Hometown Heroes
18th Annual GAL/CASA Conference
October 11, 2014
Dr. Tiffany Simpson, PsyD, LCAC, HSPP
© Copyright Creative Interventions Counseling, Inc. 2014
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Natural and healthy exploration during childhood is an
information gathering process.
Children explore each other’s bodies by looking and
touching as well as explore gender roles and behaviors.
Children involved in natural and expected sex play are of
similar age, size, developmental status, and participate in
the activity voluntarily.
Siblings do engage in sexual exploration but it is usually
seen between children who play together or are school
friends.
The sexual behaviors are limited in type and frequency and
occur in several periods of the child’s life.
Taken from: Understanding Children’s Sexual Behaviors: What’s Natural and Healthy by Toni Cavanaugh Johnson, Ph.D.
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A child’s interest in sexuality and sex is balanced by
curiosity about other aspects of his or her life.
Natural exploration may result in embarrassment but does
not usually leave the child with deep feelings of anger,
shame, fear or anxiety.
If children are caught engaging in exploration by an adult
and instructed to stop, the behavior usually diminishes, at
least in the view of the adults.
Children generally experience pleasurable sensations from
genital touching, some children experience sexual arousal
and/or orgasm.
Sexual arousal and/or orgasm are usually found in older
children entering puberty.
Taken from: Understanding Children’s Sexual Behaviors: What’s Natural and Healthy by Toni Cavanaugh Johnson, Ph.D.
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Research on sexual behavior of children ages 2 to 12
has documented that:
sexual responses are present from birth
 a wide range of sexual behaviors for this age range are normal
and non-problematic
 increasing numbers of school age children are being identified
with inappropriate or aggressive sexual behavior
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 it is not clear if this increase reflects an increase in the actual
number of cases or an increase in identification and reporting
several treatment interventions have been found to be
effective in reducing problematic sexual behavior in children,
such as cognitive behavioral group treatment
 sexual development and behavior are influenced by social,
familial, and cultural factors, as well as genetics and biology
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Taken from National Center on Sexual Behavior of Youth Fact Sheet
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Understand that boys and girls have different
private parts
Know labels for sexual body parts, but use
slang words such as “weenie” for a penis
Have limited information about pregnancy and
childbirth.
Taken from National Center on Sexual Behavior of Youth Fact Sheet
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Do not have a strong sense of modesty, enjoys own
nudity
Use elimination words with peers
May explore body differences between girls and
boys
Curious about sexual and genital parts
Touch their private parts, even in public
Exhibit sex play with peers and siblings; playing
“doctor”
Experience pleasure from touching their genitals
Taken from National Center on Sexual Behavior of Youth Fact Sheet
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Learn the correct names for the genitals but use
slang terms
Have increased knowledge about
masturbation, intercourse, and pregnancy
Understand the physical aspects of puberty by
age 10
Taken from National Center on Sexual Behavior of Youth Fact Sheet
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Sexual play with children they know, such as
playing “doctor”
Interested in sexual content in media (TV,
movies, radio)
Touch own genitals at home, in private
Look at nude pictures
Interested in the opposite sex
Shy about undressing
Shy around strange men
Taken from National Center on Sexual Behavior of Youth Fact Sheet
Natural and Healthy
Thinks other gender children
are “gross” or have “cooties.”
Chases them.
Talks about sex with friends.
Talks about having a girl/boy
friend
Of Concern
Uses “dirty” language when
other children really
complain.
Sex talk gets child in trouble.
Romanticizes all
relationships.
Wants privacy when in
bathroom or changing
clothes.
Likes to hear and tell “dirty”
jokes.
Becomes very upset when
observed changing clothes.
Seek Professional Help
Uses bad language against
other child’s family. Hurts
other gender children.
Talks about sex and sexual
acts habitually. Repeatedly in
trouble with regard to sexual
talk.
Aggressive or fearful in
demand for privacy.
Keeps getting caught telling
“dirty” jokes. Makes sexual
sounds, e.g. sighs, moans.
Still tells “dirty” jokes even
after exclusion from school
and activities.
Taken from: Understanding Children’s Sexual Behaviors: What’s Natural and Healthy by Toni Cavanaugh Johnson, Ph.D.
Natural and Healthy
Plays games with same-aged
children related to sex and
sexuality.
Draws genitals on human
figures for artistic expression
or because figure is being
portrayed in the nude.
Explores differences between
males and females, boys and
girls.
Takes advantage of
opportunity to look at nude
people.
Of Concern
Wants to play games with
much younger/older children
related to sexuality.
Draws genitals on some nude
figures but not others or on
clothed people. Genitals
disproportionate to size of
body.
Confused about male/female
differences after all questions
have been answered.
Stares/sneaks to stare at nude
people even after having seen
many people nude.
Seek Professional Help
Child or children force others
to play sexual games.
Genitals stand out as most
prominent feature of drawing.
Drawings of intercourse,
group sex or
sadism/masochism shown.
Plays male or female roles in
a sad, angry or aggressive
manner. Hates own/other sex.
Asks people to take off their
clothes. Tries to forcibly
undress people.
Taken from: Understanding Children’s Sexual Behaviors: What’s Natural and Healthy by Toni Cavanaugh Johnson, Ph.D.
Natural and Healthy
Interested in
watching/peeking
At people doing bathroom
functions.
Plays doctor, inspecting
others’ bodies.
Show others his/her genitals.
Interested in urination and
defecation.
Of Concern
Keeps getting caught
watching/peeking at others
doing bathroom functions.
Seek Professional Help
Refuses to leave people alone
in the bathroom
Frequently plays doctor and
gets caught after being told
“no”.
Wants to be nude in public
after the parent say “no” and
punishes the child.
Plays with feces. Purposely
urinates outside of the toilet
bowl.
Forces child to play doctor, to
take off clothes.
Refuses to put on clothes.
Exposes self in public after
many scoldings.
Repeatedly plays with or
smears feces. Purposely
urinates on furniture.
Taken from: Understanding Children’s Sexual Behaviors: What’s Natural and Healthy by Toni Cavanaugh Johnson, Ph.D.
Natural and Healthy
Touches/rubs own genitals
when going to sleep, when
tense, excited or afraid.
Plays house, may simulate all
roles of mommy and daddy.
Pretends to be opposite
gender.
Wants to compare genitals
with peer aged friends.
Erections
Of Concern
Continues to rub/touch
genitals in public after being
told “no”. Rubs genitals on
furniture or other objects.
Humping other children with
clothes on. Imitates sexual
behavior with dolls or stuffed
toys.
Wants to be opposite gender.
Wants to compare genitals
with much older or much
younger people.
Continuous erections
Seek Professional Help
Touches/rubs self in public or
in private to the exclusion of
normal childhood activities.
Rubs genitals on people.
Humping naked. Intercourse
with another child. Forcing
sex on another child.
Hates being own gender.
Hates own genitals.
Demands to see genitals,
breasts, buttocks of others.
Painful erections
Taken from: Understanding Children’s Sexual Behaviors: What’s Natural and Healthy by Toni Cavanaugh Johnson, Ph.D.
Natural and Healthy
Interest in touching genitals,
breasts, buttocks of other
same-age child or have child
touch his/hers.
Kisses familiar adults and
children. Allows kisses by
familiar adults and children.
Looks at the genitals,
buttocks, or breasts of others.
Of Concern
Continuously wants to touch
genitals, breasts, or buttocks
of other child/ren. Tries to
engage in oral, anal, vaginal
sex.
French kissing. Talks in
sexualized manner with
others. Fearful of hugs and
kisses by adults. Kisses
unfamiliar adult or child.
Seek Professional Help
Manipulates or forces other
child to allow touching of
genitals, breasts, buttocks.
Forced or mutual oral, anal, or
vaginal sex.
Overly familiar with
strangers. Talks/acts in a
sexualized manner with
unknown adults. Physical
contact with adults causes
excessive agitation.
Touches/stares at the genitals, Sneakily or forcibly touches
breasts, buttocks of others.
genitals, breasts, buttocks of
Asks others to touch him/her others. Tries to manipulate
on these parts.
others into touching him/her.
Taken from: Understanding Children’s Sexual Behaviors: What’s Natural and Healthy by Toni Cavanaugh Johnson, Ph.D.
Natural and Healthy
Interested in breeding
behavior of animals.
Puts something in own
genitals/rectum for the
physical sensation, curiosity
or exploration.
Asks about the genitals,
breasts, intercourse and
babies.
Looks at nude pictures.
Of Concern
Seek Professional Help
Touching genitals of animals. Sexual behavior with animals.
Puts something in own
genitals/rectum frequently or
when it feels uncomfortable.
Puts something in the genitals
or rectum of other child.
Shows fear or anxiety about
sexual topics.
Continuous fascination with
nude pictures.
Any coercion or force in
putting something in
genitals/rectum of other
children. Causing harm to
own/others genitals/rectum.
Endless questions about sex
after curiosity satisfied.
Sexual knowledge too great
for age.
Wants to masturbate to nude
pictures or display them.
Taken from: Understanding Children’s Sexual Behaviors: What’s Natural and Healthy by Toni Cavanaugh Johnson, Ph.D.
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The children engaged in the sexual behaviors do not have an
ongoing mutual play relationship.
Sexual behaviors which are engaged in by children of
different ages or developmental levels.
Sexual behaviors which are out of balance with other
aspects of the child’s life and interests.
Children who seem to have too much knowledge about
sexuality and behave in ways more consistent with adult
sexual expression.
Sexual behaviors which are significantly different than those
of other same-age children.
Understanding Children's Sexual Behaviors: What's Natural and Healthy, Toni Cavanagh Johnson, 2009
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Sexual behaviors which continue in spite of consistent and
clear requests to stop.
Children who appear unable to stop themselves from
engaging in sexual activities.
Children’s sexual behaviors which are eliciting complaints
from other children and/or adversely affecting other
children.
Children’s sexual behaviors which are directed at adults
who feel uncomfortable receiving them.
Children (four years and older) who do not understand
their rights or the rights of others in relation to sexual
contact.
Understanding Children's Sexual Behaviors: What's Natural and Healthy, Toni Cavanagh Johnson, 2009
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Sexual behaviors which progress in frequency,
intensity, or intrusiveness over time.
When fear, anxiety, deep shame, or intense guilt is
associated with the sexual behaviors.
Children who engage in extensive, persistent mutually
agreed upon adult-type sexual behaviors with other
children.
Children who manually stimulate or have oral or
genital contact with animal(s).
Children sexualize nonsexual things, or interactions
with others, or relationships.
Understanding Children's Sexual Behaviors: What's Natural and Healthy, Toni Cavanagh Johnson, 2009
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Sexual behaviors which cause physical or
emotional pain or discomfort to self or others.
Children who use sex to hurt others.
When verbal and or physical expressions of anger
precede, follow or accompany the sexual behavior.
Children who use distorted logic to justify their
sexual actions.
When coercion, force, bribery, manipulation or
threats are associated with sexual behaviors.
Understanding Children's Sexual Behaviors: What's Natural and Healthy, Toni Cavanagh Johnson, 2009
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Sexually reactive children
Children who engage in extensive mutual
sexual behaviors
Children who molest
Helping Children With Sexual Behavior Problems, Toni Cavanagh Johnson, 2009
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Engage in self-stimulating behaviors, behaviors with other
children and sometimes adults
Generally, this type of behavior is in response to things going
on around them, feelings which cause traumatic memories to
resurface
These memories may be painful, overly stimulating, or difficult
to make sense of
The child may respond by masturbating or engaging in other
sexual behaviors alone or with children or adults
Hiding the sexual behaviors or finding friends to engage in the
behaviors in private may not be possible for these children.
Helping Children With Sexual Behavior Problems, Toni Cavanagh Johnson, 2009
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The sexual behavior is a way of coping with overwhelming feelings
This type of sexual behavior is often not within the conscious control
of the child
In some situations, children are trying to understand something
sexual that was done to them by doing it to someone else
These children do not coerce others into sexual behaviors but act out
their confusion on them
Sexually reactive children do not intend to hurt others
Many of these children do not understand their own or others’
rights to privacy
Helping Children With Sexual Behavior Problems, Toni Cavanagh Johnson, 2009
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These children are often distrustful and have
been chronically hurt by adults and as a result,
relate best to other children
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In the absence of close, supportive
relationships to adults, the sexual behaviors
become a way of making a connection to other
children
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These children use sex as a way to cope with
their feelings of hurt, sadness, anxiety, and
often despair
Helping Children With Sexual Behavior Problems, Toni Cavanagh Johnson, 2009
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These children do not coerce other children
into sexual behaviors but find similarly lonely
children who will engage with them
Almost all of these children have been sexually
and emotionally abused and look to other
children to help emotionally save them
Helping Children With Sexual Behavior Problems, Toni Cavanagh Johnson, 2009
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Sexual behaviors of children who molest are frequent and
pervasive
A growing pattern of sexual behavior problems is evident in
their histories
Intense sexual confusion is the hallmark of their thinking and
behavior
Sexuality and aggression are closely linked in the thoughts and
actions of these children
Unless the children is too young to understand, children who
molest use some type of coercion to gain participation in the
sexual behaviors
Helping Children With Sexual Behavior Problems, Toni Cavanagh Johnson, 2009
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Generally this coercion consists of bribery,
trickery, manipulation, or emotional or
physical coercion
Physical force is not commonplace or necessary
because the children’s victims are selected due
to a special vulnerability such as
developmental delays, social isolation, and
emotional neediness
Helping Children With Sexual Behavior Problems, Toni Cavanagh Johnson, 2009
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Victims may be older, younger, or the same age
There is an impulsive, compulsive, and
aggressive quality to many of the behaviors of
these children, including sexual behaviors
These children generally have problems in all
areas of their lives
Helping Children With Sexual Behavior Problems, Toni Cavanagh Johnson, 2009
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Problematic sexual behaviors may be seen in children who:
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are confused based on what they have seen
live in neighborhoods where sex is a major influence
live in homes with a sexualized environment
live in homes with little or no physical, sexual, or emotional privacy
have been used to meet the emotional needs of a parent which may
have been sexualized
live with parents who act in sexual ways after drinking or taking
drugs regardless of the presence of children
live in places where sex is routinely paired with sexual aggression
have been physically abused and/or neglected and emotionally
abused
have observed physical violence to others
have been observed or photographed naked for the sexual
stimulation of others
have been sexually abused by direct physical contact to their bodies
or being used to sexually stimulate others’ bodies
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Green Light Behavior
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Yellow Light Behavior
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This behavior is natural and healthy
There is no cause for concern
This behavior is cause for some concern
Intervention may be needed
Red Light Behavior
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This behavior is indicative of a sexual behavior
problem in the child
Requires adult supervision and therapeutic
intervention
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Playing doctor or house
Occasional masturbation, no penetration
Imitating adult seduction such as flirting or
kissing
Dirty words or jokes within cultural and peer
group norm
Mutual showing of body parts by peers
Conversations with peers about reproduction
and genitals
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Preoccupation with sexual themes (especially sexual
aggression)
Sexually explicit conversations with peers
Sexual innuendo/teasing/harassment/embarrassment of
others
Attempting to expose other’s genitals (e.g. pulling up
skirts or pulling down pants)
Sexual graffiti (especially chronic and/or impacting
others)
Precocious sexual knowledge and/or activity
Single occurrences of peeping, exposing, obscenities,
pornographic interest
Preoccupation with masturbation
Mutual masturbation/group masturbation
Simulating foreplay with dolls toys, peer with clothing on
(petting, French kissing)
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Touching of genitals of others
Using force to expose others genitals or body parts
Sexually explicit conversations with significant age
difference
Chronic obscenities
Inducing fear/threats of force to coerce sexual activity
Sexually explicit proposals/threats including written notes
Repeated or chronic peeping/exposing/pornographic
interest
Compulsive masturbation
Masturbation by girls that includes penetration
Simulating intercourse with dolls, peers, animals
Oral, vaginal, anal penetration of animals or dolls
Forced touching of genitals
Genital injury or bleeding without accidental cause
Simulating intercourse with peers with clothing off
It is not advisable to use one’s own childhood experiences as the
norm for sexual experiences. There is a great deal more sexual
stimulation in our culture today, and children have a greater
knowledge about sexual behaviors than in previous generations.
Sexual behavior problems regardless of severity, are on one small
aspect of the child’s behavioral and emotional life. This one aspect
must not be allowed to overshadow the whole child, either in the
child’s self-image or in the perception of the caretaker.
It is natural for a caretaker to react strongly to children with
significant behavioral problems, sexual or otherwise. However, it is
important to remain nonjudgmental and non punitive with the
children.
Be careful not to confuse your own adult feelings, fantasies, and
behavior with those of children. Most pre-pubertal children do not
experience sexual arousal and sexual pleasure. In children under 10
or 11 years old especially, sexual activity does not represent the desire
for sexual gratification as much as exploration of their bodies, other’s
bodies, and gender roles.
While some children describe sensations related to sexual exploration
as sexually arousing and pleasurable, others describe it as weird,
funny, or exciting because it is forbidden. For some children, the
experience is described as icky, confusing, scary, and uncomfortable.
Even though children’s sexual behaviors look like adult sexual
behavior, it generally is not experienced as erotic or sensual. This is
important to consider as some adults are disgusted thinking that a
child is engaging in adult sexual behaviors and then treat the child as
disgusting.
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Praise the child for talking about the subject with
you
Ask the child if they are afraid
Ask the child what they would like you to do to
help
Educate the parents about healthy sexual behavior
Refer the child/family to a qualified professional
Use normalizing and nonjudgmental tones when
discussing sexual behaviors with a child
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Do not question the child beyond what is
necessary to establish safety
Do not shame the behavior
Do not over or under react
Do not assume how the child feels about the
sexual behavior
Do not make promises to the child that you can
not keep
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Significant experience with children
Understands child development
Has extensive and specific training AND
experience working with sexual behaviors
Working with sexual abuse victims does not
mean they are qualified to work with
problematic or maladaptive sexual behaviors
Interventions are not typical “talk” therapy
Willing to be involved in the legal process
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Psychologist vs Health Service Provider in
Psychology (HSPP)
LSW- licensed social worker
LCSW – licensed clinical social worker
LMHCA – licensed mental health counselor
associate
LMHC – licensed mental health counselor
LMFT – licensed marriage and family therapist
LCAC – licensed clinical addictions counselor
Creative Interventions Counseling, Inc.
Dr. Tiffany Simpson
Licensed Clinical Psychologist
Licensed Clinical Addictions Counselor
Registered Domestic Relations Mediator
Office: (219) 462-4742
E-mail: [email protected]
Web site: www.creativeinterventionscounseling.com
Questions?
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Araji, S. K. (1997). Sexually aggressive children: Coming to understand
them. Thousand Oaks, CA: Sage.
Bonner, B. L., Walker, C. E., & Berliner, L. (1999). Children with sexual
behavior problems: Assessment and treatment (Final Report, Grant No.
90-CA-1469). Washington, DC: Administration of Children, Youth, and
Families, Department of Health and Human Services.
DeLamater, J., & Friedrich, W. N. (2002). Human sexual development.
The Journal of Sex Research, 39, 10-14.
Friedrich, W. N., Grambsch, P., Broughton, D., Kuiper, J., & Beilke, R. L.
(1991). Normative sexual behavior in children. Pediatrics, 88, 456-464.
Gordon, B. N., & Schroeder, C. S. (1995). Sexuality: A developmental
approach to problems. New York: Plenum Press.
Hall, D. H., Matthews, F., Pearce, J., Sarlo-McGarvey, N., & Gavin, D.
(1996). The development of sexual behavior problems in children and
youth. Ontario, Canada: Central Toronto Youth Services.
Johnson, T.C. (2009). Helping children with sexual behavior problems: A
guidebook for professionals and caregivers, 4th Ed. Institute on Violence,
Abuse, and Trauma.
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Johnson, T. C. (2009). Understanding children’s sexual behaviors: What
is natural and healthy. Ed. Institute on Violence, Abuse, and Trauma.
Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993). Impact
of sexual abuse on children: A review and synthesis of recent empirical
studies. Psychological Bulletin, 113, 164-180.
National Center on Sexual Behavior of Youth, (2011). National Center
on Sexual Behavior of Youth Fact sheet found at www.ncby.org.
Pithers, W. D., Gray, A., Busconi, A., & Houchens, P. (1998). Children
with sexual behavior problems: Identification of five distinct child type
and related treatment considerations. Child Maltreatment, 3, 384-406.
Silovsky, J. F., & Bonner, B. L. (2003). Children with sexual behavior
problems. In T.H. Ollendick, & C.S. Schroeder (Eds.), Encyclopedia of
Clinical Child and Pediatric Psychology (pp.589-591). New York:
Kluwer Press.
Working with Children Exhibiting Sexual Behavior Problems Maine
Child Welfare Training Institute, December 2006, 3rd Edition
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Safer Society Press
NEARI Press
National Center On Sexual Behavior Of Youth
WWW.tcavjohn.com
Association for the Treatment of Sexual
Abusers (ATSA)
Order information www.tcavjohn.com