or trauma history, it brings those issues up for them. It can be very complex and very overwhelming. The best programs that treat this are programs that do this in a group.
focused way. In a treatment program that I was responsible for a few years ago, we address these behaviors with children in group. So they learn those normative boundaries together. They get excited about learning what's okay, what's safe and what they're supposed to do. They're reinforced for that. They get accurate information, but we also had parent groups.
where the parents were able to talk together and understand about the experience of that and normalize that process, normalize the struggles. Oh, Dawn, it does. And it makes parents feel so much less alone and really become advocates for their own children and for children in general. But to really bust through a lot of those myths and anxieties and help them to not feel so isolating. Yeah.
Exactly. Yeah. And we do have rules that we encourage kids. It might be important just to sort of mention those and then provide some resources for you to identify those materials. But some of the simple rules for younger children is things like, you know, no touching other people's private parts. And for some kids, you have to be very specific about that. No hocking loogies on them. No, you know, biting. No, you know, some kids you got to.
You've got to be very specific about it. But no touching other people's private parts in any way. You can't touch it with a 10-foot pole. You can't poke your brother's genitals from across the room with a broom handle. You have some kids, you've got to really be very specific. And no other people touching your private parts. And then we also, for younger children, explain the exceptions to that.
Like when a doctor or a parent may do something to keep you clean and safe, help you clean and be, a doctor might need to check your private parts to make sure everything's okay. No showing your private parts to others. Or maybe a way of phrasing that would be, you keep your clothes on when other people can see you. That's a rule in our family. No looking at other people's private parts. And then depending on the parents, the family's own values around this, touching your own private parts when you're alone is okay.
or no touching your private parts in public. Sometimes we language that as you can touch your own private parts when you're alone.
as long as you're alone and it doesn't take too much time. You know, because that is a pleasurable feeling for children. We don't want them to feel like their bodies are dirty or nasty or they can't learn about how they operate. We do want them to have that natural curiosity, but have it within an appropriate healthy frame. And then when kids get older, we modify those rules, get a little bit more specific about it. How effective can therapy be? The good news is treatment can be very effective.
Just like with anything that we get treatment for, we want to go to a person who's knowledgeable about the issue that we're dealing with, has training in it. And as we kind of started this conversation saying, there's a lot of medical professionals that they have the medical knowledge about how bodies operate, but they may not have the psychological information about child development and about this behavior in particular. Same is true for mental health professionals. They may have a lot of training, but they may not have had much training in early child development.
very little training in child sexual development, and then no training in this area. The dirty little secret is no graduate schools are training this information except some very few. That's frustrating. It is. And as you imagine, in lots of curriculums, there's a lot to cover. So some things kind of get dropped off the plate. So the good news is that treatment is very, very effective. And it can be done individually. When children are having a higher level of problematic behavior, that tends to be most effectively treated in a group.
I have some colleagues at the University of Oklahoma, at the University of Oklahoma Child Study Center. There's a program there called the Center on Child Abuse and Neglect. They have been some of the leaders nationally in curricula and training around problematic sexual behavior and addressing it and are working very hard right now, currently under a SAMHSA grant, to disseminate that training nationally. So you will find more places and people around the country that have more training in this than you would have found easily, say, 10 years ago.
What are some questions that parents can ask a therapist to know if this is the right mental health professional to take their child to? Great question. We want to find out kind of what their expertise is, sort of what their training is. And if they're uncomfortable answering that, then that's a red flag that you should see in other mental health professionals. If they get defensive about that, it's like anyone should want to know what our training is, whether you're consulting your medical doctor, your dentist, or your mental health professional.
So are they familiar also with children's mental health disorders? Because sometimes these behaviors are expressions of the mental health difficulties a child is already having, developmentally, impulse control issues, that kind of thing. Are they familiar with the impact of trauma on children? Because we mentioned already that a third to half or less are kids that have been sexually abused.
But a lot of times people don't recognize that children who are exposed to violence within the family, that may even have a greater impact, other kinds of violence exposure. So does this clinician have training in trauma? Are they familiar with the impacts of that for children? Do they understand they have training in mental health diagnoses such as attention deficit, hyperactive disorder, again, child maltreatment, et cetera? Are they experienced with children who have behavior problems in general? Do they have?
knowledge and are they comfortable working with that and then really kind of in broadening that out how familiar are you with the current research around children with problematic sexual behavior and there is a lot of good current research and training around that have you worked with children with this behavior before what approaches or procedures do you use
How do you bring caregivers into this? Because if a clinician is only treating the child, that would be a red flag to me. This is a family issue. We already talked about the impact on the caregiver and how they feel and how isolated they feel and often blamed or there's something catastrophically wrong with my child. And if the medical professional is not willing to address and alleviate those concerns with the caregiver and.
even spend the majority of their time with the caregiver because the ones who are really going to have to supervise this, monitor it, and respond to it are the caregivers. We actually have data to support that when children themselves, for trauma in particular, it's not a perfect analogy, but we have data to support that when children who've been exposed to trauma aren't even treated themselves, but the caregivers are taught everything they need to know to support that child, children do better than when children get treatment alone without a caregiver. That makes perfect sense to me.
It does. Children don't treat their own diabetes. It's up to the caregiver to know how to manage it. Now, as they grow up, they learn, I got to get exercise. I got to eat well. I got to do these things. So there's some similarities there. The younger the child, the more the time with the caregiver needs to be, the crucial time that the professional is spending. That makes such good sense. Can you suggest some resources for parents? And we will include these. Give us some resources. Sure, sure.
One of my favorite resources and one of the best that's easy, accessible, et cetera, is a series of booklets. There's two booklets. They're called Taking Action, Taking Action Booklets. SaferSocietyPress.org is the publisher of this. The beauty of these books are simple little booklets. There's two of them. There's one of the red cover authored by Dr. Jane Salofsky. She's at the University of Oklahoma, as I mentioned earlier. That's for children.
who've exhibited problematic sexual behavior. If you have, and we consider children with problematic sexual behaviors, those being 12 and under, when you're going 13 and up, now you're talking about adolescence and kind of a lot of bets are off. We're talking about adolescent behavior. So we really talk about that as a different category of behavior because now many municipalities may consider a child 13 and older as prosecutable with these behaviors, depending on the age of the person who was on the receiving end.
Again, that's a separate category. It's a separate conversation. But one of the books is a blue-covered book, and it's the same title, Taking Action for Adolescents, and it's been authored by Dr. Barbara Bonner. Those are both available at safersocietypress.org. You can order the books for $4, or you can actually download them free online from that website. Okay, excellent. Great resource. Very accessible. What I love about that book is it starts the conversation, and it really goes through everything we've talked about today, Dawn, in terms of...
Typical sexual development, how children develop in general and develop sexually, and what behaviors you might expect at different ages, and then when do you know it's problematic, and then what to do. And there's some resources in the back of the book. A couple of other websites. The National Center on the Sexual Behavior of Youth, ncsby.org, the National Center on the Sexual Behavior of Youth, which happens to also be at the University of Oklahoma.
They have a federal grant to support them in disseminating accurate information about child sexual development. What's wonderful about this site is it has information for professionals, but it also has a lot of good information for caregivers, including an online caregiver newsletter. Really, really good resource information, and it can take a very deep dive into the material on that site. So the National Center on the Sexual Behavior Review would be the top of the list. Other resources, the National Center for Missing and Exploited Children.
is another awesome resource. They have over the last several years really done a lot of developmental educational information for children around safety in general. So it's important that we include in our conversation that one of the other things that's crucial to addressing with children is teaching children safety skills to protect their own bodies from
others who might harm them, whether it's physical or sexual. So teaching children skills to keep their body safe is part of this education that every child should have. Every parent should be doing that and starting at a very young age with children as soon as they become verbal. And the knowledge should grow with children as they get older. So for example, this conversation never stops. 25% of women will have an unwanted sexual contact in college.
25 that's a high number i'm surprised it's not higher it probably is like with most of this data there's an iceberg kind of thing here it's what gets reported and what's known and what's under
the surface because again a lot of times people are embarrassed they won't say anything about it so the number could very likely be higher it persists lifelong so this conversation never stops it just gets more sophisticated and more open-ended but we want to have that conversation as well so there's also some very good resource material
for teaching about being safe online, for being safe when it comes to your own personal space in your body. A wonderful online website is called Amaze. I believe it's amaze.org. There's some wonderful educational videos for children on a variety of topics there.
The National Center for Missing and Exploited Children has a number of really wonderful web-based educational programs for children. They have a whole section called Kids Smarts, and it ends with a Z. So Kids Smarts, K-I-D-S-M-A-R-T-Z dot org, Kids Smarts. There are things on setting physical boundaries, learning about your body, and just a variety of really good educational resources. They're all online.
The National Child Traumatic Stress Network. If a caregiver knows, whether they be an adoptive parent or foster parent, that the child has had trauma exposure previously, they really need to educate themselves about child trauma. The best clearinghouse of that information is the National Child Traumatic Stress Network. And I mentioned earlier, you mentioned in the introduction, I'm a member of the network and I co-chair our problematic sexual behavior work group. Any type of potential trauma a child may have been exposed to.
You're going to find information about it on this website. So it's nctsn.org. Our work group within that network wrote a book for children with problematic sexual behavior. And you can find it free and downloadable free on that website. It's called AJ Story, a book about not okay touches. And you can download the book free on the NCTSN website.
It's another website that I would absolutely highly recommend that every parent should take a look at. And any professional listening should know about this website. And that's AJ, A period, J period. Yeah, initials AJ, AJ Story, a book about not okay touches. And they would find it under the child sexual abuse tab on the website.
Okay, excellent. So especially for those stakeholders who are listening, who work with adoptive foster children and any parents listening, and especially mental health professionals, they definitely want to be aware of that website. Excellent. We will include links to all of these. I think they are all terribly important. I mean, just for normal development or typical development as well.
Thank you so much, Roy Van Tassel, for talking with us today about a subject that I think is so important for all parents, but especially for foster adoptive and kinship parents. Thank you so very much. You're very welcome. Thank you for the opportunity. And it was a pleasure spending this time.