Promoting Positive Sexual Development in Youths After Trauma

Child abuse is a widespread issue. The Department of Health and Human Services’ Children’s Bureau reports that of the 860,624 children living in Oregon during 2012, 9,576 of them were reported to be victims of some level of child maltreatment. These maltreatments include medical or general neglect and physical, emotional and/or sexual abuse. While the workshop was aimed at treating all children with sexual behavior problems (SBPs), it paid special attention to those in foster care.

As discussed in the workshop, Dr. Julie Larreiu, Charles H., Zeanah, Sherryl Scott Heller, Jean Valliere, Sarah Hinshaw-Fuselier, Yutaka Aoki, and Michelle Drilling argued in their 2001 study, “Evaluation Of A Preventive Intervention For Maltreated Infants And Toddlers In Foster Care,” young children in foster care have an increased risk for cognitive, social, and behavioral problems (p. 215). In most cases, these abnormalities are a result of the environment from which the children were taken, but as Zeanah, et. al. explain, “there is widespread support for the notion that foster care itself may contribute to poor adaptation, at least for some children” (2001, p. 215). This is why treatment for children, especially those in foster care, is crucial. It is imperative that victims’ issues be dealt with in order to promote healthy development. While there are many stages and types of development for young children, this reflection paper focuses primarily on promoting healthy sexual development in young children, particularly those in foster care.

The first step to positive sexual development is identifying the fact that the child is suffering from trauma in the first place. Before an issue can be addressed, it must first be recognized. It may seem that only children who suffer sexual abuse develop SBPs, but any child who is not encouraged and educated on appropriate sexual behavior may exhibit unhealthy behaviors. The incidence is higher in children who suffer from trauma—but not necessarily that of a sexual nature. As was explained in the workshop, according to a 2001 study conducted by Kerry Drach, Joyce Weintzen, and Lawrence Ricci, children with reported cases of sexual abuse score no higher on the Child Sexual Behavior Inventory than children who have suffered other types of abuse (p. 490). This is why it is important that parents, caregivers, and mental health professionals are equipped to recognize issues that may be the result of previous trauma.

Recognizing the signs of trauma is not difficult once an individual has been educated. Often, there will already be knowledge of prior abuse. However, understanding the response behaviors is important for addressing the trauma and encouraging the recovery process. Several discussions during the workshop were aimed at explaining and identifying these behaviors. The list of signs is long but includes depression and anxiety; issues with sleeping, dissociation, derealization, or depersonalization, low self-esteem, hyperarousal, difficulty concentrating, emotional instability, and changes in physiological patterns (e.g., sleeping and appetite). This is not a definitive list, nor is it likely that every child will exhibit all of these symptoms, but it is important to recognize how the effects of trauma can manifest in a young child.

Sexual development was a focus during the workshop, specifically, how to encourage positive sexual development in a child who suffers from the effects of trauma. What was referred to in the workshop as “natural and healthy” sexualized behavior is a child’s way of attempting to understand their own body, gender role, and behaviors. It is usually limited in practice and exercise. It was described in the workshop as “light-hearted” and spontaneous behavior. Feelings of embarrassment are normal, but shame, anger, anxiety, and fear are not. Problematic behaviors include compulsion and behaviors that are beyond the developmental range and age of the child. Children who are victims of trauma may use bribery or manipulation to coerce other children into engaging with them sexually. Threats and force may also be seen as acceptable behavior by the victimized child. As was highlighted during the workshop, it is important when questioning these children to choose careful wording. A question like, “Where did you learn that?” suggests that the child has a reason for their behavior, and assumes that they were a victim of child sexual abuse—which earlier discussions have shown is not always (or even most likely) the case.

Promoting positive sexual behavior begins by addressing the child’s underlying trauma. Various types of therapies are used. “Parent psycho-education” teaches parents to communicate with their children about their feelings and experiences. It advocates the parents’ addressing of their own possible childhood issues. This allows for healthier attachment between the child and parent (Zindler et al., 2001, p. 17). Child-parent psychotherapy is also recommended. This includes joint therapy sessions, intervention strategies, and teaching the parents to be effective role models (Zindler et al., 2001, p. 19). These strategies, working in conjunction with one another, are aimed at helping both the child and the parents learn to cope with the trauma.

Once the underlying trauma has been addressed, promoting healthy sexual behavior consists of allowing for appropriate exploration, educating the child on what these appropriate ways are, and setting boundaries. The workshop explains that SBPs do diminish with time and therapy. The workshop recommended using cognitive behavior therapy (CBT) that addresses both the symptoms of the trauma and the SBPs. This includes age-appropriate sex education, coping strategies, teaching self-control, and setting rules for sexual behaviors and boundaries. It also includes teaching the child sexual abuse safety. Setting manageable rules is also an effective strategy. The workshop provided an example from William Friedrich, whereby the parents develop (with the child’s input) a list of rules. These rules include statements like, “I do not touch other people’s private parts” and “If I am thinking about doing something sexual, I can distract myself by doing something else.” These statements help the child understand exactly what is expected of them. It allows the child to take part in their own recovery process and give them back some of the control they likely feel they are lacking.

Another important component necessary for the promotion of positive sexual development in a child who has previously suffered trauma is ensuring that the parents (foster or otherwise) are equally educated. A child living in a home with parents who have not been prepared to aid in the child’s treatment may lead to the parents’ actually adding to the negative behaviors. The workshop discussed the importance of the parents’ developing an effective safety plan for the child. It also stressed that parents must be educated on how to effectively communicate about sex education and other sex topics with the children. Parenting, relaxation and relationship building strategies were also highlighted. Because it is very important for the child to feel confident about their relationship with their parents (or other caregivers), this relationship building is of the utmost importance. Lastly, the workshop provided a link to the website www.TCavJohn.com which provides informational booklets and other resources for encouraging healthy and positive sexual development. The guidebook “Helping Children With Sexual Behavior Problems: A Guidebook for Professionals and Caregivers” is one of the materials which provides great information about the subject (Cavanaugh 2014).

While many of the strategies discussed were aimed at child-patient interactions, as a mental health provider, understanding how to communicate these strategies is important. The workshop itself managed to present these various topics and educational information in a way that was clear, insightful and allowed for the attendees to process the information in a way that made clear how and why the information was necessary to learn. Overall, those walking out of the workshop left with a better understanding of childhood trauma, sexual behavior problems, and how to best promote healthy, positive sexual behavior in young trauma victims.

References

Cavanaugh, T. (n.d.). Fundamentals. Toni Cavanagh Johnson, Ph.D. Retrieved March 19, 2014, from http://www.tcavjohn.com/products.php

Child Maltreatment. (n.d.). Department of Health and Human Services Children's Bureau. Retrieved March 17, 2014, from http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment

Drach, K. M., Wientzen, J., & Ricci, L. R. (2001). The diagnostic utility of sexual behavior problems in diagnosing sexual abuse in a forensic child abuse evaluation clinic. Child Abuse & Neglect, 25(4), 489-503.

Zeanah, C. H., Larrieu, J. A., Heller, S. S., Valliere, J., Hinshaw-Fuselier, S., Aoki, Y., et al. (2001). Evaluation Of A Preventive Intervention For Maltreated Infants And Toddlers In Foster Care. Journal of the American Academy of Child & Adolescent Psychiatry, 40(2), 214-221.

Zindler, P., Hogan, A., & Graham, M. (2010). Addressing the unique and trauma-related needs of young children. Florida State University Center for Prevention & Early Intervention Policy, 1, 3-29. Retrieved March 16, 2014, from http://cpiep.fsu.edu