Faculty work to change treatment for sexual behavior problems

Penn State Child Maltreatment Solutions Network faculty member Brian Allen is exploring new frontiers in a field of child mental health that are often underexamined, underfunded and overlooked. Allen, a clinical child psychologist practicing at Penn State Hershey Medical Center, hopes to change the conversation -- or lack thereof -- surrounding child sexual behavior problems with help from a Children’s Miracle Network grant.

More than 9 percent of children and preteens struggle with some form of sexual behavior problems (SBP). SBP in children are typically recognized as sexual actions perpetrated by a child that are developmentally inappropriate or harmful, either to themselves or to other children. Allen says that a common misconception associated with this issue is that children with SBP have been sexually abused, when in fact around 60 percent of children with SBP have no sexual abuse history. Though untrue, this misconception is widespread, leading many to attempt to treat SBP in the same way that one would treat a victim of sexual abuse, maltreatment or posttraumatic stress disorder.

Additionally, sexual behavior problems in children have received minimal attention in research.  The only treatment models that have been specifically targeted and tested for SBP are group treatments, with few completed clinical trials. In addition, only one of these clinical trials obtained follow-up data.

“Evidence tells us that a minority of children with sexual behavior problems have a sexual abuse history, and there are no individual treatment models beyond sexual abuse for this population,” Allen said.

While the group treatment model has proven effective in a small number of trials, Allen claims it is a less feasible method overall.

“The probability of getting a large enough group of children with SBP in one area who are entering treatment at the same time is low, especially in smaller communities,” Allen said.

This logistical issue can often render group therapies impractical. For this reason, Allen and his team are creating and testing a first-of-its-kind, individual treatment model for children with SBP. This type of therapy will be one-on-one, making it more accessible to all children who need it, regardless of whether or not there are others grappling with similar issues in their community. Allen’s research aims to be a groundbreaking step toward making treatment more substantive and accessible to those facing SBP.

The $37,000 grant that Allen received will fund the creation of this therapy; a clinical trial involving 15 children, 5 to 12 years old; and a post-pilot analysis of the effectiveness of the treatment. The model will be based on popular cognitive behavior techniques from the Children with Problematic Sexual Behavior–Cognitive Behavioral Therapy out of Oklahoma University Health Science Center, often referred to as the Oklahoma model. Throughout the study, Allen will evaluate the frequency, severity and number of instances of SBP in the children.

The study will be run through the Stine Foundation Transforming Lives of Children (TLC) Clinic at Penn State Hershey. TLC is an evidence-based specialty clinic and part of its mission is to serve as a research lab for the Child Maltreatment Solutions Network. It is the only mental health clinic within the Network that provides treatment services to children. 

Allen’s research requires a significant amount of work in an unexplored territory. Other members of the research team include network faculty member Chad Shenk, assistant professor of human development and family studies and co-investigator on the grant, and Lucy Berliner, a licensed clinical social worker and a foremost authority on SBP, who will be a consultant during the development process.

This yearlong pilot investigation began July 1 with children already presenting for treatment and some referred from the Children's Resource Center in Harrisburg.  If this trial goes as planned, the team will continue their research with the intention of providing a sustainable treatment model effective enough for widespread use on children with SBP. The outcome of this could be considerable, since children with SBP have higher rates of school problems, depression, sexual risk-taking and involvement with the justice system, among other things -- all of which could be reduced with appropriate treatment.