Ask the Institute: What is PSB? How can we help kids overcome it?

For many years, NCA and its member centers and MDTs held fast to a brightline rule – we do not treat perpetrators, only victims. But few things in life, child sexual abuse included, adhere to such strict parameters. And there is now a growing recognition that children who engage in problematic sexual behavior are not “perpetrators,” but rather children who need a specialized approach to treatment.

Children with problematic sexual behavior (PSB) are defined as youth ages 12 and younger who engage in behaviors involving sexual body parts (i.e., genitals, anus, buttocks, or breasts) that are developmentally inappropriate or potentially harmful to themselves or others. Evidence-based treatment modalities have been developed to help treat children with  PSB. Problematic Sexual Behavior-Cognitive-Behavioral Therapy (PSB-CBT^TM) developed specifically for PSB can be provided in family or group therapy. Additionally, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is delivered with added PSB-focused components for children whose PSB is related to trauma. Treating PSB can seem complicated because of the grey areas it presents both for the providers and for the children and their families. But clarity about treatment approaches can help us address barriers for families, so that children and youth can receive the assistance they need. While the implementation of PSB-CBT^TM and TF-CBT for Trauma-related PSB share much in common, there are several important differentiators.

To begin with, the two approaches overlap in age. TF-CBT for trauma-related PSB is used with children ages 3-12, while PSB-CBT has versions for preschool children (ages 3-6), school-age children (ages 7-12, adapted for youth up to age 14), and adolescents (ages 13-18). Both approaches (PSB-CBT and TF-CBT) treat the child who engaged in PSB.

• TF-CBT for trauma-related PSB is for children who have experienced trauma, have posttraumatic stress symptoms, and whose PSB appears connected to that trauma. The underlying trauma can be any event – including sexual abuse, natural disasters, death, separation, to name but a few. Trauma remains the primary focus of treatment. The role of the caregiver is emphasized and PSB-focused components (such as safety planning, sexual behavior rules, sex education, body safety skills, and parenting strategies to reduce PSB) are enhanced to the standard TF-CBT components.
• In PSB-CBT^TM , PSB is the primary focus of treatment and child may or may not have a history of trauma. PSB-CBT^TM is trauma informed approach and has significant overlap with the PRAC components of TF-CBT. However, in PSB-CBT^TM, trauma is not the primary focus of treatment.

Choosing between the two is a clinical decision based on assessment, and for some children it is not one treatment or the other. Standard TF-CBT is also appropriate for children impacted by another child’s PSB who develop posttraumatic stress symptoms.

Both approaches include key components of behavior parent training, to prevent and respond to problematic sexual behavior. Caregiver sessions also address some of the psychological barriers that keep children and families from participating in treatment: shame, embarrassment, and the myths and misinformation related to PSB.

If you, or the clinicians that serve the children in your jurisdiction, haven’t already received training in one or both approaches, it is time to consider doing so. The National Center on the Sexual Behavior of Youth offers a wide range of training including PSB-CBT and Advanced TF-CBT for Trauma-related PSB, a training for clinicians who have already completed TF-CBT training. TF-CBT training information is available at tfcbt.org. Click here to learn more about PSB-CBT, and more about TF-CBT Advanced Training.

Advanced training in PSB for TF-CBT providers often is a good start for Children’s Advocacy Centers who want to gain evidence-based skills in enhancing safety and reducing PSB in children. Training in PSB-CBT^TM includes training for the senior leaders and provides tools for supporting community understanding and coordination of care, as the families are often involved with multiple systems (child welfare, law enforcement, juvenile justice, and others). Learn how you can be part of the solution to the issue of PSB.