ADOLESCENT SEXUAL
BEHAVIOR PROBLEMS:
RECOVERY
&
RELAPSE PREVENTION
Ana SaldivarSchlosser, MS,
LPC, NBCC, R.
Psych (p)
atschlosser@g
mail.com
DISCLOSURE
I have no financial relationships with
a commercial entity producing
health-care related products and or
services.
FACTS OF SEXUAL DEVELOPMENT
 Sexual responses are present from birth
 Sexual development and behavior are influenced by
social, familial and cultural factors, as well as
genetics and biology.
 Wide range of sexual behavior in children is normal
and non-problematic
 More children are being identified with inappropriate
sexual behavior
 Treatments such as cognitive behavioral therapy are
proving effective in reducing problem sexual
behavior
 *1*
HANDS UP: TRUE OR FALSE?
12 AND UNDER
Sexual acts between children are normal Children with SBP should not live with
and not harmful
other kids
Children with Sexual Behavior Problems
(SBP) have been sexually abused
Children with SBP should be placed in
specialized inpatient/residential tx
Children with SBP should not attend
public school
Children who have been sexually abused
act out later sexually with other kids
Without long term intensive tx they will
continue to have sexual behavior
problems
Girls rarely have sexual behavior
problems
Children with SBP grow up to be adult
sex offenders
FACTS OF 12 AND UNDER
Some sexual behavior between children
is not appropriate
With intervention and treatment, most
children with SBP can live safely with
other children
Sexual acts between children can be
significantly harmful
Outpatient treatment can be successful
for most children with SBP
Many children with SBP have not been
sexually abused
Most children with SBP can safely attend
any school
Most children who have been sexually
abused DO NOT have SBP’s
Most treated children do not continue to
have SBP. “short term” 12-32 weeks of
treatment. 15% recidivism after 2 yrs
As many as 1/3 children with SBP are
girls. Up to 65% in preschool age
Most children with SBP do not
demonstrate continued SBP into
adolescence and adulthood
*14*
PLAY VS. PROBLEM BEHAVIOR
12 AND UNDER
Sexual Play
Problem Sexual Behavior
Exploratory and spontaneous
Frequent, repeated, compulsive
Intermittently and mutual agreement
Aggressive, forced or coerced, causing
harm
Similar age, size, development level
No fear, anger or anxiety present
Varying sizes, ages, developmental level
Decreases when told to stop
Do not decrease when told to stop
Controlled by increase of supervision
Often occurs between siblings, cousins,
peers
Occurs between children who do not
know each other well. Becomes more
sneaky if supervised more
NORMAL T YPICAL
ADOLESCENT SEXUALIT Y
Sexually explicit conversation with peers
Obscenities and jokes within cultural
norm
Flirting, innuendo, courting
Interest in erotica
Solitary and or mutual masturbation
Foreplay (making out, fondling)
Monogamist intercourse (stable or serial)
 *6*
YELLOW FLAGS
 Preoccupation/Anxiety regarding sex
 Pornographic interest
 Promiscuity/Polygamist Behavior/Indiscriminant
Contact
 Sexually Aggressive Themes/Obscenities
 Violating others body/personal space
 Pulling skirts up or pants down
 Single occerance peeping, exposing, frottage,
with KNOWN peers
 Mooning and Obscene gestures
 *6*
RED FLAGS
 Compulsive masturbation (especially chronic or
public)
 Degredation/Humiliation of others using sexual
themes
 Attempting to expose OTHERS genitals
 Sexually Aggressive Pornography
 Sexual conversation with significantly younger
children
 Touching and grabbing others genitals without
permission
 Verbal or written sexually explicit threats
 Sadistic acts (cutting/mutilation)
 *6*
ILLEGAL BEHAVIORS
 Sexual abuse, molestation, harassment
 Obscene phone calls, chat, texts etc
 Voyeurism
 Exhibitionism
 Frottage
 Child sexual abuse
 Rape
 Bestiality
 Penetration including using weapon or foreign object
 *6*
MOTIVATION FOR SEXUAL BEHAVIOR
 Exploration/curiosity
 What’s this all about? Self/others
 Imitation/learning
 See/do/practice/teach
 Sensation seeking
arousing when bored/ calming when stressed
 Reinforcement: feels good
 Arousal, orgasm, tension reducing
 Pleasure: self/others
 Relationship, intimacy, friendship, love
 Compensation/improvement
 Feel better, do better, regain self image or control
 Anger/retaliation
get back at others, make others feel hurt, angry
ADOLESCENT VS ADULTS OFFENDERS
lower recidivism
engage in fewer abusive
behaviors over shorter periods of
time
have less aggressive sexual
behavior
“Pan-sexual” no real preference
STATISTICS OF ADOLESCENT SEXUAL
OFFENDERS (ASO)
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17% of all sex crime arrests are by ASOs
1/3 of all sex offenses are against children
Females under 18 account for 1% of forcible rapes
7% of all juvenile arrests for sex crimes are female (excluding
prostitution)
ASO commit “limited” (touching over clothes, short term) and
“extensive” (use of force/coercion, aggressive, long term LT)
15% of ASO offenses include penetration/intercourse (LT)
ASO do not have a specific family profile
ASO self reported victimizations range from 20 -55% often
reporting more physical than sexual abuse
Recidivism of ASO who received treatment ranges from 5 -14%
and are lower than other delinquent behaviors (8 -58%)
No cure or 100% reliable, validated instrument to predict
 *13*
OFFENDER UMBRELLA
 PTSD 60% male/40% female
 Sexually Reactive, unresolved grief/trauma, repeatedly violate
boundaries
 Repetition compulsion to regain control over own abuse, use relapse
prevention
 CBT, DBT etc, respond well to therapy, gravitate to victims at their
“stuckness”
 DEVELOPMENTAL DELAYS-FASD
 Require structure and supervision, No Cognitive Behavioral, Concrete
 MENTAL HEALTH
 OCD, RAD, ADHD, Bipolar, PDD, concurrent disorder treatment
 *2*
OFFENDER UMBRELLA
 PSYCHOTIC
 Conduct disorder, anti-social, delinquent (violence,
gangs, not in reality)
 Poor prognosis, arousal is from the control/coercion
of victim
 Mostly men, 1% are female
 PEDOPHELIA/HEBOPHELIA
 Genetics? No Trauma, No Effective Prevention plan
 Sexual “preference” and attraction (physical)
 Not typically responsive to therapy
 *2*
HALF WAY….
Questions??
T YPOLOGIES OF ASO
 PSYCHOSOCIAL DEFICIT: Outpatient Responsive *4*
 Naïve/Experimenter
 Undersocialized Child Exploiter
 Pseudo-Socialized Child Exploiter
 Group Influenced Offender
 DELINQUENT: Inpatient/Residential Treatment *4*
 Sexually Aggressive
 Sexual Compulsives
 Disturbed Impulsive
 *3 *
FEMALE ASO T YPOLOGIES
Explorer/Exploiter
Pre-Disposed-Severe Abuse History
Male Coerced
 PSYCHOLOGICALLY DISTURBED:
 Sexually Compulsive
 Pre-disposed Adjustment Reaction
 Sexualized Identity
 Disturbed Impulsive
 *5*
DIFFERENCES IN FEMALE VS MALE ASO
FEMALES
MALES
Same gender offences typically
Opposite gender offences
Sibling targets typically
More offending towards non- immediate
Romance, love, fantasy element
See child as object/means to an end
Mostly contact offences
commit non-contact offenses more
Tend to take more responsibility
Blame victim more
Longer offending
More impulsive shorter term offenses
More empathetic towards victim
Less offenders-fluid with physical abuse
Not usually aroused
Are aroused during
Abused by male figure (father)
Absent or inconsis. male figure (father)
HOW DOES THE OFFENSE OCCUR?
Motivation to offend
A. Emotional needs
B. Sexual needs
C. Blockage
 1.
2. Internal Barriers
3. External Barriers
4. Victims Resistance
*7*
FOUR PRECONDITIONS MODEL
*7*
EVALUATING SEXUAL INTERACTIONS
 Consent vs Compliance/Cooperation
 Coercion
 Equality
Rules of Consent:
S a m e l ev e l e m o t i o n a l ly
A p p r o p r ia te a g e ( 2 ye a r s )
H o n e s t y a b o u t w h a t ’ s to o c c ur
B o t h S ay “ Ye s ”
Pe r m i s s i o n to s ay “ n o ” a t a ny t i m e
B o t h u n d e r s t a n d w h a t i s g o i n g to h a p p e n
No impaired thinking
Both clean and sober
E q u a l i n te l l ig e n c e
A f f ec t i o n / ex is t i n g r e l a t i o n s h i p
*12*
RELAPSE PREVENTION PLANNING
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Under standing Lapses vs Relapses
Grooming, Maintenance, and Gateway Behaviors
Thinking error s
Warning signs
Prevention/coping steps
 IMPULSE CONTROL METHODS:
 Thought stopping
 Urge or impulse charting
 Thought switching
 AROUSAL CONTROL METHODS:
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Masturbatory reconditioning
Boredom tapes
Vicarious Sentitization
Empathy Covert Sensitization
 Offending fantasy, empathy scene, positive scene
 Covert sensitization
 Offending fantasy, negative scene, positive scene
 *12*
DEVIANT CYCLE-THINKING ERRORS
*12*
SAFET Y PLANNING
 Address physical boundaries in all areas of of fenders
home/school/work etc
 Knock when door closed, no locks on inside of door, no shared
bed
 Children of opposite sex should not share room after 5 years of
age
 Children should not share bedroom with parent after age one
 Sexually abused children may not cuddle in bed with parents
One person in a room/bathroom at at time
Rules around play
Touching between offender-victim
SAFET Y PLANNING CONTINUED…
*8*
Clothing- noone should be in underwear only
Touching- always ask permission, no viewing others privates
Being alone with others-have a “witness” , never allow babysitting
Horseplay/wrestling/tickling-limited-clarify hugs, kisses affection etc
Feelings-emotional boundaries
One on one time with parents
Technology-monitor ALL means of access to internet, cell phone, chat
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no Sexual talk or innuendo with media
No drugs or alcohol
Never put child in charge of discipline and caretaking
No gift giving between of fender -victim
REASONS YOUTH HAVE SEX
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Physical pleasure
Peer pressure
Proving man or woman hood
Parental pressure
Curiosity -new experiences
Love and af fection
Risk taking
Wanting to get pregnant
Wanting to be an adult
Rebelling against parents
Public opinion
Wanting to hold on to boyfriend or girlfriend
AM I READY FOR SEX?
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Am I feeling pressured to have sex?
Will having sex fit my moral or religious beliefs?
Will I feel guilty if I have sex?
Do I want to have sex to get love, affection or attention?
Do I want to have sex to prove that I am sexually attractive?
Am I afraid that my reputation will be hurt if I have sex?
Do I think sex will bring my partner and me closer together, both
emotionally and physically?
Do my partner and I both want the same things from sex?
Can I talk to my partner about birth control and can we share the
responsibility for birth control?
Can I talk to my partner about sexually transmitted diseases?
If birth control fails, are we ready to deal with an unplanned
pregnancy?
YES to 1 ,3,4,5,6 or 7 or NO to 2,8,9,10, or 11 use caution
 *9*
SEXUAL ETIQUETTE
 Never force
 Respect ‘no’
 Avoid potentially difficult situations
 Be prepared
 There is a shared responsibility in sexual
relationship
 Communicate openly about contraception
 Sexual privacy should be respected
 Be considerate of others
 Sexual harassment is not a joke
 *10*
ASSESSMENT INTERVIEWING AND INTAKE
 Make sure you are aware of your own level of comfort talking
about sexual issues
 Sit at 90 degrees from the child
 If you are asking about negative or embarrassing issues,
assume there’s more
 If you are asking about normally expected issues, assume
there is none
 Be careful not to supply the answer -be willing to sit in silence
 Use concrete materials (family trees, maps, floor plans,
timelines, pictures, charts)
 Areas: social, school/vocational, Non -sexual Delinquency,
Emotional Expression (non -sexual), Self esteem, sexual
development, masturbation, sexual victimization, sexual
of fense, denial, minimization, sexual attitudes, non -of fensive
sexual relationships, family issues, living environment
 *11*
GUIDE FOR PROFESSIONALS WORKING
WITH PARENTS OF ASO
 Explore parents’ feelings about the premised that their child’s
problems now as the whole family’s problems
 Explore concepts of a faith and or support system (families often
alienated)
 Discuss with parents whether they feel ready and open to
receiving help with their family’s problem
 Ask parents to name the single most likely person or thing to
blame for their child’s problem (opens to release deflecting)
 Focus on helping parents to let go of their need to minimize their
child’s behavior
REMEMBER:
 Do not overreact as most sexual behaviors in children are within
the typical or expected range
 Inappropriate or problematic sexual behavior in children is not a
clear indicator that a child has been sexually abused
 Most children will stop the behavior if they are told the rules,
mildly restricted, well supervised and praised for appropriate
behavior
 If the sexual behavior is problematic as described above -refer to
treatment
 If behavior extends to other environments -seek treatment
 *1*
REFERENCES
 1 Na ti o nal Ce n te r o n Sex ua l B e h avior fo r Yo ut h - (N CSBY) Sex ua l D eve lopme nt
 2 M i ke B o n iello - Sex ua l Of fe n di ng Yo ut h
 3 P H ASE Ty po l o gy o f Ado l e sc ent Sex Of fe n de r s - M i c h ael O’ B ri en a n d Wa l te r H .
B e ra , M A
 4 Ty po l o gies o f Juve n iles Wh o h ave Co m mit te d Sex ua l Of fe n s es - To m Leve r see ,
LCSW
 5 Fe m a le Pe rpet ra to r s Ty po l o gy a n d Tre a t m ent i s sues - Susa n Pe ddi e , M SW,
RSW
 6 Ra n g e o f Ado l e sc ent Sex ua l B e h avior - Ryan
 7 Th e o r y o f “ Fo ur P re c o n dit ions: A M o de l” Fi n kelhor, D ( 1 9 8 4) Ch i ld Sex ua l
Abus e : N ew Th e o r y a n d Re s e a rc h ( pg . 5 3 - 6 8 ) N ew Yo rk : Fre e P re s s.
 8 Ch i ldh ood Sex ua l it y : It ’ s Pe r fe c t l y N o rm a l - Way n e D ue h n , P h . D .
 9 Am I Re a dy Fo r Sex ? H IV / AID S n et wo rk o f So ut h e a ste rn AB
 10 Sex ua l E t i q uet te - Co n t ra c ept ive Te c h n olo gy Upda te
 1 1 In te r v iewin g Ado l esc ent s w h o h ave s ex ua lly o f fe n de d - Worling , 2 0 0 9
 1 2 Pa t h ways : A G ui de d wo rk bo o k fo r Yo ut h c o m plet ing t re a t m en t - 3 r d
 1 3 N CSBY Fa c t Sh e et - Ado l e sc ent Sex Of fe n de r s
 14 N CSBY Fa c t Sh e et - Childre n w i t h Sex ua l B e h avior P ro bl e ms
EXTENDED REFERENCES *1*
EXTENDED REFERENCES *13*
EXTENDED REFERENCES *13* CONT.
THANK YOU!!

Please feel free to contact me:
Ana Saldivar-Schlosser, MS, LPC, NBCC,
R. Psych (p)
[email protected]
918-508-1567