A normative sample of 1,114 children was contrasted with a sample of 620 sexually abused children and 577 psychiatric outpatients on the Child Sexual Behavior Inventory (CSBI), a 38-item behavior checklist assessing sexual behavior in children 2 to 12 years old. The CSBI total score and each individual item differed significantly between the three groups after controlling for age, sex, maternal education, and family income. Sexually abused children exhibited a greater frequency of sexual behaviors than either the normative or psychiatric outpatient samples. Test-retest reliability and interitem correlation were satisfactory. Sexual behavior problems were related to other generic behavior problems. This contributed to the reduced discrimination between psychiatric outpatients and sexually abused children when compared to the normative/sexually abused discrimination.

This research was conducted to define empirically derived and clinically relevant types of children with sexual behavior problems. A theory-driven hierarchical cluster analysis was performed using Ward's method. Five distinct types of children with sexual behavior problems emerged. Significant differences were found among the five child types on a large number of historical, diagnostic, behavioral, and demographic variables, including number of victims, degree of aggression employed during sexual acting out, sexual penetration, psychiatric diagnosis, internalizing, and externalizing. Clinical relevance of the child types was examined by analyzing change scores on an objective measure of sexualized behaviors in children who had earlier been assigned randomly to one of two treatment conditions. The analysis of treatment efficacy revealed a significant main effect of child type and a significant child type by treatment type interaction. After a short time in treatment, the highly traumatized child type derived significantly more benefit from a cognitive behavioral intervention than from an expressive therapy. This study demonstrates that distinct types of children with sexual behavior problems exist, that they can be distinguished on a wide range of clinically relevant variables, and that identification of child type may be relevant to choice of treatment modalities and outcome.

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