email page print pageAll Topic Reviews
12 and HoldingA Guide to Asperger SyndromeA Lethal InheritanceA Mother's Courage: Talking Back to AutismA Parent's Guide to Asperger Syndrome and High-Functioning AutismA Special EducationA Toss Of The DiceA Tribe ApartA User Guide to the GF/CF Diet for Autism, Asperger Syndrome and AD/HDA Walk in the Rain With a BrainABC of Eating DisordersADD-Friendly Ways to Organize Your LifeADHD Grown UpADHD in the Schools: Assessment and Intervention StrategiesAdolescence and Body ImageAdolescent DepressionAggression and Antisocial Behavior in Children and AdolescentsAll Alone in the UniverseAlpha GirlsAmericaAnother PlanetAntisocial Behavior in Children and AdolescentsAsperger Syndrome and Your ChildAsperger Syndrome, Adolescence, and IdentityAsperger's and GirlsAssessment of Childhood DisordersAttention Deficit DisorderAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderAutism - The Eighth Colour of the RainbowAutism and MeAutism's False ProphetsAutistic Spectrum DisordersBad GirlBeen There, Done That? DO THIS!Before I DieBetween Two WorldsBeyond AppearanceBig Mouth & Ugly GirlBipolar ChildrenBipolar Disorder in Childhood and Early AdolescenceBipolar DisordersBipolar KidsBlackwell Handbook of Childhood Cognitive DevelopmentBody Image, Eating Disorders, and ObesityBody Image, Eating Disorders, and Obesity in YouthBoy AloneBrain-Based Therapy with Children and AdolescentsBreaking PointBreathing UnderwaterBringing Up ParentsBullying and TeasingBullying PreventionBut I Love HimCan't Eat, Won't EatCaring for a Child with AutismCatalystChild and Adolescent PsychiatryChild and Adolescent Psychological DisordersChild and Adolescent PsychopathologyChild NeuropsychologyChild Well-BeingChildren and SexualityChildren Changed by TraumaChildren with Emerald EyesChildren with Sexual Behavior ProblemsChildren, Sexuality and SexualizationChildren’s Dreaming and the Development of Consciousness City of OneCommunication Issues In Autism And Asperger SyndromeConcepts of NormalityConcise Guide to Child and Adolescent PsychiatryConquering the Beast WithinConsuming KidsContesting ChildhoodCount Us InCrackedCrossesCutCyber-Safe Kids, Cyber-Savvy TeensDamageDemystifying the Autistic ExperienceDescartes' BabyDilemmas of DesireDirtyDisconnected KidsDoing SchoolDon't Bother Me Mom--I'm Learning!Don't Pick On MeDying to Be ThinEarly Intervention Programs and PoliciesEating an ArtichokeEducating Children With AutismEight Stories UpElijah's CupEmerald City BluesEmotional and Behavioral Problems of Young ChildrenEpilepticEthical Dilemmas in PediatricsEvery Girl Tells a StoryExiting NirvanaExploiting ChildhoodEye ContactFacing BipolarFamily HistoryFast GirlsForever YoungFreaks, Geeks and Asperger SyndromeFreewillFrictionGirl CultureGirl in the MirrorGirlfightingGirlhoodGirlWiseHandbook of Evidence-Based Therapies for Children and AdolescentsHandbook of Preschool Mental HealthHealing ADDHelping Children Cope With Disasters and TerrorismHelping Hyperactive KidsHelping Parents, Youth, and Teachers Understand Medications for Behavioral and Emotional ProblemsHelping Students Overcome Depression and AnxietyHelping Teens Who CutHollow KidsHope's BoyHow Infants Know MindsHow to Keep Your Teenager Out of Trouble and What to Do If You Can'tHurry Down SunshineI Am Not Joey PigzaIdentifying Hyperactive ChildrenIf Your Adolescent Has an Eating DisorderIn the Company of CraziesIncorporating Social Goals in the ClassroomIntegrated YogaIntrusive ParentingIssues for Families, Schools and CommunitiesJake RileyJoey Pigza Loses ControlJoey Pigza Swallowed the KeyJuvenile-Onset SchizophreniaKim: Empty InsideLearning and Behavior Problems in Asperger SyndromeLearning Disorders and Disorders of the Self in Children and AdolescentsLearning Outside the Lines Let Kids Be KidsLiberation's ChildrenLife As We Know ItLisa, Bright and DarkLook Me in the EyeLoserLove and SexLove That DogMad at SchoolMaking ADD WorkMaking American BoysManicMastering Anger and AggressionMaverick MindMedicating ChildrenMind FieldsMind to MindMommy I'm Still in HereMore Than a LabelMy Flesh and BloodMyths of ChildhoodNew Hope for Children and Teens with Bipolar DisorderNew Look at ADHD: Inhibition, Time, and Self-ControlNo Child Left DifferentNo Two AlikeNon-Drug Treatments for ADHDNot Much Just Chillin'NurtureShockOdd Girl OutOdd Girl Speaks OutOne Hot SecondOne in ThirteenOphelia SpeaksOphelia's MomOur Journey Through High Functioning Autism and Asperger SyndromeOut of the WoodsOvercoming ADHDOvercoming School AnxietyParenting a Child Who Has Intense EmotionsParenting Children With ADHDParenting Your Out-Of-Control TeenagerPediatric PsychopharmacologyPediatric PsychopharmacologyPediatric PsychopharmacologyPeople with HyperactivityPhobic and Anxiety Disorders in Children and AdolescentsPINSPlease Don't Label My ChildPraising Boys WellPraising Girls WellProblem Child or Quirky Kid?Problem GirlsPsychotherapy for Children and AdolescentsPsychotherapy with Children and AdolescentsPurgeRaising a Moody ChildRaising BlazeRaising Generation RxRaising Resilient ChildrenReady or Not, Here Life ComesReclaiming Our ChildrenRedressing the EmperorReducing Adolescent RiskRemembering Our ChildhoodResilience in ChildrenRethinking ADHDReweaving the Autistic TapestryRitalin is Not the Answer Action GuideRitalin NationRunning on RitalinRunning with ScissorsRutter's Child and Adolescent PsychiatrySeeing EzraSex and the American TeenagerSex, Therapy, and KidsSexting and Young PeopleSexual Teens, Sexual MediaShort Term 12Should I Medicate My Child?SmashedSnapshots of AutismSongs Without WordsSophie Spikey Has a Very Big ProblemSpeakStaying Connected to Your TeenagerStick FigureStraight Talk about Psychiatric Medications for KidsStraight Talk about Psychological Testing for KidsStraight Talk about Your Child's Mental HealthStrange SonStudent DepressionSuicidal Behavior in Children and AdolescentsSurvival Strategies for Parenting Children with Bipolar DisorderSurviving OpheliaTaking Charge of ADHD, Revised EditionTaming the Troublesome ChildTemple GrandinThe American Psychiatric Publishing Textbook Of Child And Adolescent PsychiatryThe Anti-Romantic ChildThe Bipolar ChildThe Boy Who Loved WindowsThe Boy Who Was Raised as a DogThe Buffalo TreeThe Bully Action GuideThe Bully, the Bullied, and the BystanderThe Burn JournalsThe Color of AbsenceThe Curious Incident of the Dog in the Night-TimeThe Depressed ChildThe Developing MindThe Dragons of AutismThe Einstein SyndromeThe EpidemicThe Evolution of ChildhoodThe Explosive ChildThe Eyes of van GoghThe Fasting GirlThe Field of the DogsThe Flight of a DoveThe Hidden Gifts of the Introverted ChildThe Horse BoyThe Identity TrapThe Inner World of a Suicidal YouthThe Inside Story on Teen GirlsThe Kindness of StrangersThe Last Normal ChildThe Little MonsterThe Medicated ChildThe Myth of LazinessThe New Gay TeenagerThe Nurture AssumptionThe OASIS Guide to Asperger SyndromeThe Other ParentThe Perversion of YouthThe Philosophy of AutismThe Psychoanalytic Study of the ChildThe Real Truth About Teens and SexThe Ride TogetherThe Rise and Fall of the American TeenagerThe Science of ADHDThe Sex Lives of TeenagersThe Survival Guide for Kids With LD*The Unhappy ChildThen Again, Maybe I Won'tTherapy with ChildrenThings I Have to Tell YouThings Tom LikesThrough the Glass WallThumbsuckerTotally WiredTouching Spirit BearTrauma in the Lives of ChildrenTreating ADHD and Comorbid DisordersTreatment of Childhood DisordersTwistedUnder the Wolf, Under the DogUnhappy TeenagersUnstrange MindsWastedWe've Got IssuesWeather Reports from the Autism FrontWhat about the KidsWhat in the World Are Your Kids Doing Online?What Works for Whom?What Would Joey Do?What's Happening to My Body? Book for BoysWhat's Happening to My Body? Book for GirlsWhat's Happening to Tom?When Nothing Matters AnymoreWhen Your Child Has an Eating DisorderWhose America?Why Don't Students Like SchoolWill's ChoiceWinnicott On the ChildWorried All the TimeYou Hear MeYoung Minds in Social WorldsYoung People and Mental HealthYour Child, Bully or Victim?
If you are a clinician and work with children and families, it is almost certainly that you have encountered a child in your office or in the community that the parent/s is highly concerned about their son or daughter's sexual acting out behaviors. Many of these behaviors, in my experience, have ranged from benign and completely developmentally appropriate to behaviors that are surely symptoms needing to be targeted and raise questions about inherent "assumptions" that these behaviors must be learned from somewhere. In American society, sex and sexuality continue to be subjects that are feared, ignored, silenced, or simply brushed to the side. With these cultural and societal influences, there is no wonder why many clinicians don't feel prepared to answer such questions from parents. Many clinicians simply refer clients to "experts" in the community in order to avoid having to make a decision about how to appropriately intervene. Frankly, training around sexual behavior problems in children, adolescents and even adults are quite lacking in the mental health field. Moreover, unless you attend a specialized training program that targets these issues, it is hard to find worthy training at all around sexual behavior issues. Given the relative commonality of expressions of sex and sexuality in addition to the relative common histories of chaotic home environments, physical abuse and neglect, and sexual abuse histories, a focus in educating current and future clinicians seems obvious. Yet, as a society, we are behind in the research targeting sexual behavior problems, particularly the pathogenesis of sexual behavior problems. To date, there are very few large sample studies that target normative versus pathological sexual behavior problems. Fortunately, for the mental health and research fields, William N. Friedrich has written a book that not only addresses normative versus pathological sexual behaviors in children and adolescents, it goes the most important step further and describes a treatment approach that targets the influence and role of the family as well as the role attachment plays in these behaviors. As Friedrich writes, "sexual behavior problems are relational and should be treated as such."
Friedrich's book, from start to finish, is clearly articulated and well-focused. He takes the reader from the overview of the book, through the research and rationale for this type of an approach, to a sequenced assessment and treatment manual of sexual behavior problems. If one is a part of the therapeutic community, then one is acutely aware of the intense debates that take place regarding the role of attachment in the treatment of children who come from chaotic backgrounds and have lacked the stability and predictability that help children develop the appropriate skills to regulate their affects, understand and maintain healthy and safe relationships, develop solid sense-of-self, and help individuals develop behavioral control mechanisms. The undisputed fact is that attachment is a very real part of human development and is correlated with healthy development. What is constantly being debated is how does one utilize this knowledge to create appropriate and data supported treatments for children who have chaotic and disrupted backgrounds and develop maladaptive coping strategies to manage life's daily challenges.
There is an abundance of "theorists" touting how to approach children who have "attachment disorders" that have actually been proven to be harmful, however Friedrich takes his emphasis on "relational" and integrates a model of treatment that holds significant support for its efficacy. Parent-Child Interaction Therapy is a model of therapy that focuses on increasing a parent's ability to respond to the needs of their child, integrates behavioral approaches to parenting, and emphasizes nurturing the parent-child relationship. The idea being that improved parenting skill, improved awareness of the needs of a child by a parent, improved consistency and behavioral approaches, provides the stability and structure that helps the child to develop a closer relationship with parents and, in turn, allows the parent to begin to improve positive feelings about and see their child in more loving ways.
Friedrich has taken the view that sexual behavior problems in children and adolescents have particular risk factors making it more likely that one will develop sexual behavior problem, one being a history of chaotic homes and the lack of a child's needs being met. Furthermore, he claims that due to the histories of the "culture" around sex and sexuality a family brings to the existence and more importantly maintenance of sexual behavior problems, targeting families is a key aspect to improving targeted behaviors. Friedrich suggest that a targeted intervention promoting effective and behaviorally driven parenting skills, increasing awareness and response to a child's needs, targeting psycho-education and skill development within the child, and emphasizing nurturing environments, will lead to better and sustainable outcomes for these individuals and families. As an evidenced driven therapist, I can appreciate a Family-Based, Attachment-Oriented approach to working with families with children that express sexual behavior problems. What this approach does, is allows for the normalization of sexual behavior, provides the needed psycho-education on appropriate sexual development, provides an emphasis on families to solve their problems and increase their ability to effectively parent, and gives the child skills to manage their life without resorting to sexualized behaviors as a coping strategy.
Overall, Friedrich's book Children with Sexual Behavior Problems: Family-Based, Attachment-Focused Therapy, is a thorough overview and practical treatment guide for treating children with sexual behavior issues. Given that much of his data that was presented in this book came from his own studies, additional research and data are needed to fully test the validity of a Family-Centered, Attachment-Focused approach utilizing Parent-Child Interaction Therapy as a major means of increasing parenting skills of children with sexual behavior problems. Furthermore, aside from the anecdotal evidence presented, further investigation into understanding the mechanisms of change, and isolating the strategies that are most helpful with this type of approach would be extremely helpful for the therapeutic community. I would recommend this book for any practitioner that focuses their practice on treating children, adolescents and families.
© 2010 Ryan R. Lindsay
Ryan R. Lindsay, LCSW, St. Louis Center for Family Development, LLC, Clinical Director/Co-Founder, firstname.lastname@example.org. Ryan Lindsay is the Clinical Director and co-founder of the St. Louis Center for Family Development, LLC, a mental health and social service agency that provides in-home, trauma-informed, evidenced-based interventions to individuals in the St. Louis, MO community. Prior to his current position, he was the co-founder of the Ann Arbor DBT Center and worked to develop and help lead an Adolescent DBT Program for Washtenaw County Community Support and Treatment Services in Ann Arbor, MI. Ryan works daily to improve the lives of those individuals who suffer from emotional pain as a result of trauma.