What Drives Problematic Sexual Behavior in Kids

Teresa Huizar: Hi, I’m Teresa Huizar, your host of One in Ten. In today’s episode, What Drives Problematic Sexual Behavior in Kids, I speak with Dr. Brian Allen, professor in the Department of Pediatrics at Penn State. Now, if you’ve been a long-time listener of One in Ten, you know that we’ve had several guests share the latest research on a particular aspect of prevention or intervention with youth with problematic sexual behaviors. What we haven’t had up until now has been a meta-analysis or a state of the research analysis to demonstrate the cross-cutting findings among many studies. Dr. Allen set out to do just that. And as you will hear, we both know more about youth with problematic sexual behaviors than ever before. And also, there’s still many outstanding research questions. What do we actually know about what motivates problematic sexual behaviors in kids and youth? How do we most effectively treat it? And how can we help parents effectively address it?

I know you’ll be as interested in this topic as I was. Please take a listen.

Brian, welcome to One in Ten.

Brian Allen: Thank you, thanks for having me.

TH: So how did you start becoming interested in your work on problematic sexual behaviors in youth?

BA: That’s a great question. So I was teaching in Texas at the time at a university and I had a graduate student. I’ll call her out. Her name was Alexandra Teyes. She was absolutely a phenomenal student. And in her course, I was teaching on developmental psychology at the graduate level. She took that course and wrote her term paper on children with problematic sexual behavior. And I had worked in the child abuse field for many years at that point. That was my internship and fellowship and that’s what I was doing. And so I was excited to read her paper because I felt I would know a lot about that topic. And when I read her paper, it was very well cited. Like I said, she was a phenomenal student. I realized that maybe I didn’t know as much as I thought I did. And so I got fascinated with this. So I decided I was going to take that summer and read everything I could find on problematic sexual behavior. And it took me maybe a week because that’s all that was there. I found several papers and one book and that was about it.

I got excited about that idea that this is a fairly untouched field or area. There was some really good work that had been done up to that point, but there was a lot of different places that we could go with it. And that got really exciting to me. And so as I started getting into it, I kind of started learning in terms of treatment and assessment, some things that did work, some things that didn’t, lots of questions to answer. And so that was how I came into that. And now it’s been, yeah, about 15 years that I’ve been researching this topic.

TH: I think a little more research done on the topics that sound right, which kind of leads us into why you’re here today to talk about a meta-analysis you did regarding PSB. And so I have a few things. First of all, for folks who are like, what is that? Just because everybody listening knows about child abuse, but not all of them are researchers. So can you just explain what this is and how the study is a little different than other types of studies people may be more familiar with?

BA: Sure, so a meta-analysis is basically the idea is that we take all of the research that we can find on a given topic and through some different statistical things, we’re able to put all of that data together into one big analysis. And what that allows us to do is really, you know, in a normal study, you might have, if you’re lucky, a couple of hundred children. In this case, we can do an analysis where we might have 8- to 9,000 children. And what that allows us to do is really have a powerful study that allows us to look at things like not just are two things related, but are they related in certain situations and not in others? You know, is it for particular genders or age or some of these different kinds of things that you can’t do usually with just one study? So that’s basically the idea of a meta-analysis in terms of what we’re doing and how we get into the statistics of it all.

TH: It just allows you to look at a large data set and therefore you have not only more factors but see what the strength of these associations are as well. So for our listeners don’t worry we’re not going to go down a long rabbit trail of all the different things on methodologies and analysis because that’s not my area of expertise either. But what interested me in the study is because it feels like it comes at a seminal moment.

In that, lots of Children’s Advocacy Centers and child abuse professionals are working with kids and youth that have problematic sexual behaviors now. This is a topic that has been discussed much more widely, not only in the field, but in the public as well. There’ve been media reports, more is known about what treatments work and don’t, as you said earlier, and other things. I really appreciated this kind of point in time in which we’re trying to learn as much as possible and consolidate what we do know. So I’m just wondering what you were hoping this piece would add to the literature. In other words, yes, you wanted to know kind of the overall scope of what we know now about PSB, but there were some specific areas that you were especially interested in exploring through this. What were those, and why were you interested in them?

BA: Yeah, one of things I’ll say is that the research that we have really coming out now on PSB is coming from either an academic site like what we have here and I have colleagues in Oklahoma at an academic site or it’s coming from CACs because of the efforts that the NCA and others have put into trying to increase access to services for these children. It’s given us a wealth of data that we didn’t have before. And one of the things that we were trying to look at in this meta-analysis is historically speaking, the assumption largely was that problematic sexual behavior was the result of some kind of sexual abuse. Somebody had taught this to the child or somebody had demonstrated this to the child in some way. And so the child’s behavior then is a reaction to that abuse. And one of the things that we started finding, people even before me started documenting a little bit, was that a lot of these children that have these problems did not have a sexual abuse history. And so if that’s the case, then why might they have these problems?

And we’ve had some different ideas, one of which is just behaviorally, they’re really dysregulated. They have a hard time controlling emotions and behaviors. One of them is social learning. Children have seen this in different ways, maybe something abusive, but also there’s a lot of non-abusive forms of modeling. And so one of the things we were trying to do with this study was to look at how strong was the connection of PSB with all of these different kinds of influences. So we did look at the connection of PSB to sexual abuse. But then we also looked at the connection of PSB to other kinds of behavior problems. Is it just group with behavior problems in general? So we were trying to look at all these different influences and things that we know are related. How do they shake out in terms of what are the strongest or most closely related correlates and factors and which are maybe more weakly related? And we think that that will help us better understand where these behaviors come from. And then ultimately better understand how to treat them.

TH: And you also, if I’m remembering right, looked at some different demographic factors as well, I think. Is that right?

BA: Correct, yeah. One of the things I think just in our everyday frame of mind, we tend to think of sexual behavioral concerns being more of a male problem or a male-focused problem. Most of the research was saying when we’re looking at children, prepubescent preteen children, that there wasn’t a lot of relationship to gender. It was happening in girls, it was happening in boys.

Same thing with age. We tend to think of sexual behavior a lot of times as children are moving towards puberty, they start getting interested in these problems and that might be when the behavior pops up. But a lot of the studies were finding that it was really younger children that were more likely to have these problems. And so, I don’t know if I’m jumping ahead, but in the meta-analysis, that’s really what we showed. We showed that gender-wise, there wasn’t really a lot of differences. It was statistically significant, but that was because we had 9,000 people in it.

But it wasn’t something that would be, you know, gender wasn’t something that really is going to show up in clinic very often as a cause for PSB. For age though, the relationship was a little stronger. We do see these behaviors with a bit more frequency with younger ages than we do with older ages. So yeah, we looked at those demographic correlates as well.

TH: Well, let’s dive into the age for a moment because I do think that what you’re saying, especially if someone doesn’t have a clinical practice, might be a little surprising because, and even I would say potentially for some CACs, often when a child is being brought to us, they could be preschool, but they might well be school-aged. So they might not be seeing the youngest of them anyway because some of that behavior may have just been dismissed as like not required in intervention or whatever. But what I’m curious about and also just found interesting and want to explore with you is that you point out in the paper that there’s a difference in sort of the motivation behind the behavior based on age and that the literature seems fairly consistent on that. Can you talk about that a little bit?

BA: One of the things that clinically I find happening to talk with lot of parents about is why the child might be displaying these types of behaviors. Because I think as adults we default to this idea of sexual arousal and pleasure and some of those more adult concepts of sexual behavior. That when you’re dealing with younger children, most of those concepts are not relevant. The three, four, five, six year old, they don’t know things about sexual gratification or orgasms or any of that kind of, they don’t know that stuff. What they know is that when this particular part of my body is stimulated, it creates a weird feeling. And that’s about the extent of it. So when we have really young kids, you have to remember these kids do not have typically a sense of embarrassment or shame or any of those types of things. They tend to be pretty poorly regulated in general. Three, four, five year olds are much more difficult for them to control emotions and behaviors than a more mature child. And so it’s a combination of things where the behavior just might wind up becoming problematic, but it’s not because of what we often think of as, quote unquote, sexual. When you move a little bit farther along and you get into the school age range, we start having a lot more discussion or thoughts about some of these topics. So, you know, I have a 10-year-old daughter and I can remember her asking questions two or three years ago when she was seven, eight years old. Because these comments, these topics are in the school, they are in the community, they’ll hear them, they’ll see things, and they’ll ask questions. And for a lot of these kids that create some curiosity, they start wondering, what are these things I’m hearing? And that’s where we get a lot of internet pornography issues is that a child has learned to Google things because we teach them that. And so they hear something, they Google it, and now they’re seeing videos of these topics. And then you get all the way up to the 11, 12-year-old who maybe are displaying some pretty pubescent, if not actually pubescent interests and desires and questions that are a little bit more mature. So this age range covers a whole bunch of different motivations and abilities and yeah, it’s hard sometimes for people to really think about it in that lens.

TH: In some ways, it kind of ties to different developmental stages, as you’re saying, right? That with little kids, just maybe some impulsivity or, you know, then you have all the curiosity that comes along shortly thereafter. And unfortunately, as you’re saying, exposure to highly sexualized content, I mean, it’s almost universal. I think it’s very challenging for parents to prevent that from being the case, even if they’ve spent a lot of time doing parental controls on all the various devices and apps and all of those things. Algorithms themselves, if someone has been curious and as you say, Google something, the algorithms themselves will feed content to kids in a way that’s not helpful.

BA: Yeah, and it’s really interesting too, when we talk to some of these parents and clinicians that we train, we hear this from them too, after they start treating some of these cases. Children wind up being exposed to a lot of these things. Sometimes deliberately, which might fall into use of other times just by happenstance, walking through a living room and there’s something on the screen or changing the diaper of a younger sibling or any of these kinds of things where they’re exposed to some kind of sexual content. When we ask parents, they’ll often, if these kinds of things are happening at home, they’ll often tell us, they’re not real shy about it typically, sometimes you get that, but they’ll tell us, know, dad was slapping mom on the buttocks or something and making some kind of comment. Like these things happen. And then when we ask them, have you talked to your child about any of this? Have you given them any, let me sit you down and talk to you about limits and boundaries. And their eyes will get big and they’ll say, no, we haven’t done that. I mean, he’s only seven. What do you teach a seven-year-old?

You know, so it’s really interesting. There’s this very clear disconnect that we have that children are exposed to sexual content on a regular basis, including inside of homes. But then the idea of talking to the child about sexual content and limits and boundaries really just freaks a lot of people out and they don’t know what to say. And they’re just shocked that you would even ask that question. So children are then left with their own devices. I mean, they’re left to try and figure out these things, make sense of these things, and then they get in trouble for something and then maybe don’t know what they got in trouble for. So it’s a very interesting kind of space to work in.

TH: You know, one of the nice things about talking to someone who doesn’t only research this but has a clinical practice is that you can dive into the practical implications of these things. And what I was thinking about as we were talking is that, do you think that reluctance to talk to, let’s say that seven-year-old about what they’re seeing, hearing, whatever, do you think that’s about some misperceived idea about the innocence of children but not wanting to infringe on that?

Or do you think it’s just adult discomfort with having these conversations with kids or something else?

BA: I think the overarching idea is it’s very cultural. I have colleagues in Sweden, for instance, and I spent some time there where this whole, and we have data on this too, that these behaviors are more commonly displayed in Sweden than they are in the United States. But in Sweden, they don’t view it as particularly being a problem. They teach their children about these things. They have curriculum in preschool on body part names and autonomy and personal space, and it goes all the way up through school into the high school years.

And it’s just viewed as being a biological part of life that they don’t shy away from and we just teach people about it. In the United States, we don’t do that. In the United States, there is this larger cultural perspective of you are in some way corrupting the child or you’re ruining their innocence or they don’t need to worry about those things. I think part of it is just this cultural perspective creates the lack of any consideration. So we will ask parents sometimes, when do you think a child should know these things? And we’ll get some parents who just reflexively say on their wedding night. And we kind of go, so they’re gonna get to be, I don’t know what, 23, 24, 25, 26, however old they are, they get married and you’d think they’re not gonna know any of this until their wedding night? And then the parents go, oh yeah, well, yeah. So I think it’s just this lack of reflection the parents go through. It’s a discomfort that it creates. And then I think along with that, there is this moral sense that you’re doing something immoral with the child, you’re corrupting them, you’re giving them information that is inappropriate or that they can’t handle. And not only does it create this situation of children maybe performing these behaviors because they don’t know what they’re doing, but I think it also goes to that issue of sexual abuse prevention. If we can’t talk about body part names and we can’t talk about safe and unsafe touches and we can’t talk, then you have to talk about sexual body parts to talk about those things.

And so we do see that happen a lot with the parents who haven’t taught their children anything. They’re also the children who haven’t learned anything about prevention. And it kind of goes hand in hand sometimes.

TH: So following that thread a little bit, let’s talk about what you found in terms of the relationship between problematic sexual behaviors and child sexual abuse. As you did say right from the top, first of all, there’s been this sort of assumed association and then some research that has demonstrated that. And I think almost in the field, when we first started doing PSB work, we spent a lot of time, not trying to disabuse people of the idea there was a relationship, but the idea that it was a one-to-one relationship. We saw a lot of times like, talk to your MDT partners because it might not be that this person is acting out because they were sexually abused. I mean, we need to know if they are or aren’t, but let’s not assume they are. So it’s interesting, you know, to see that we’re diving back in to see what does research tell us as a whole about that?

BA: So there is a relationship there. It was the second strongest correlate that we found was a sexual abuse history. And so there is definitely evidence there that can happen. And so I don’t think the clinicians are necessarily off base if they have that thought. And I will tell clinicians when we do our training, if you have a child with problematic sexual behavior, ask the question. Absolutely ask the question. Somebody should ask this child if anyone has committed any of these behaviors against them or if they have seen these behaviors somewhere.

TH: Where’d you get this idea, right?

BA: Those are all perfectly acceptable questions to ask, but it still falls into the same thing that you get with forensic interviewing. If the child says no, and you don’t have any compelling evidence to not believe that, like an STI or something like that, then it may legitimately be the case that they did not learn this from another person. There’s other explanations for that. So I don’t think it’s inappropriate for someone to see these behaviors and then say, let me investigate sexual abuse.

That’s perfectly fine, I think. The issue is when you can’t validate sexual abuse, you can’t indicate it. There’s lots of other reasons that the child may be displaying the behaviors as well, and you’re better suited by looking to those explanations. So it’s an interesting kind of clinical thing that we do have to talk with clinicians about.

TH: Clinicians, multidisciplinary team members, whole CAC staff, the whole gamut. So you also looked at physical abuse. What did you find there?

BA: So physical abuse is interesting because of all the different forms of maltreatment. Sexual abuse and physical abuse are the two that have been most consistently linked to PSB. And the reason we found that so interesting and we wanted to make sure we looked at was that because as we talked about sexual abuse was clearly for a long time considered to be a factor with PSB. But physical abuse doesn’t quite have that same connection. Why would someone who was physically abused demonstrate problematic sexual behavior? That didn’t quite connect in the same way. So we wanted to look at that as well. And we did wind up finding pretty robust relationship between physical abuse and problematic sexual behavior. So we did validate that. It wasn’t as strong as it was with sexual abuse, but it was there. So it was very interesting for us to find that. That kind of validated some things that we were seeing in some of the literature here. And when we put it all together, it was a pretty robust relationship.

TH: And this is speculation. This is not what I find in your study. But why so? What do you think?

BA: So one of the things that we’ve been looking at and that we’ve tested in a couple of different ways is going back to that issue of dysregulation, behavioral-emotional dysregulation, and how connected PSB seems to be with behavior problems in general, which was the strongest correlate, was other kinds of behavior problems, aggression, oppositional behavior, those kinds of things. And we actually have a really well-established research literature that shows physical abuse predicts the onset of aggression and oppositional behavior and all those other kinds of behavioral problems. The reason for that seems to be because a child growing up in that environment does not learn how to regulate emotions and behaviors very effectively. And so we’ve actually tested that in several other papers that we have where we find that it does work that way, that physical abuse at point A tends to predict the inability of the child to regulate emotions two years down the road, we’ll say, and we’re seeing the child with problematic sexual behavior. So it does seem to be that physical abuse is resulting in a child not developing very effective emotion, behavior, regulation abilities that then give rise to problematic sexual behavior, as well as other behavioral problems as well.

TH: I’m curious about how you think about that because as you say, I think that we’ve all seen kids who were physically abused and then were aggressive, right, with others. And maybe they’re getting in fights in school or hitting younger siblings or whatever they’re doing, right? I’m curious if you think that the PSB is just, they can’t regulate their emotions. And of course they haven’t had that modeled for them if they’ve been abused.

Or if you think there’s something about the aggression itself that’s a part of that, or if you think that’s just an adult motivation that has nothing to do with this.

BA: So it’s interesting that you asked that because one of the things that we found in that meta-analysis that we’re talking about was when we restricted the PSB only to intrusive forms of behaviors, which is you’re doing something to or with another individual as opposed to self-focused things or maybe exhibitionistic, showing kinds of behaviors. But when you are engaging another individual in these behaviors, the relationship with physical abuse was even stronger.

Yeah, so part of the thought that I have is that the physical abuse is also modeling forms of coercion. Because physical abuse, by definition, is coercive, physically coercive. And so the child is not just developing this poorly regulated emotional behavioral response, but also has had this modeling of coercive behavior that now that I’m in a situation and I want to do something, I’d kind of learn how to get the other person to do the things that I want to do. The other part of it that’s really interesting that we didn’t show in this meta-analysis, but I’ve only seen it tested once, we’re going to try and do it. It came from a group in Canada. And what they found was that this kind of physiological or emotional dysregulation, all these kinds of problems, predicted both of them. The difference in predicting whether the child developed problematic sexual behavior or just non-sexual behavior problems was some kind of social learning of sexuality.

So the children who developed the PSB not only had the dysregulation, but they also had some kind of exposure, some kind of modeling. Now that could be sexual abuse. It could be watching pornography. It could be a lot of things. But you take that dysregulated child who maybe is aggressive or oppositional or all those things, and then show them something sexual or expose them in some way to some kind of sexual behavior. Well, now the behavior problems can take on a sexual flavor as well.

And then just my own personal thought, if you then combine that picture with some kind of modeling of coercion, which the physical abuse does, I think that’s the recipe for disaster. And you have a child who’s got some kind of sexualization, is extremely poorly regulated, and has learned coercion as a form of achieving ends. I think that’s the ultimate recipe for a bad situation.

TH: And unfortunately, you know, even with PSB, there’s a range of behavior, right? And so that may put a kid on a pathway to more, as you’re saying, more coercive, more aggressive behaviors, even in PSB behaviors. So it’s just interesting to think about. One of the things I was also thinking as we were talking is I think because there’s been this kind of longstanding association between child sexual abuse and PSB to some degree, people who work with child sexual abuse victims do think about, okay, do we need to think about what’s going on here with PSB? So not just the other way that somebody presents with a PSB case, right? And we go, are they sexually abused? But even for sexual abuse victims, is there something we should be looking at in terms of their behaviors, acting out, anything like that, right? I don’t know that we think about that automatically for physical abuse. And so I think that’s a very interesting, you know, set of points you’re making around physical abuse and maybe something we should be paying more attention to is should we also be looking at, when we’re looking at all these oppositional behaviors or aggression or whatever, should we also have any questions to the caregiver or anyone else about, has there been any sexual acting out as a part of that too?

BA: It’s one of those topics that I think, not even just in CACs, but in general clinical practice, I don’t think asking about sexual behavior or screening for sexual behavior is a common thing. Given some of the data that we have with its relationship with just problematic behaviors in general, I think it would be to our advantage if we screen for it, regardless of their presenting concerns or their history. And I think that message is starting to filter out. A colleague of mine here at Penn State, who’s really well known in the behavior problems field and the oppositional behavior and all that research and behavior problems. He’s emailed me saying, what do I do if I got a kid who I’m worried about this? Like, how do I screen for this? And so I think that it’s getting more attention. And I think that that’s some of the important pieces of it is how do we make sure it is screened for, it is asked about. A lot of caregivers maybe don’t want to bring this piece up because it’s embarrassing or it’s excused away as boys being boys or any of those kinds of things. And so we wind up not knowing about it until maybe we’re farther down the road with treatment or we never find out at all. So I think screening is an important thing that we can do.

TH: So staying on this thread for a moment of aggression and other related things. And I cannot remember from your paper, did you guys look at intimate partner violence and its relationship in this paper or not?

BA: We did not, and one of the reasons being is I think we would have found, I think we found maybe four total effect sizes that we could have pooled, which is just not enough to do. There are a couple of papers out there that do look at intimate partner violence, but we didn’t have enough to do it for the meta.

TH: In this particular paper. You also though, and you’ve referenced for the externalizing behavior piece of it, but you also looked, if I’m remembering right, at internalizing behaviors and its relationship with PSB. First of all, for folks who might not be familiar with that term, can you describe what we’re talking about and then whether or not you found any relationship?

BA: So externalizing problems are things that happen external to the child. So this is aggression and this is oppositional behavior and those types of things. Internalizing problems are those things that happen internal to the child that we can’t necessarily always see as easily. So anxiety, depression, somatic complaints, some of those types of things. We usually can’t see them, but they’re things that we know the child is dealing with internally.

And we did find that there was a relationship of PSB with internalizing problems. It wasn’t as strong as the relationship with external behavior problems, but it was there and it was significant. So it was really, I think, some good evidence too, to that point of emotion regulation. The child is really struggling with their ability to regulate emotions. Clinically, we hear kids talk about that in various ways. Sometimes we hear about problematic sexual behavior as a coping skill.

So particularly the self-focused kinds of things that the children might do. Like I said, children can learn pretty early that it’s a strange sensation when you touch certain areas of your body. And so if they’re anxious or they’re depressed or any of those kinds of things, some of these children can learn pretty easily that it creates a coping sensation, distraction from whatever it is that they’re anxious or sad about. So we do see a connection there as well.

TH: So I’m wondering, you in the paper itself, you talk a little bit about the gaps in the literature. What do you see for, you know, PSB as the primary key questions that are just unanswered right now? I mean, I’m sure there many questions, but ones that are really either provoking your curiosity or where you’re like, this is a real problem that we don’t know the answer to this.

BA: Yeah, boy, that could be a long list. Anybody’s watching, we need people doing research on this. So get in touch with me and we can talk. One of the biggest gaps I think that we have is cross-cultural research. So we talked about this in the paper, we only had two studies that we were able to find that were from a non-Western context. And they both came from Korea, from South Korea.

So we’ve got some from Europe, we’ve got some from Canada, we’ve got some from the United States. And outside of that, we don’t have a whole lot. Now, there’s a lot of cultural differences across those three places, but what we wind up not knowing so much about is the extent to which these problems are culturally determined versus is determined by maybe something more biological or even more developmental. And I think that would give us a lot of really good insight on how to look at, not just the etiology of these things, but also the assessment and treatment of these things. The other part that I think we need more research on is some of those etiological pieces in that 98% of all research on problematic sexual behavior has been research that at one point in time, I go and have the caregiver fill out two or three measures and then I look and see how those measures are related. So we don’t know much about the developmental progression.

We don’t know much about where these kids started from and then we don’t know much about where they go. You know, that could be the caregiver too. The caregiver is depressed and so they score the child high on everything as opposed to being a more objective, you know, assessment. So there’s lots of methodological problems that I think gets in our way of making more definitive conclusions. And if we could answer some of those things, I think we could get better with our treatment approaches and who needs what and how do we maximize the effectiveness of what we’re doing for the child that we have with us. So those are just a couple of areas, but there’s a lot.

TH: You know what I’m so curious about is with Australia recently deciding to restrict social media to kids under the age of 16. I think there’s a natural experiment that’s going to go on and come to the social learning aspect of this. And I’m very curious about what that will mean, not just related to PSB, but other things as well. Because, know, presumably, even though kids have a lot of creativity and ability to get access to things that we think they don’t, even so, we should see some restriction in their access to some of this content that’s so concerning to folks. So I’m just curious what will happen with that. And also, you know, recent moves by certain other countries to do the same. I’ll be curious to see if in the U.S. where we have much more access to this, you know, I won’t be surprised if our numbers wind up remaining high and to me, in fact, be higher than some of those. I’m curious for you, what is next for you research wise. You know, you’ve talked about your research interests, but what are you working on now or planning to work on?

BA: So we have a number of different, we always have a number of different things going on. We just finished developing and testing a new assessment measure that is now done, finished, ready to be used. So that’s been an eight-year project. Maybe nine-year project. We had COVID in there and funding shortfall. I think that that’s going to allow us to ask a lot of questions in a more sophisticated way than we’ve been able to do in the past.

So we are looking at doing a couple of different developmental studies. We’re going to try and get the kids early and then see if we can follow them and look at different kinds of factors that might predict who continues to display these behaviors and who doesn’t. We have a treatment that we developed here about 10 years ago that we’ve been disseminating for the last few years and we’re doing a clinical trial of that. And we’re also doing continued, when clinicians are done in the training and they’re using it, we still get feedback from them and we get qualitative feedback because we’re always interested in what they like and what they don’t and what seems to be working and what doesn’t. So in this particular topic, we’ve got some pure research things going on like developmental studies and clinical trials, but we also have a lot of implementation work. We also have a lot of dissemination in this case with the measure and the intervention. So there’s lots of things going on.

TH: Sounds like you’re kept very busy. I’m wondering, when you think about not only the study we’ve been talking about today, but just the body of knowledge that exists, your own experience, what do think the implications of this really is for listeners? So whether they’re child abuse professionals here in the US or they’re around the globe, you know, how should they interpret this? What should they be focused on?

BA: You know, one of the things that when we do trainings on our intervention, one of the things that I always start out by telling the clinicians is that you know how to treat these problems. You just don’t know that you know how to treat these problems. And what I mean by that is that there’s no special six sense, third eye, crystal ball or, you know, really in-depth, highly specialized skillset that you have to develop to work with these kids. Most of these kids can be effectively treated by doing things that we already do.

You just have to know how to do them with these particular kinds of cases. And thankfully, most of the clinicians that we train do say like, yeah, I feel like I can do this, right? And it makes sense. And I would say that to our systems of care is the same thing. If we can get service brokers to better understand these kids and not live in that world of fear, which we get a lot. When you have an eight-year-old who has some kind of problematic sexual behavior, the automatic thought for a lot of them becomes that this is a future sex offender of America.

And so we have to try and squash it and get very punitive. And in some places you get police or district attorneys who get very criminal justice oriented about how to respond. And when you actually understand some of these things and you do an assessment of the child and you understand what, you know, an effective treatment might look like, you really come to understand that the risk is quite low. And we do have some data that shows us the risk is quite low.

I think the implication here is better awareness and understanding of these children and what they’re dealing with and where these behaviors come from can improve not just our ability to protect children because the fewer children displaying these problems, the fewer children being exposed to inappropriate sexual behavior, but also these children have a lot of very negative consequences for themselves in terms of health and mental health. And so we can improve the welfare of children by better understanding these children and that cuts across the clinical, the criminal justice, the child welfare, it cuts across all those different fields.

TH: Well, this is an area that I think is critically important. I want the kids who have acted out to go on to lead healthy lives in which they thrive. And as you say, we also want to prevent other children from being the recipients of behavior they should never have experienced in the first place. So is there any other question that I should have asked you and didn’t, or anything else that you wanted to make sure we talked about today?

BA: You know, I’m trying to think of some good stories to tell, but you know, the one thing I will say is that, I always love when I hear clinicians who was primarily who I work with that we train other professionals as well sometimes, but I always love when I hear clinicians get on our phone calls and just light up because they talk about these kids that we thought, you know, we didn’t know what to do. And our CAC was really hesitant to take them on because we don’t see perpetrators.

Right. And that’s kind of been a foundational, you know, which I completely understand we don’t in our clinic either, but reconceptualizing these children away from the idea that they’re a perpetrator that we can treat. And I always tell CAC clinicians, are the most suited clinicians to be able to treat these children. And in my experience during training, I think that’s absolutely 100 % accurate. So when these clinicians come back in and you could tell at the beginning, they were very hesitant about these cases and needed a lot of support. And then they get to the end of it like, man, this is, oh, I get this. I get, I know what we’re doing.

It gives you a lot of hope that we are on the right track. We are doing what we want to do. What we’re intending out to do, which is to improve the lives of these children, improve the lives of society, and you can see it. So for anyone out there who’s watching and you have questions about this, myself, but I have colleagues, I have colleagues in Oklahoma who do a great job. I got colleagues in some other places who do a great job. Come to some trainings, come talk to us, send us emails and information. We have lots of stuff we can give you. It wasn’t necessarily the case 15 to 20 years ago. But now we have lots of stuff we can give you and some good directions to point you in.

TH: Well, Brian, I appreciate you for bringing up the world’s worst myth that we’ve been trying to squash for years, which is that these kids cannot be treated in CACs. I mean, I feel like I’ve said that a million times over the last almost 18 years, I’ve worked at NCA. So we’re singing out of the same songbook on that one. I think it’s vital work, it’s important work, it’s good prevention work, it’s critical intervention work, and these kids are our kids.

Appreciate every single thing that you’re doing, including the work that you’re doing with CACs, and come back and talk to us about it any time.

BA: I will, and I will tell you, I’ll leave you off with this. 10 years ago, I heard that a lot more than I hear it now.

TH: I yearn for the day when you do not hear it at all.

BA: There’ll always be one or two in any training of 25 clinicians or so that we do, but I don’t hear it nearly as much as I used to. And I think that’s a good thing. I think you all are doing a great job getting that word out and I think people are seeing it. They understand it. It’s happening. And then other people are learning from that. So hopefully we just keep going that direction.

TH: Sure, thank you again, Brian.

BA: All right. Thanks, Teresa.

TH: Thanks for listening to One in Ten. If you like this episode, please share it with a friend or colleague. And for more information about this or any of our other episodes, please visit our podcast website at oneintenpodcast.org.