OU College of Medicine Partners With U.S. Department of Defense to Address Problematic Sexual Behavior in Youth

When young people act out sexually in ways that are harmful to others or themselves, the stigma surrounding the issue can be paralyzing for everyone affected. However, data shows that treatment for problematic sexual behavior in youth is highly effective. Faculty members at the University of Oklahoma Health Sciences Center are among the nation's leaders on this topic, and they recently received a federal grant to assist the U.S. Department of Defense in addressing problematic sexual behavior of youth in the military.

The National Center on the Sexual Behavior of Youth (NCSBY) is housed within the OU College of Medicine, Department of Pediatrics. Its personnel have been trailblazers in the research and treatment of problematic sexual behavior of youth, and in training parents, caregivers, healthcare providers and others around the world to prevent and respond to incidents.

NCSBY's new work is funded by the Office of Juvenile Justice and Delinquency Prevention, a component of the U.S. Department of Justice. NCSBY is assisting the U.S. Department of Defense in developing training materials and resources to address the issue of youth problematic sexual behavior in all branches of the military.

"This is an issue that communities and people worldwide struggle to address," said clinical child psychologist Jane Silovsky, Ph.D., director of NCSBY. "But the Department of Defense has done a remarkable job of understanding the science about the appropriate response to the children with behavior problems, as well as their caregivers and the children who are impacted."

In many cases, problematic sexual behavior in youth involves one young person harming another young person, Silovsky said. Studies show the behavior peaks between the ages of 12 and 14, and that young people rarely act out on strangers; most of the time, they're acting out on siblings, cousins, schoolmates and others within their social networks. Exposure to violence is a major risk factor, whether it's domestic violence, physical abuse, harsh parenting practices, or community violence. Exposure to sexualized media is another risk factor; young people can access pornography on any device, despite the best efforts of their caregivers, Silovsky said. In addition, there are individual risks, such as a child having developmental disabilities, being on the autism spectrum and having impulse disorders.

"These risk factors can impact children's emotional regulation skills, impulse control skills, and their understanding of the rules and how you treat others," Silovsky said. "A common myth is that all youth with problematic sexual behavior are being sexually abused themselves. While sexual abuse is a risk factor and a concern, there are many kids with problematic sexual behavior have not been sexually abused."

Nor are children with problematic sexual behavior the same as adults who have illegal behaviors or adults with pedophilia who have inappropriate arousal toward children, Silovsky said, and treating them as adults does more harm than good. Rather, the approach involves cognitive behavioral therapy, in which children and caregivers alike build new skills, protective and resilience factors, and learn to manage their emotions. The treatment involves group therapy - the youth in one group, parents/caregivers in another, with time during each session when they're all together.

The good news is that when children and families are connected to evidence-based treatment, the recidivism rate is less than 2 percent, said licensed clinical psychologist Jennifer Shields, Ph.D., whose expertise with NCSBY is family engagement. With appropriate treatment, supervision and monitoring, most youth with problematic sexual behavior can be maintained in their home or community environment rather than inpatient care, she said.

"That's what gives me hope as a provider - we have empirical evidence that this treatment works for kids," Shields said. "Caregiver involvement is critical to the outcomes. We help parents and caregivers learn better strategies to supervise and guide their children, build healthy relationship skills, and immediately address anything problematic in a way that helps kids learn from the experience and develop better behaviors."

NCSBY is working with the military's Family Advocacy Program to develop training materials that their multidisciplinary team of providers will use to address problematic sexual behavior. In addition to trained to recognize potential problems, Silovsky said.

NCSBY also has a Parent Partnership Board comprised of parents whose families have finished treatment programs and want to support other families who are in the same situation. They developed a guide that supports parents as they talk to their children about sexual behavior.

"As health providers, we can support families and tell them there is hope, but it's entirely different when families with a shared experience get together," Shields said. "Parents come in feeling guilty and judged, but they have a space where they can talk with each other, which also helps to promote healing."

NCSBY's training and technical team expertise was built from over 30 years of research and clinical care for preschool and school-age children and adolescents with problematic sexual behavior and their caregivers at OU Child Study Center. For more information about the work of NCSBY, visit www.ncsby.org

Training and Technical Assistance activities are made possible in part by grant 2016-MU-MU-K053 and 2019-MC-FX-K022 awarded by the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect those of the Department of Justice.