Sexual reactive behavior: myth or fact?

PHOTO BY tom croke Gerald P. Koocher, Ph.D., ABPP thinks the term “sexual reactive behavior,” has no scientific basis and that terminology can create negative preconceived notions. Koocher is associate provost and professor of psychology at Simmons College.

Children are one of life’s greatest mysteries – just ask any parent. Since the inception of psychological reflection, children have been one of the demographics that have come under a microscope. While some advances and understanding has been achieved, many areas remain unclear, in particular, the subject of sexuality in children.

According to Robert A. Dell, Psy.D, private practitioner in West Hartford, Conn., it often comes as a big surprise to some people that children are sexual creatures. “There is a good amount of positive/prosocial types of sexual behavior that goes under the radar of the parents,” he says. “The healthy child engages in sexual play,” he says, noting that the behavior occurs between friends and no coercion is involved. “It has a lighthearted quality. The child is usually easily redirected.” However, when such actions become repetitive and “driven” in nature, this may signify a problem.

Other markers can herald a serious issue, including use of force or trickery, says Dell. He adds that sexual behavior between children who are not peers, who have a significant age difference or have no prior friendship or relationship, should also raise a red flag. “When the behavior has

a driven quality or occurs at a high frequency, that is a tip-off that it is problematic,” he says, adding that elements of adult sexuality, such as penetration, ejaculation or orgasm, also indicate a problem. “But the bar is always moving,” he says. “Twenty years ago, oral sex between two 13-year olds was an outlier, but not so much now.”

The term “sexually reactive behavior,” coined by California psychologist Toni Cavanaugh Johnson, has been used in some cases, but lends itself to different interpretations. Dell believes the term applies to the “lens through which we look at child trauma.” He prefers the term “problem sexual behavior” or PSB, which he says is more descriptive of the action. “Within the field of psychology working with PSB, there is more hope. There is a more positive framework that children can change and shift behavior. A child’s behavior is situational and transitional. The typical diagnosis is Disruptive Behavior Disorder NOS. This describes the behavior without speculation of the underlying dynamics,” he says. “We’ve made progress in abandoning the adult model. This is more of a diagnostic model. There are limits in looking at teens as mini-adults.”

Craig Latham, Ph.D., owner Latham Consulting Group, LLC in Northampton, Mass., considers “sexually reactive behavior” a “classification useful when thinking about behavior.” He says, “By definition, it is a reaction to being abused oneself. It’s a form of social learning and is synonymous with trauma reactive. Children are trying to make sense of the action.”

Gerald P. Koocher, Ph.D., ABPP, associate provost and professor of psychology at Simmons College in Boston, maintains that the term has no scientific basis. He says, “Suppose a child sees a superhero movie and then copies the behavior. Is he having “superhero syndrome?” Rather than apply a label, he suggests that a thorough, diagnostic exam determine the root cause of the behavior. “Children act out sexually for lots of reasons. It doesn’t necessarily flow from witnessing violence or seeing pornography,” he says. “The classic literature notes how children master their fears by play. Two children playing doctor could be simply curious about anatomical differences. Clinicians must understand what’s normal curiosity.”

Public discussion has become so overheated and irrational when it comes to perceived sexual misbehavior by children, according to Latham. “Parents believe their child will be damaged for life. It is wildly out of proportion,” he says.

However, children who do demonstrate a problem, but are ignored or disbelieved, may face more difficult issues in the future, says Latham. “If a parent doesn’t know [about the behavior], doesn’t believe it or does not get treatment for the child, the child eventually gets angry, rather than stop. He’ll identify with the role of the aggressor,” he says. “The likelihood is if no one believes him then the child views the world as dichotomous. He becomes victim and victimizer. In normal development, children don’t abuse. It happens when there’s a developmental insult, that is, someone abuses the child.”

When a child manifests sexually unacceptable behavior, the first line of defense is usually cognitive behavioral therapy, a treatment option typically used for most types of trauma-related issues, according to David Prescott, LICSW, who works at Becket Family of Services – Becket House at Belgrade, Maine.  He explains that at Becket House, programs are individualized to meet the client’s specific needs. “We modify treatment goals and relationships. In our program, we teach what accountability is and enlist the child in the process of changing to a healthy life,” he says. “It’s holistic in nature and addresses thoughts, behavior and attitude related to sexual behavior and development. All programs should be as trauma-informed as possible.” He adds that enlisting the family’s help is key.

Prescott says that the research in this area is unclear and tenuous and maintains that the focus when working with children should be on developing healthy relationships and interpersonal respect. “Everything we thought we knew 20 years ago is wrong. We thought that 40 to 50 percent of adults who started sexually offending as teens would continue. We thought kids would be destined to become sexual offenders, based on retrospective studies,” he says. “Now we know that when someone is caught, gets sanctioned and undergoes rehabilitation, it’s a very different population from adults. Only a fraction becomes adult sexual offenders.”

Accurate recidivism rates are difficult to pinpoint. Prescott cites a 2006 study of 8,000 adolescents that found only 7.37 percent were known to re-offend.

Koocher warns that terminology can create negative preconceived notions. “We get into trouble when we think someone has been a victim,” he says. Labeling a child without any concerted effort to uncover underlying reasons for a particular behavior could ultimately influence the way a child is treated. “A child will believe and others will see them that way, when they are labeled,” he says.

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