Assessment of Sexual Behavior Problems in

Children Areas and Scope

The scope of the assessment varies from one case to another. In many cases, the
necessary assessment information can be obtained from a review of the extensive
background information that is often included in these referrals. This can often be
accomplished in a single session, but in some cases that involves more complicated
diagnostic concerns, more time may be needed.

Family and Social Environment

Childrens behaviors are often reflective of their environment, and changes in envi-
ronment are key if sustained behavioral changes are to occur. Environmental fac-
tors may carry more weight than individual child factors, so the assessment should
include current and future contextual factors, including:

Quality of the caregiver-child relationship, including an assessment of the

level of positive adult caregiver engagement with the child.
The caregivers ability to monitor and supervise behavior.
The caregivers warmth and support offered to the child.
Whether there are positive and/or negative role models in the childs social
environment
Discipline, limits, structure, and consequences applied.
Disciplinary consistency.
Childs response to discipline.
Emotional boundary violations.
Physical boundary violations.
Sexual boundary violations.
Availability of opportunities for inappropriate behavior.
Extent and degree of sexual stimulation in the childs past and current envi-
ronment.
Extent and degree of violent stimulation in the childs past and current envi-
ronment.
Exposure to, and protection from, potentially traumatic situations.
Cultural factors within the home and community:
o Racial
o Ethnic
o Religious
o Socioeconomic
Factors related to resilience.
Strengths and resources that can be developed.

Since effective interventions usually involve working directly with and through par-
ents or other adult caregivers, it is critical to assess those areas in order to develop
appropriate goals and strategies.
Psychological and Behavioral Status

In some cases, sexual behavior problems may be a dominant concern, in other cases,
the assessment may indicate that the sexual behavior problems are a lower priority.
It is suggested that a broad assessment of general functioning should be combined
with a specific assessment of sexual behavior.

A number of non-sexual problems have been described among children with sexual
behavior problems:

Externalizing behavior problems

o ADHD
o ODD
o Aggressive behavior
Internalizing problems
o PTSD
o Depression
o Anxiety
Developmental and learning problems
Adverse environments
o Physical abuse
o Neglect
o Exposure to Violence

Assessing for problems related to abuse or trauma is especially important since a

significant number of children with sexual behavior problems have histories of
abuse or trauma. Less often, children may present with serious neuropsychiatric
conditions such as bipolar disorder. As a general rule, common explanations for be-
havior involving more prevalent conditions and more everyday explanations should
be considered before considering explanations based on conditions that are more
rare.

Assessing Sexual Behavior

A key component of this evaluation is information relating to a clear behavioral de-

scription of the sexual behavior involved, including

o What was the actual behavior?

o When the problematic sexual behaviors started?
o How frequently did the sexual behavior problems occur?
o How and whether the sexual behavior problems progressed or changed over
time

It is often helpful to sequence the sexual behavioral history chronologically, and

compare it, if possible, with key events in the childs life. Multiple information
sources are important. Gather information from the child, parents/caregivers,
teachers, and/or other children. This information may be available from investiga-
tive reports, records, and private evaluations.
Assess whether the pattern of sexual behavior problems is:

o Self-focused
o Other-directed
o Planned
o Aggressive
o Coercive

These factors are critical in assessing the extent of supervision and restriction need-
ed in order to protect other children. Included in this history is an assessment of the
attention to prior efforts or lack of efforts made by others to correct the behaviors,
and the childs responses to these efforts.

Good assessment should try to identify situations or circumstances under which

sexual behavior problems seem to occur. Generally, current and recent factors
maintaining the behavior problems, both environmental and emotional, may be
more salient than long past factors. Rather than etiological factors, recommenda-
tions ought to focus more on what current factors are maintaining the behav-
ior and what future maintaining or restrictive factors may arise. Finding the
ultimate cause of the sexual behavior problems is far less important than assessing
what current and future factors need to be identified to help.

Interviewing Children about Their Sexual Behavior Problems:

o Be sensitive to developmental issues and past trauma history

o Atmosphere should be supportive and unpressured
o Goal is information gathering and not to obtain a confession
o Do not use interrogation or pressure strategies with children
o Polygraphs or other techniques designed to elicit confessions should not be
used with children

Formal Testing:

Psychological testing can be helpful.

o Child Sexual Behavior Inventory III (CSBI-III)

o Designed for children ages 2-12
o Measures frequency of common and atypical behaviors, self-focused
and other-focused behaviors, sexual knowledge, and level of sexual in-
terest
o Age and gender norms are available
o Child Sexual Behavior Checklist (CSBCL 2nd Revision)
o For children 12 and under
o Can be completed by anyone who knows the child well
o Lists 150 behaviors related to sex and sexuality in children
o Gathers details about childrens sexual behaviors with other children
o Lists 26 problematic characteristics of childrens sexual behaviors
 o Gathers a broad range of information that is useful for assessment and
treatment planning
o Weekly Behavior Report
o A shorter instrument used for tracking week-to-week changes in gen-
eral and sexual behavior among young children.

Inappropriate Assessment Procedures:

Deviant arousal assessment techniques, such as phallometry, should not be used

since sexual attraction toward children is not considered deviant for children. Other
assessment elements, such as deficient victim empathy or patterns of grooming be-
haviors are irrelevant or qualitatively different among children.

It should not be assumed that sexual behavior problems alone sufficient to conclude
that there has been sexual abuse. In truth, there probably are multiple pathways to
sexual behavior problems, some of which involve sexual abuse and some of which
do not. Assessors should understand that providing good intervention services and
expecting good outcomes is still possible, even if the original causes of the behavior
are unclear, and even if the facts concerning sexual abuse history are inconclusive.
When cases have been appropriately investigated, but findings are inconclusive, it is
poor practice to keep questioning children over and over about abuse, or to keep
seeking additional interviews, additional experts, or additional medical examina-
tions.

Temporal Factors:

The behavior and status of children can change over time, particularly as the child
develops and matures, and as circumstances and social environment changes. The
validity of any clinical assessment can change over time.

When offering recommendations about limiting contact with other children, or oth-
er restrictive interventions, assessment reports should explicitly state that the rec-
ommendations apply to current circumstances and may not be valid later in the
childs life.

As a general principle, behavior occurring recently should be given greater weight

than behavior occurring in the distant past. In cases where the sexual behavior
problems last occurred a year or more ago, and it appears that the problems have
not reoccurred, it might be more appropriate to give greater weight to the childs
more recent desistance than to the childs long past sexual behavior problems.

Association for the Treatment of Sexual Abusers, (2006). Report of the ATSA Task
Force on Children with Sexual Behavior Problems. ATSA web-site.
http://www.atsa.com/sites/default/files/Report-TFCSBP.pdf