Looking at Sexual Behaviors in Children Symptomatically, Not Just Problematically

By Geoff Sidoli, MSW, LCSW

One of the challenges arising from defining trauma is determining how each individual child will react and subsequently, what unique symptoms they will exhibit. Additionally, the field of traumatic stress has worked tirelessly to understand trauma, but we continue to lack consensus on what trauma is. Studies have shown us that a wide range of contextual factors will impact and affect children’s exposure to traumatic events. This has led us to recognize that we cannot easily capture a child’s experiences and responses in a siloed or separate manner.

Understanding Sexual Behaviors in Children

When addressing concerning sexual behaviors in children, it is critical we remember that sexual behaviors for children and adolescents are normal and should be expected.  Being grounded in that knowledge is key to determining what constitutes normative sexual behaviors and how to respond to problematic sexual behaviors with a measured response. Historically, the field has navigated numerous beliefs in what has caused or been correlated with problematic sexual behaviors.  The most frequently discussed influence is a child’s own history of being sexually abused.  More recent data reveal that while sexual abuse is a common factor, numerous other forms of neglect and abuse are more prevalent; such as interpersonal violence, physical abuse, and neglect. Children’s Advocacy Centers (CACs) now report that about 80% of children presenting with problematic sexual behaviors (PSBs) have experienced at least one traumatic event in their past.

Using Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

TF-CBT is intended to focus on reducing the impact of traumatic events and the subsequent symptoms. And, while TF-CBT is not meant to be a cure all for every child presenting for trauma treatment, we must not limit its application to some trauma symptoms while excluding others. Using a comprehensive assessment to determine the relationship between trauma and PSB should be a critical first step in both determining what treatment a child needs and developing an individualized approach to that treatment.  Developmental theories recognize the profound impact that our kids’ histories of neglect, abuse, and adversity can have on their learning and behavior. We also need to consider how their development was influenced by their contextual life experiences and the availability of supportive relationships which can drastically differentiate one child’s developmental pathway from another’s. Studies show that a failure to intervene early with the after-effects of trauma can lead to a long-term pattern of behavioral health problems. When working with kids exhibiting PSB who present with a trauma history, utilizing TF-CBT allows clinicians to integrate key components addressing sexual behaviors as trauma symptoms rather than just a behavioral problem.

How TF-CBT Can Address PSB

Using elements like psychoeducation, coping skills, affect regulation, and cognitive reprocessing, clinicians can address the multiple factors influencing the child’s behavior and promote safety, healing, and healthy development. Additionally, since TF-CBT emphasizes caregiver involvement, conjoint sessions can help foster communication and help families practice the skills learned in treatment, as well as provide a supportive environment to work through issues related to connection, communication, and trauma.

Using a trauma lens and approach to treatment allows children to experience a reduction in trauma symptoms, mitigate future problems, and improve their overall life experiences. Given the robust research supporting TF-CBT’s work with trauma, the abundance of trained clinicians, and the prevalence of trauma among children exhibiting PSB, it would be remiss not to use our resources to tackle this unmet need. 

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Clinicians are invited to our Advanced TF-CBT PSB Intensive Learning Community starting in October 2025. This is a 10-month advanced virtual training that includes a total of 5 days of virtual training over two learning sessions for trained TF-CBT clinicians who work with children 12 and under who are exhibiting problematic sexual behaviors. Clinicians will learn how to adapt their existing skills to address youth with PSB, help keep kids safe, families together, and recidivism low. This intensive advanced course comes with 11 group consultation calls to help put new skills to work. Registration for members is $1,250, and 25 CEs have been approved by NBCC and NASW.

Learn more about how to best address sexual behaviors in children and youth at Seamless 2025, the premier virtual conference for mental health professionals serving child victims of abuse, coming September 17-18, 2025.

Lastly, click this link to be directed to the NCA Institute for Better Mental Health Outcomes Training Calendar for our other learning opportunities.