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CHILDREN WITH SEXUAL BEHAVIOR PROBLEMS Preadolescent children often engage in sexual behavior and exploration spontaneously, such as exposing and examining their genitals and those of their peers (e.g., Friedrich et al., 1991). These behaviors generally decrease with age due to socialization and increasing awareness of cultural norms as children enter middle childhood (Friedrich et al., 1991). In contrast, some children under the age of 12 have sexual behavior problems, defined as initiating “behaviors involving sexual body parts (i.e., genitals, anus, buttocks, or breasts) that are developmentally inappropriate or potentially harmful to themselves or others” (Chaffin et al., 2008, p. 200). The objective behind these behaviors may not be linked to sexual pleasure and instead may be the product of anxiety, attention seeking, or self-soothing (Chaffin et al., 2008; Chaffin, Letourneau , & Silovsky, 2002). Common Characteristics Children with SBP are a heterogeneous group, and there are no clear demographic, psychiatric, or social factors that differentiate children with SBP from their same-age peers (Chaffin et al., 2008; Chaffin, Letourneau, & Silovsky, 2002). Sexual behavior problems have been observed equally in both boys and girls (Friedrich et al., 1991; Friedrich & Luecke , 1988; Gray et al., 1999; Silovsky & Niec, 2002), in contrast to the large gender differences in rates of sexual offending among adolescents and adults (U.S. Department of Justice, 2011). One of the most common characteristics of children with SBP is a history of maltreatment, including physical abuse, verbal abuse, neglect, and witnessing domestic violence , in addition to sexual abuse (e.g., Friedrich & Luecke, GENERAL CONSIDERATIONS Children and adolescents with sexual behavior problems (SBP) have become a major focus of researchers and policymakers only in relatively recent years. Attention to juveniles with SBP increased in the 1980s and 1990s subsequent to research indicating that many adult sex offenders’ deviant sexual fantasies and/or behaviors began in adolescence (e.g., Abel, Mittelman, & Becker, 1985) and the realization that juveniles represent a significant proportion of arrests for sexual crime in the United States (about 17% in 2010; U.S. Department of Justice, 2011). Due to the increasing demand for treatment of juveniles with SBP, specialized assessment and treatment approaches for adult sex offenders were adapted for use with juveniles, despite minimal evidence that such approaches would be appropriate (e.g., Chaffin, 2008). In recent years, the literature on children and adolescents with SBP has grown considerably, producing substantial information on the nature of the population as well as effective interventions. This chapter provides an overview of common characteristics , promising subtyping approaches, and empirically supported assessment and treatment for children and adolescents with SBP. The review of children with SBP is gender-neutral, as this research often includes males and females (e.g., Gray et al., 1997; Merrick et al., 2008). The section devoted to adolescents focuses on males adjudicated for sexual offenses, as this subgroup has been the subject of the majority of the research. Interested readers are referred to the small but growing literature on female adolescents with SBP (e.g., Frey, 2010; McCartan et al., 2011). Children and Adolescents with Sexual Behavior Problems AMANDA M. FANNIFF, PH.D. JUDITH V. BECKER, PH.D. AMY L. GAMBOW, M.S. 17 Children and Adolescents with Sexual Behavior Problems 169 This typology merely reflects the severity of the behaviors, and its clinical implications are unclear. Pithers and colleagues (1998) identified subtypes of children with SBP through the use of hierarchical cluster analysis , using data from a variety of clinically relevant measures as well as demographics, characteristics of the SBP, and previous victimization. The resulting five subtypes were categorized as nonsymptomatic; sexually aggressive; abuse-reactive; highly traumatized; and rule-breaking. The subgroups differed in abuse history, diagnoses, and demographic variables, but for the most part, the children in these subtypes did not engage in qualitatively different sexual behaviors. The nonsymptomatic child type was described as the least severe type, including having the fewest victims, having the least aggressive behavior, and being least likely to be diagnosed with a psychiatric disorder. The sexually aggressive and abuse-reactive children were more likely than those in the other groups to engage in penetrative acts, but the sexually aggressive youths had been victimized by fewer perpetrators and demonstrated social competence, whereas the abusereactive youths had more perpetrators and higher rates of disruptive behavior disorders. The rule-breaking subtype had the most frequent sexualized behaviors, had a high degree of aggression, and scored higher on externalizing than any other group. The highly traumatized child type was found to have been...

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