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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An examination of the bases of two influential sets of publications suggests that their conclusions regarding the effectiveness of treatment with sex offenders were unnecessarily gloomy. The present article presents a more optimistic view of the literature, asserting that recent, relatively well-controlled evaluations have shown that treatment can be effective. To be maximally effective, according to this appraisal of the literature, treatment must be comprehensive, cognitive-behaviorally based, and include a relapse prevention component. Earlier outcome research that produced either treatment failure, or at best equivocal results, did not meet these criteria.

This article is the first report from a 5-year demonstration project examining the comparative efficacy of specialized and traditional treatments with children who have exhibited sexual behavior problems. Baseline data concerning the demographics, psychological adjustment, and victimization and perpetration histories of 72 6 to 12-year-old children who have engaged in sexual misbehavior are reported in this article. Information regarding the caregivers and extended families of these children is also presented. The data clearly demonstrate that families of children with sexual behavior problems are marked by an array of characteristics indicative of parental and familial distress, including high rates of (1) violence between parents; (2) sexual victimization and perpetration with the extended family; (3) physical abuse of the children who have exhibited sexual behavior problems; (4) children who have witnessed violence between their parents; (5) parental arrest; (6) denial of responsibility for perpetration of sexual abuse by members of the extended family; (7) poverty; (8) special educational services; (9) prior therapy for children; and (10) clinical scores on behavioral rating instruments. In particular, several significant differences emerged between younger children (6-9 years) and older children (10-12). Younger children had (1) been sexually and physically abused at an earlier age; (2) been more likely to have witnessed physical violence between parents; (3) performed problematic sexual behaviors at an earlier age; (4) a higher annual rate of problematic sexual behaviors; (5) had a higher percentage of hands-on sexual behaviors; and (6) had higher scores on measures indicative of sexual behavior problems (e.g., Child Sexual Behavior Inventory, Child Behavior Checklist -Sexual Problems Subscale).at DALHOUSIE UNIV on June 4, 2016 sax.sagepub.com Downloaded from 268 Based on these data, treatment recommendations are made for families containing children with sexual behavior problems. Given the extensive data suggesting parental characteristics that could serve as mediating variables in the sexual behavior problems of their children, effective intervention requires the involvement of the children's caregivers. The comparative efficacy of specialized and traditional treatments for these families will be reported in subsequent articles.

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